Risk factors for surgical failure in patients undergoing surgery for primary hyperparathyroidism.

INTRODUCTION: Primary hyperparathyroidism is the third most common endocrine disease. The aim of our study was to determine long-term outcomes and risk factors for persistence in patients undergoing parathyroidectomy for primary hyperparathyroidism. METHODS: Retrospective study including patients undergoing parathyroidectomy between 2009-2019. Cure was defined as reestablishment of normal calcium homeostasis lasting a minimum of 6 months. Persistence was defined by ongoing hypercalcemia more than 6 months after surgery. Recurrent PHTP was defined by recurrence of hypercalcemia after a normocalcemic interval at more than 6 months after surgery. A more detailed analysis was performed on patients with normocalcemia and persistently elevated PTH levels after surgery. Variables independently related to persistence were analyzed by multivariate analysis. RESULTS: We included 212 patients. Mean age was 59 years and 83% were women. Cure was observed in 204 patients (96.2%), persistence in 8 (3.8%) and recurrence in 3 (1.4%). Four patients (1.9%) presented normocalcemia and persistently elevated PTH after surgery. All presented parathyroid pathology (2 adenomas and 2 hyperplasia). In follow-up we observed that adenoma subgroup presented one patient with CKD and one with vitamin D deficiency while in the hyperplasia subgroup two patients presented CKD. Persistence was independently associated with hyperplasia (Odds ratio = 12.6, IC95% = 1.28-124, p = 0.030) and normal parathyroid tissue (Odds ratio = 188, IC95% = 9.33-379, p = 0.001) on histopathological report. CONCLUSION: Primary hyperparathyroidism is a safe procedure in terms of morbidity and long-term outcomes. Hyperplasia and normal parathyroid tissue on histopathological report are risk factors for persistence. An interdisciplinary diagnostic and therapeutic approach is required to prevent persistence.

Six-year experience of microvascular free-flap reconstruction of head and neck neoplasms.

INTRODUCTION: Microvascular free-flap reconstruction is one of the treatment options after large resection of head and neck neoplasms. The objectives of this study are to identify short-term outcomes and risk factors for flap complication in patients who underwent neoplasms resection of head and neck with microvascular free-flap reconstruction. METHODS: Retrospective study of patients who underwent surgery for head and neck neoplasm with microvascular free-flap reconstruction between January 2014-2020. Complications were studied at 30-days follow-up and divided into medical and flap complications. Factors independently associated with flap complication were analyzed. RESULTS: We included 31 patients (15 men). The mean age was 60 years. Reconstruction was performed with radial-forearm flap in 74% (n=23) and with free-fibula flap in 26% (n=8). Mean surgical time was 420 minutes. Median hospital length of stay was 7 days. Medical complications were of 23%. Minor complications were of 35% and major of 32%. There was no mortality in 30-days follow-up. Flap complications were of 35%. Reintervention was of 29%, surgical site infection of 9%, dehiscence of 29% and flap loss of 9.7%.  Surgical site infection was independently associated with prolonged surgical time (Odds ratio [OR]=1.03, IC95%=0.98-1.04, p=0.02) and body mass index equal to or greater than 30 (OR=1.38, IC95%=0.84-2.26, p=0.04) while flap loss was associated with prolonged surgical time (OR=1.02, IC95%=0.99-1.04, p=0.01). CONCLUSION: Microsurgical free-flap reconstruction should be considered in our population in patients with large head and neck neoplasms. Preoperative assessment of the risk of postoperative complications is essential before selecting patients for this surgery.

Risk factors for surgical failure in patients undergoing surgery for primary hyperparathyroidism. / Factores de riesgo de persistencia en pacientes con tratamiento quirúrgico de hiperparatiroidismo primario.

INTRODUCTION: Primary hyperparathyroidism is the third most common endocrine disease. The aim of our study was to determine long-term outcomes and risk factors for persistence in patients undergoing parathyroidectomy for primary hyperparathyroidism. METHODS: Retrospective study including patients undergoing parathyroidectomy between 2009- 2019. Cure was defined as reestablishment of normal calcium homeostasis lasting a minimum of 6 months. Persistence was defined by ongoing hypercalcemia more than 6 months after surgery. Recurrent PHTP was defined by recurrence of hypercalcemia after a normocalcemic interval at more than 6 months after surgery. A more detailed analysis was performed on patients with normocalcemia and persistently elevated PTH levels after surgery. Variables independently related to persistence were analyzed by multivariate analysis. RESULTS: We included 212 patients. Mean age was 59 years and 83% were women. Cure was observed in 204 patients (96.2%), persistence in 8 (3.8%) and recurrence in 3 (1.4%). Four patients (1.9%) presented normocalcemia and persistently elevated PTH after surgery. All presented parathyroid pathology (2 adenomas and 2 hyperplasia). In follow-up we observed that adenoma subgroup presented one patient with CKD and one with vitamin D deficiency while in the hyperplasia subgroup two patients presented CKD. Persistence was independently associated with hyperplasia (Odds ratio=12.6, IC95%=1.28-124, p=0.030) and normal parathyroid tissue (Odds ratio=188, IC95%=9.33-379, p=0.001) on histopathological report. CONCLUSIóN: Primary hyperparathyroidism is a safe procedure in terms of morbidity and long-term outcomes. Hyperplasia and normal parathyroid tissue on histopathological report are risk factors for persistence. An interdisciplinary diagnostic and therapeutic approach is required to prevent persistence.

Análisis de Biomarcadores para pronóstico de neoplasias de Glándulas Salivales / Analysis of Biomarkers for prognosis of Salivary Gland Neoplasms

Introducción y objetivos: La probabilidad de recurrencia del adenoma pleomorfo y la agresividad de algunas variedades de neoplasias malignas de glándulas salivales requieren de un recurso de fácil aplicación que contribuya a establecer un pronóstico. El objetivo de este trabajo fue analizar biomarcadores en tejido tumoral obtenido por escisión quirúrgica a fin de determinar su implicancia en el pronóstico de tumores malignos y benignos potencialmente recidivantes de glándulas salivales. Materiales y métodos: Este estudio, de tipo descriptivo transversal, fue realizado sobre una selección de treinta y seis pacientes con diagnóstico de tumores benignos y malignos de glándulas salivales con y sin recidiva. Ellos fueron seleccionados en los Servicios de Cirugía de Cabeza y Cuello de los hospitales Córdoba y Privado de la ciudad de Córdoba. El protocolo de trabajo y el consentimiento informado que firmaron los participantes fueron previamente aprobados por los Comités Institucionales de Ética de Investigación en Salud (CIEIS) de los hospitales mencionados. Los pacientes fueron distribuidos en cuatro grupos de estudio según el comportamiento biológico y la presencia o no de recidiva: TBSR (tumor benigno sin recidiva), BCR (tumor benigno con recidiva), TMSR (tumor maligno sin recidiva), TMCR (tumor maligno con recidiva). Se confeccionó una ficha individual y se obtuvieron muestras de tejido tumoral, las cuales fueron fijadas para luego aplicar las técnicas de inmunohistoquímica. Dos observadores independientes realizaron el análisis mediante microscopía óptica. Resultados: MUC1, Ki-67 y p53 presentan un alto porcentaje de marcación (91, 91 y 86%, respectivamente), en tanto que c-erbB-2 sólo se expresó en un 20% de los casos. Este último marcó solamente en un 10% de los tumores benignos y Ki-67 fue el único se expresó que en el 100% de los tumores malignos.

SUMMARY: Introduction and objective: the probability of recurrence of pleomorphic adenoma and the aggressiveness of home malignant salivary gland neoplasms require an easily applicable method to help in establishing a prognosis. The aim of this study was to analyze the expression of biomarkers in tumor tissue obtained by surgical excision in order to determine its implication in predicting malignant and potentially recurrent benign salivary gland tumors. Materials and methods: a descriptive cross study was carry out on thirty-six patients with diagnosis of benign and malignant salivary gland tumors both with and without recurrence. They were selected from the Head and Neck Surgery Departments of the Córdoba and Privado hospitals, in Córdoba, Argentina. The study protocol and the informed consent which were signed by the participants were reviously approved by the Institutional Committee for Ethics in Health Research (CIEIS) of the involved hospitals. Patients were distributed in four study groups according to tumor biological behavior and presence or absence of recurrence: BTwR (benign tumor without recurrence), BTR (benign tumor with (recurrence), MTwR (malignant tumor without recurrence) and MTR (malignant tumor with recurrence). An individual record was produced and tumor tissue samples were obtained and fixed for immunohistochemistry procedures. A light microscopy analysis was performed by two independent observers. Results: MUC1, p53 and Ki-67 have marked in a high percentage (91, 91 and 86%, respectively) whereas c-erbB-2 was expressed only in 20% of cases

Análisis de Biomarcadores para pronóstico de neoplasias de Glándulas Salivales / Analysis of Biomarkers for prognosis of Salivary Gland Neoplasms

Introducción y objetivos: La probabilidad de recurrencia del adenoma pleomorfo y la agresividad de algunas variedades de neoplasias malignas de glándulas salivales requieren de un recurso de fácil aplicación que contribuya a establecer un pronóstico. El objetivo de este trabajo fue analizar biomarcadores en tejido tumoral obtenido por escisión quirúrgica a fin de determinar su implicancia en el pronóstico de tumores malignos y benignos potencialmente recidivantes de glándulas salivales. Materiales y métodos: Este estudio, de tipo descriptivo transversal, fue realizado sobre una selección de treinta y seis pacientes con diagnóstico de tumores benignos y malignos de glándulas salivales con y sin recidiva. Ellos fueron seleccionados en los Servicios de Cirugía de Cabeza y Cuello de los hospitales Córdoba y Privado de la ciudad de Córdoba. El protocolo de trabajo y el consentimiento informado que firmaron los participantes fueron previamente aprobados por los Comités Institucionales de Etica de Investigación en Salud (CIEIS) de los hospitales mencionados. Los pacientes fueron distribuidos en cuatro grupos de estudio según el comportamiento biológico y la presencia o no de recidiva: TBSR (tumor benigno sin recidiva), BCR (tumor benigno con recidiva), TMSR (tumor maligno sin recidiva), TMCR (tumor maligno con recidiva). Se confeccionó una ficha individual y se obtuvieron muestras de tejido tumoral, las cuales fueron fijadas para luego aplicar las técnicas de inmunohistoquímica. Dos observadores independientes realizaron el análisis mediante microscopía óptica. Resultados: MUC1, Ki-67 y p53 presentan un alto porcentaje de marcación (91, 91 y 86%, respectivamente), en tanto que c-erbB-2 sólo se expresó en un 20% de los casos. Este último marcó solamente en un 10% de los tumores benignos y Ki-67 fue el único se expresó que en el 100% de los tumores malignos.(AU)

SUMMARY: Introduction and objective: the probability of recurrence of pleomorphic adenoma and the aggressiveness of home malignant salivary gland neoplasms require an easily applicable method to help in establishing a prognosis. The aim of this study was to analyze the expression of biomarkers in tumor tissue obtained by surgical excision in order to determine its implication in predicting malignant and potentially recurrent benign salivary gland tumors. Materials and methods: a descriptive cross study was carry out on thirty-six patients with diagnosis of benign and malignant salivary gland tumors both with and without recurrence. They were selected from the Head and Neck Surgery Departments of the Córdoba and Privado hospitals, in Córdoba, Argentina. The study protocol and the informed consent which were signed by the participants were reviously approved by the Institutional Committee for Ethics in Health Research (CIEIS) of the involved hospitals. Patients were distributed in four study groups according to tumor biological behavior and presence or absence of recurrence: BTwR (benign tumor without recurrence), BTR (benign tumor with (recurrence), MTwR (malignant tumor without recurrence) and MTR (malignant tumor with recurrence). An individual record was produced and tumor tissue samples were obtained and fixed for immunohistochemistry procedures. A light microscopy analysis was performed by two independent observers. Results: MUC1, p53 and Ki-67 have marked in a high percentage (91, 91 and 86%, respectively) whereas c-erbB-2 was expressed only in 20% of cases(AU)