Changes in heart rate during the peri-ictal period in focal epilepsy

Objective: We explored changes in heart rate during the peri-ictal period in patients with focal epilepsy, and differences in heart rate changes according to epileptic site and side were assessed. Methods: A total of 198 epileptic seizures in 102 patients with focal epilepsy, who had a definite epileptogenic focus and had undergone surgical treatment, were assessed from 2014 to 2019. Heart rate was measured manually during the peri-ictal period. Change in heart rate and the time it occurred were assessed and compared between different epileptic sites and sides. Results: Heart rate increased in 177 (89.4%) of 198 seizures. In 82 (44.8%) of 183 seizures, the change in heart rate occurred before seizure onset. The median period of heart rate change was seven seconds (interquartile range: 3­11 seconds) in seizures with heart rate change before seizure onset. The number of seizures with heart rate increase before seizure onset was significantly greater for medial temporal lobe epilepsy compared to lateral temporal lobe epilepsy (p=0.019) and extratemporal lobe epilepsy (p=0.002). Significance: A change in heart rate prior to seizure onset is more likely to occur in patients with medial temporal lobe epilepsy, compared to those with lateral temporal lobe epilepsy and extratemporal lobe epilepsy. Patients with medial temporal lobe epilepsy may likely benefit from seizure warning and detection devices.

A novel KCNT1 mutation in a Chinese family with severe autosomal-dominant nocturnal frontal lobe epilepsy.

We describe a Chinese family with severe autosomal-dominant nocturnal frontal lobe epilepsy (ADNFLE) and psychiatric problems in whom whole-exome family trio sequencing identified a heterozygous mutation in the potassium channel subfamily T, member 1 (KCNT1), a sodium-gated potassium channel gene, which was a novel missense mutation c.2153A>T (p. Asp718Val). The typical characteristics of the three patients in the family were refractory epilepsy, acquired cognitive impairment, and psychiatric problems, which include hallucinations and suicidal thoughts and behaviors. The age at onset was found to be earlier in son and daughter of the proband than that of the proband, as proven by the proband's history of an epileptic seizure at the age of 16 years and her son's and daughter's history of seizures at the age of 8 years. Magnetic resonance imaging findings were negative for any abnormalities. Because of psychiatric symptoms, these three patients were administered risperidone at different times during their illness. The protestor's son had tried fenofibrate treatment, but clinical remission was unclear. In summary, our findings broadened the mutation database in relation to KCNT1 and implicated the sodium-gated potassium channel complex in ADNFLE, more broadly, in the pathogenesis of focal epilepsies.

Role of Heterotypic Neutrophil-in-Tumor Structure in the Prognosis of Patients With Buccal Mucosa Squamous Cell Carcinoma.

OBJECTIVE: To analyze the role of frequency of heterotypic neutrophil-in-tumor structure (FNiT) in the prognosis of patients with buccal mucosa squamous cell carcinoma (BMSCC). METHODS: In vitro, we cocultured BMSCC cell line-H157 with neutrophils to form heterotypic neutrophil-in-tumor structures, which were then subject to fluorescence staining. Clinically, 145 patients were retrospectively enrolled. Associations between FNiT and clinicopathological variables including age, sex, smoking history, drinking history, betel nut chewing, tumor stage, node stage, metastasis, disease stage, lymphovascular invasion, extranodal extension, perineural invasion, and tumor grade were analyzed by chi-square test, and the main endpoints of interest were recurrence-free survival (RFS) and disease-specific survival (DSS) which were analyzed by the Kaplan-Meier method and Cox model. RESULTS: Fluorescent staining results of typical heterotypic neutrophil-in-tumor structure showed that well-differentiated H157 cells had a stronger ability to internalize more neutrophils than poorly-differentiated H157 cells, with the latter often internalizing only one neutrophil or nothing. The mean FNiT was 4.2‰, with a range from 2.3‰ to 7.8‰. A total of 80 patients relapsed and 84 patients died of the disease. The 5-year RFS and DSS rate was 42% and 42%, respectively. Patients with an FNiT≥4.2‰ had a significantly higher risk for locoregional recurrence and cancer-caused death than those with an FNiT<4.2‰ (p=0.001 and p<0.001, respectively). The FNiT alone was independently significant in predicting poor RFS, and the FNiT along with tumor grade was an independent predictor for DSS. CONCLUSION: The FNiT as a novel predictor is significantly negatively associated with both the RFS and DSS of patients with BMSCC.

Impact of the Body Mass Index on Hemorrhage After Surgery for Thyroid Cancer.

OBJECTIVE: To investigate the effects of different values of the body mass index (BMI) on postoperative hemorrhage (PH) in thyroid cancer (TC) and its clinical management. METHODS: This retrospective cohort study selected 43 patients with hemorrhage after TC surgery in 7413 cases. Patients were divided based on the BMI (kg/m2) into normal (24), overweight group (24 ≤BMl<28) and obese (≥28) groups. Clinical and pathologic data, bleeding cause, bleeding site, treatment and prognosis were assessed. RESULTS: BMI (P=0.038) is an independent risk factor for PH of TC, related to hypertension (P=0.004) and coronary heart disease (P=0.001) in the three groups. Preoperative weight loss was not noted (P=0.477). Hemorrhage in 60.47% of patients occurred between 4 h and 8 h after surgery. The higher the BMI, the longer was the operative time (≥1 h, 65.12%) (P=0.017), which resulted in greater intraoperative blood loss (≥20 mL, 74.42%) (P=0.025), postoperative hypoparathyroidism (P=0.015) and the probability of injury to the recurrent laryngeal nerve (P=0.026). The main causes of bleeding were incomplete vascular ligation (30.23%), severe postoperative cervical activity (16.28%) and long-term use of anticoagulant drugs (11.63%). Overall survival at 5 years in the obese group was poor (P=0.015). Forty patients (93.02%) underwent surgical exploration and hemostasis and two patients (4.65%) underwent tracheotomy. All PH complications disappeared completely after active postoperative treatment, and all patients were discharged from hospital. CONCLUSION: Obesity is closely associated with PH in TC patients. Therefore, in obese patients, active prevention preoperatively, complete hemostasis intraoperatively, early detection and timely treatment postoperatively are the key factors to reduce PH risk.

Prognostic Value of a Family History of Oral Tongue Squamous Cell Carcinoma: A Matched-Pair Study.

OBJECTIVES/HYPOTHESIS: To analyze the prognostic value of a family cancer history for predicting survival in patients with oral tongue squamous cell carcinoma (SCC). STUDY DESIGN: Retrospective case series. METHODS: Each patient with a family history was paired with one patient with sporadic oral tongue SCC without a family history. The primary endpoint was disease-specific survival (DSS). RESULTS: In total, 124 patients were enrolled as participants with a family cancer history, and the 5-year DSS rate was 51%. In the matched group, the 5-year DSS rate was 40%. The difference was significant (P = .032). In the smoking patients with a family history, the 5-year DSS rate was 43%. In the smoking patients from the matched group, the 5-year DSS rate was 17%; the difference was significant (P = .028). In nonsmoking patients with a history of cancer, the 5-year DSS rate was 51%; in nonsmoking patients in the matched group, the 5-year DSS rate was 40%; the difference was not significant (P = .141). CONCLUSIONS: A family cancer history is associated with improved DSS in surgically treated oral tongue SCC patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E605-E610, 2020.

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.

Value of lingual lymph node metastasis in patients with squamous cell carcinoma of the tongue.

OBJECTIVES: To investigate the role of lingual lymph node (LLN) metastasis on locoregional control (LRC) in patients with locally advanced tongue squamous cell carcinoma (SCC). METHODS: A total of 231 patients were prospectively enrolled. Analyses focused on the association between the LLN metastasis and clinical pathologic variables as well as the significance of LLN metastasis in predicting prognosis. RESULTS: LLNs were noted in 58 patients, 33 of whom were positive for LLN metastasis. LLN metastasis was significantly related to adverse pathologic characteristics. In patients with LLN metastasis, the 5-year LRC rate was 45%. In patients without LLN metastasis, the 5-year LRC rate was 65% and the difference was significant (P = 0.013). Further, Cox model analysis confirmed the independence of LLN metastasis from prognosis prediction. CONCLUSION: LLN metastasis in locally advanced tongue SCC is relatively uncommon; however, LLNs should be routinely dissected because they could significantly decrease locoregional control. LEVEL OF EVIDENCE: 2b. Laryngoscope, 129:2527-2530, 2019.

Deep Parotid Lymph Node Metastasis Is Associated With Recurrence in High-Grade Mucoepidermoid Carcinoma of the Parotid Gland.

PURPOSE: The goal of the present study was to assess the association between intraparotid lymph node (IPN) metastasis and prognosis in high-grade mucoepidermoid carcinoma (MEC) of the parotid gland. PATIENTS AND METHODS: Patients with surgically treated primary high-grade MEC of the parotid gland were retrospectively enrolled. The association between IPN metastasis and clinicopathologic variables was analyzed using χ2 tests, and recurrence-free survival (RFS) rate was calculated by the Kaplan-Meier method; independent prognostic factors were evaluated by the Cox proportional hazards method. RESULTS: IPN metastasis was noted in 59 patients (48.4%), including 19 cases in the deep lobe and 47 cases in the superficial lobe of the parotid gland. IPN metastasis was statistically related to tumor stage and node stage regardless of the location of the metastasis in the deep or superficial lobe. Patients with superficial and deep lymph node metastasis had a low 5-year RFS rate of 11%. Cox model analysis reported that the status of IPN metastasis was an independent risk factor for recurrence. CONCLUSIONS: IPN metastasis substantially decreases the RFS rate, especially when there is lymph node metastasis in the deep lobe of the parotid gland.

Upregulated lncRNA small nucleolar RNA host gene 1 promotes 1-methyl-4-phenylpyridinium ion-induced cytotoxicity and reactive oxygen species production through miR-15b-5p/GSK3ß axis in human dopaminergic SH-SY5Y cells.

Long noncoding RNA (lncRNA) small nucleolar RNA host gene 1 (SNHG1) has been demonstrated to be upregulated and play a crucial role in the pathology of Parkinson's disease (PD). However, the exact role of SNHG1 and its underlying mechanisms in PD remains elusive. In this study, we found that SNHG1 and glycogen synthase kinase 3 beta (GSK3ß) were upregulated, but miR-15b-5p was downregulated in 1-methyl-4-phenylpyridinium ion (MPP+ )-treated SH-SY5Y cells. The upregulation of SNHG1 enhanced MPP+ -induced cellular toxicity in SH-SY5Y cells, as shown by decreased cell viability, increased ROS production, and increased number of TdT-mediated dUTP Nick-End labeling-positive cells, accompanied with the upregulation of cleaved caspase 3 and elevation of cytochrome C release. Meanwhile, SNHG1 knockdown presented the converse effects. SNHG1 was demonstrated to interact with miR-15b-5p. Moreover, SNHG1 could attenuate the inhibitory effects of miR-15b-5p on MPP+ -induced cytotoxicity and production of ROS. Besides, GSK3ß was identified as a direct target of miR-15b-5p. The inhibitory effects of SNHG1 knockdown or miR-15b-5p overexpression on MPP+ -induced cytotoxicity and reactive oxygen species (ROS) production were abrogated by upregulation of GSK3ß. Taken together, these results demonstrate that upregulated lncRNA SNHG1 promotes MPP+ -induced cytotoxicity and ROS production through the miR-15b-5p/GSK3ß axis in human dopaminergic SH-SY5Y cells, suggesting that SNHG1 may act as a potential therapeutic target for PD treatment in the future.

[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.

Upregulation of lncRNA-ATB by Transforming Growth Factor ß1 (TGF-ß1) Promotes Migration and Invasion of Papillary Thyroid Carcinoma Cells.

BACKGROUND lncRNA-ATB plays an oncogenic role in various types of malignancies, but its involvement in papillary thyroid carcinoma (PTC) cells, which is a main type of thyroid cancer, is unknown. MATERIAL AND METHODS A total of 76 patients with PTC and 28 people with normal physiological conditions were included in this study. Tumor tissues and adjacent healthy tissues were collected from PTC patients and blood was extracted from both patients and healthy controls. Expression of lncRNA-ATB in those tissues was detected by qRT-PCR. All patients were followed up for 5 years and diagnostic and prognostic values of serum lncRNA-ATB for PTC were investigated by ROC curve analysis and survival curve analysis, respectively. lncRNA-ATB overexpression PTC cell lines were established and effects of lncRNA-ATB overexpression on cell migration and invasion were investigated by Transwell cell migration and invasion assay, respectively. Effects of lncRNA-ATB overexpression on TGF-ß1 expression were investigated by Western blot. RESULTS lncRNA-ATB expression level was higher in tumor tissues than in adjacent healthy tissues in most PTC patients. Serum level of lncRNA-ATB was higher in cancer patients than in healthy control. Serum lncRNA-ATB can be used to accurately predict PTC and its prognosis. lncRNA-ATB overexpression promoted tumor cell migration and invasion, lncRNA-ATB overexpression showed no significant effects on TGF-ß1 expression, and TGF-ß1 treatment increased the expression level of lncRNA-ATB. CONCLUSIONS Upregulation of lncRNA-ATB by TGF-b1 promotes migration and invasion of PTC cells.

[Postoperatively repair methods of head and facial skin malignancies in the advanced ages].

OBJECTIVE: To investigate postoperatively repairing methods and their clinical effects of the olders over 80 years old with head and facial skin malignancies. METHOD: Eighteen cases of skin cancers in the head and face, whose malignancies were resected with Mohs microscopic surgery, according to the local or systemic condition of patients after surgery we choose different repairing methods: free skin flap grafting in 2 cases, local skin flap transferring 12 cases; including rotation skin flap grafting 6 cases, sliding flap 4 cases, nasolabial flap 2 cases; transposition flap 4 cases. RESULT: Operations of the 18 cases went well without special complications. All of the flaps were alive with partial flap necrosis in 1 case, which was cured 1 month later by dressing changes. During the follow-up period ranged from 6 months to 2 years,no tumor recurred,the functional recovery and appearance were satisfactory. CONCLUSION: Choosing operating methods in head and facial skin malignancies should consider patients' age, disease state and general condition. Reparing methods of Head and facial skin malignancies in the advanced ages should be selected according to their specific circumstances, especially the simple, convenient and rapid with less trauma way.

Complete recovery of visual disorder following surgical resection of adenoid cystic carcinoma arising in the pterygopalatine fossa: case report and review of the literature.

Adenoid cystic carcinoma (ACC) arising in the pterygopalatine fossa was rare, only 3 cases have been reported. In previous literature, few authors reported whether the visual deficit could be resolved following the resection of the tumor. One patient with visual dysfunction induced by ACC arising in the pterygopalatine fossa was reported. Complete visual recovery was achieved following the operation. And the patient was satisfied with the appearance and the functional results in the follow-up. Visual loss contributed by the tumor in the pterygopalatine fossa could recover in selected patients.

Risk Factors for Early and Late Donor-Site Morbidity After Free Fibula Flap Harvest.

PURPOSE: This article reports on the incidence of donor-site complications and identifies predictive factors for early and late donor-site complications. MATERIALS AND METHODS: From January 2007 through December 2012, 45 patients underwent free fibula flap reconstruction and their medical records were reviewed. They were asked to complete a questionnaire on the operated leg and they were evaluated for ankle stability and ambulatory status. RESULTS: One patient (2.2%) developed a complication owing to a hematoma, but no other patients had any complications. During the risk factor analysis, no domain was found to be statistically associated with early morbidity; late dysfunction was noted in 20 patients (57.1%), and of these cases, at least 2 symptoms were found in 10 patients (50%). The most common complication was numbness followed by toe contracture and abnormal ambulatory movement. During the risk analysis, the following domains affected late donor-site morbidity: harvested fibula length, operation time, and follow-up time. Furthermore, in cases with complications, patients with the osteocutaneous fibula flap complained more than patients with the osseous flap (P = .07). CONCLUSION: Early donor-site morbidity was uncommon, but late morbidity occurred frequently. Harvested fibula length, operation time, and follow-up time were statistically linked to postoperative function.

Reconstruction of full-thickness buccal defects with submental island flap.

Our goal was to introduce the application of submental island flap in reconstructing through-and-through cheek defects. From January 2009 to January 2013, 7 patients (5 men and 2 women) with full-thickness buccal defects due to tumor resection received submental flap reconstruction at the Affiliated Tumor Hospital of Zhengzhou University; surgical procedure and success rate as well as functional results were described. Distal partial necrosis occurred in 1 flap, but all flaps survived. All patients were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling; the appearance was reported to be good or acceptable in all cases, and the mean postoperative mouth-open width was 4.2 (range, 3.7-5.0) cm. One patient had a local recurrence in the follow-up. Therefore, submental island flap is a reliable procedure for through-and-through buccal defects in selected patients.

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.

[Clinical observation of intra-operative PTH assay in hyperparathyroidism due to parathyroid tumors].

OBJECTIVE: To investigate the clinical manifestations and diagnostic method of hyperparathyroidism due to parathyroid tumors and to evaluate the intra-operative detection of parathyroid hormone in surgical treatment. METHOD: Thirty-seven cases with functional parathyroid tumors from January 2003 to October 2012 were retrospectively analyzed. The clinical manifestation, examination and operation method, changes of parathyroid hormone before and after operation were collected. RESULT: All cases were definitely diagnosed before operation. The sensitivity and the positively predictive values of neck ultrasonography were 86.5% and 97.6% respectively, and the same data of Tc-99m-MIBI was 97.2% and 100.0%. The PTH levels declined by 84.9% ten minutes after tumor resecting compared with the level before operation. The serum calcium and PTH returned to normal levels and symptomatic relief occurred after operation. CONCLUSION: Recurrent bone disease, long-term urinary calculus and obscure gastrointestinal symptoms were common symptoms of hyperparathyroidism due to parathyroid tumors. The neck ultrasonography and Tc-99m-MIBI were suitable for location of parathyroid tumors. Surgical operation was an effective treatment for parathyroid tumor. Intra-operative PTH assay would be able to ensure the radical excision and the operative safety for functional parathyroid tumors.

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.