Impact of BMI on Complications and Satisfaction in Patients With Papillary Thyroid Cancer and Lateral Neck Metastasis.

BACKGROUND: This study investigates the effect of body mass index (BMI) on complications and satisfaction in patients who underwent thyroidectomy and lateral neck dissection. METHODS: We retrospectively reviewed 386 patients with papillary thyroid cancer who underwent total thyroidectomy and lateral neck dissection between January 2013 and December 2016. We compared variables including population characteristics, subjective satisfaction, and complications in nonobese (BMI < 28.0 kg/m2) and obese (BMI ≥ 28.0 kg/m2) patients. RESULTS: Obesity was associated with an increased risk of postoperative hemorrhage (POH) (P = .014), accessory nerve injury (P < .001), operative time (P < .001) and infection (P = .013). However, obese patients had higher subjective satisfaction and Vancouver Scar Scale (VSS) scores (P < .05). CONCLUSIONS: Obesity was associated with increased risk of POH, injury of the SAN, and infection. Interestingly, we found that obese patients had higher subjective satisfaction and VSS scores.

[Stromal cell-derived factor-1 inducing metastasis squamous cell carcinoma of head and neck induced via integrin ανß3-CXC chemokine receptor 4/7 biological axis].

OBJECTIVE: To observe the influence of LM609/AMD3100/CCX754 on chemotactic capability, cytoskeleton, and expression of integrin ανß3 protein of squamous cell carcinoma of head and neck (SCCHN) cell line PCI-13 induced by stromal cell-derived factor-1 (SDF-1) in vitro. METHODS: Migration assays, flow cytometry and immunofluorescence were used to observe the effects of SDF-1, LM609, AMD3100 and CCX754 on the migration, cytoskeleton and the expression of integrin ανß3 protein in PCI-13 cell lines. RESULTS: SDF-1 favored PCI-13 cell migration, pseudopod formation, and activities of integrin ανß3 phosphorylation. LM609, AMD3100, and CCX754 blocked all these effects. CONCLUSIONS: SDF-1 can induce metastatic SCCHN by integrin ανß3-CXC chemokine receptor (CXCR) 4/CXCR7 axi. LM609, AMD3100, and CCX754 and can reduce the regulation of SDF-1 on SCCHN activity.

Long-term quality of life in survivors of head and neck cancer who have had defects reconstructed with radial forearm free flaps.

The purpose of our study was to investigate (by postal questionnaire) the long-term quality of life (QoL) in Chinese patients who have had resections of head and neck cancer and immediate reconstruction by radial forearm free flaps. We performed a retrospective questionnaire survey and case series in the Affiliated Tumor Hospital of Zhengzhou University. The subjects were consecutive patients treated for head and neck cancers during a 13-year period. The patients completed the University of Washington Quality of Life (version 4) questionnaires. Among the 178 patients treated during the course of 13 years, 87 were alive and disease free. Fifty-six (64.4%) of the 87 questionnaires were returned. The mean follow-up duration was 7.9 years (range, 3-13 y). Of the 12 disease-specific domains on the University of Washington Quality of Life, the best-scoring domain was pain, followed by mood, anxiety, and shoulder, whereas the lowest scores were for saliva, taste, and speech. The domains considered as the most important were saliva, speech, and taste. We conclude that the radial forearm free flap for the reconstruction of defects of the head and neck after resection for cancer significantly influenced the patients' long-term QoL.

[Diagnosis and surgical treatment of parathyroid neoplasms].

OBJECTIVE: To explore the clinical features, diagnosis and surgical treatment of parathyroid neoplasms. METHODS: From January 2003 to December 2011, a total of 51 patients were recruited. Their clinical data, presentations, examinations and surgical approaches were analyzed retrospectively. RESULTS: Among them, there were parathyroid adenoma (n = 32), parathyroid cysts (n = 18) and parathyroid carcinoma (n = 1). The sensitivity and positive rate of neck ultrasonography and (99)Tc(m)-methoxyisobutylisonitrile (MIBI) were 84.3% and 93.5%, 91.7% and 100.0% respectively. The high levels of serum calcium and parathyroid hormone (PTH) in 32 cases of parathyroid adenoma and 1 case of parathyroid carcinoma returned to normal after operation. The levels of serum calcium and PTH remained normal in 18 cases of parathyroid cysts. CONCLUSIONS: The clinical manifestations of parathyroid adenoma were complex. The serum levels of calcium and PTH and neck ultrasonography are preferred screening tools for parathyroid neoplasms.(99)Tc(m)-MIBI is suitable for tumor localization.Surgery is effective and safe for parathyroid neoplasm.Real time intraoperative monitoring of PTH is of great importance.

Intra- and postoperative complications in 137 cases of giant thyroid gland tumor.

The intra- and postoperative complications resulting from surgery for giant thyroid gland tumors (diameter greater than 10 cm) present serious challenges to patient recovery. Although there are a number of methods, all have limitations. In this study, we present our experience with several complications of surgical treatment of giant thyroid gland tumors to increase the awareness and aid the prevention of these complications. A total of 137 consecutive patients who underwent surgical treatment in Henan Tumor Hospital were retrospectively analyzed. Statistics pertaining to the patients' clinical factors were gathered. We found that the most common surgical complications were recurrent laryngeal nerve (RLN) injury and symptomatic hypoparathyroidism. Other complications included incision site infections, bleeding, infection and chyle fistula, the incidence of which increased significantly with increasing extent of surgery from group I (near-total thyroidectomy) to group V (total thyroidectomy plus lateral neck dissection). Low complication rates may be achieved with more accurate knowledge of the surgical anatomy, skilled surgical treatment and experience. More extensive surgery results in a greater number of complications.

[Experience of surgical treatment for cervical esophageal carcinoma].

OBJECTIVE: To summarize the experience of surgical treatment for cervical esophageal carcinoma. METHODS: Clinical and follow-up data of 82 patients with cervical esophageal carcinoma undergone surgical treatment in Henan Provincial Cancer Hospital from Dec. 1993 to Dec. 2005 were analyzed retrospectively. The difference of the therapeutic regimen and 5-year survival rate of these patients were evaluated. RESULTS: Before 1997, patients mainly underwent surgical therapy solely (27 cases). After 1997, 50 cases received surgical therapy following neoadjuvant radiotherapy (multimodality group), except 5 early-stage cases received surgical therapy solely. Seventy-three patients underwent esophagectomy without thoracotomy, including 21 cases of invert-stripping of the esophagus, and 52 cases of blunt denudation of esophagus. Nine patients underwent transthoracic esophagectomy. Concurrent monolateral or bilateral cervical lymph node dissection accounted for 14 cases and combined organ resection 12 cases. No serious hemorrhage and tracheal or bronchial tearing occurred. No hospital death occurred. Postoperative complications were found in 14 patients, and the incidence of complication was 19.5%. In sole surgery group, upper incised margins of 5 patients were confirmed to be positive. The laryngeal function of 26 patients in sole surgery group was preserved, while 47 patients in multimodality group preserved. Lymph node metastasis occurred in 14 cases, including 13 cases cervical lymph node metastasis (monolateral 9, bilateral 4) and 1 case of upper mediastinal lymph node metastasis. During follow-up, 3 patients were lost. The total 5-year survival rate was 43%. The patients in multimodality group had higher 5-year survival rate as compared to those in sole surgery group. (50.2% vs 33.9%,chi(2 )=7.17,P=0.007). The 5-year survival rates of patients with transthoracic esophagectomy, esophagectomy plus concurrent monolateral or bilateral cervical lymph nodes dissection or combined organ resection were 36.5%, 45.8% and 33.3% respectively. All the 5-year survival rates of these subgroups were lower as compared to multimodality group. CONCLUSIONS: For patients with early stage cervical esophageal carcinoma and with proximal end of residual normal esophagus longer than 2 cm, the optimal therapy should be surgery. For most of the patients, surgery combined with neoadjuvant radiotherapy is the ideal therapeutic strategy, which can lower the risk of positive revised margin, improve the possibility of preserving the laryngeal function and result in the improvement of 5-year survival rate. Esophagectomy without thoracotomy should be preferred. Combined organ resection or bilateral lymph node dissection should be chosen carefully because these operating procedures may lead to severe injury and function lose.

[Malignant fibrous histiocytoma of head and neck: clinical analysis of 21 cases].

BACKGROUND & OBJECTIVE: Malignant fibrous histiocytoma (MFH) is a type of pleomorphic neoplastic diseases with complex pathological structure. Its histological origin is uncertain. It was often classified as other carcinoma. This study was designed to investigate the clinical and pathological features and improve the diagnosis and treatment. METHODS: To summarize and analyze the clinical experiences of 21 cases of MFH at head and neck proved histologically from June 1984 to June 1999 treated in Department of Head and Neck Surgery, Henan Tumor Hospital. RESULTS: Twenty cases were followed up more than 3 years; one case was lost. The 3-year survival rate was 42.9%(9/21). Nineteen cases were treated with surgery. Two cases in advanced stage were treated by non-surgery who died in 2 and 5 months. Among the patients treated with surgery, 6 cases survived without evidence of recurrence more than 3 years, 13 cases recurred within 2 years and 9 cases with metastasis. Seven cases received second surgery after recurrence. Among them,3 cases survived more than 3 years after second surgery. Of all 21 patients, 12 were proved with cervical lymph node metastasis. CONCLUSION: MFH at head and neck region is a kind of malignant disease with high recurrent rate and the cervical lymph node metastasis rate was 57.1%. Amplified radical surgery is the first choice of treatment. The second surgery has special value to the recurrent patients. Radiotherapy alone or chemotherapy alone is not effective to MFH of head and neck region.