ABSTRACT
The transligamental intraoperative neuromonitoring of the recurrent nerve is established in many surgical clinics as an useful and reliable technique. It is especially suitable to identify the recurrent nerve and to monitor its function during thyroid operation. We have analysed 14 early postoperative recurrent nerve palsies between June 1997 and December 2000 (1,23 % related to nerves at risk). As a result of complete follow up we found 4 permanent nerve palsies (0,35 % related to nerves at risk). In 11 out of 14 cases the neuromonitoring revealed a dysfunction of the recurrent nerve. The following long distance microsurgical preparation showed no interruption of the continuity of the nerve. Knowing the fact of unilateral negative monitoring signal we adapted our operative strategy. Therefore we did not observe bilateral nerve palsies. In 3 patients we found a positive nerve signal but nevertheless these patients showed postoperative unilateral recurrent palsies. The possible reasons are discussed. We are convinced that the neuromonitoring of the recurrent laryngeal nerve is an important progress in thyroid surgery.
Subject(s)
Monitoring, Intraoperative , Postoperative Complications/etiology , Recurrent Laryngeal Nerve Injuries , Thyroid Diseases/surgery , Thyroidectomy , Vocal Cord Paralysis/etiology , Follow-Up Studies , Humans , Lymph Node Excision , Microsurgery , Postoperative Complications/physiopathology , Recurrent Laryngeal Nerve/physiopathology , Risk Factors , Thyroid Neoplasms/surgery , Vocal Cord Paralysis/physiopathologyABSTRACT
BACKGROUND: Changes in the p53 gene product can be immunogenic and enable the formation of p53 serum antibodies (p53ab), detectable in patients with different cancer types. So far, there have been no reports describing the detectability of p53ab in gastric cancer patients. METHODS: We investigated the presence of p53ab and their clinical relevance in a cohort of 74 gastric cancer patients, using an enzyme-linked immunosorbent assay system. RESULTS: In our investigation 20.3% of all patients (15 of 74) and 46.9% of the patients with immunohistochemically (IHC) p53-positive tumors (15 of 32) showed detectable p53ab in serum. All p53ab-positive patients had IHC p53-positive tumors. We have found a significant correlation of p53ab with a higher tumor stage (P = 0.002) and also with a poor prognosis of survival (P = 0.04). CONCLUSION: We have shown that in gastric cancer patients p53ab are also detectable and that p53ab positivity is a predictor of an unfavorable prognosis.
