[Surgical treatment of thyroid carcinoma with the upper mediastinal invasion].

OBJECTIVE: To study the surgical management of the thyroid carcinoma with the upper mediastinal invasion. METHODS: Among the 560 thyroid carcinoma cases receiving surgery from 1988 to 1999, there were 10 cases of the upper mediastinal, the 10 cases were retrospectively analyzed for their preoperative diagnosis, surgical methods and postoperative complications. RESULTS: The upper mediastinal invasion rate of the 560 cases was 1.9% (10/516). There are three paths for the upper mediastinal invasion: (1) Trachea esophagus groove and upper mediastinal lymphatic node metastasis. (2) Tumor direct invasion. (3) Primary malignant substernal goiter. Operative methods include: (1) Tumor removal without using sternum incision. (2) Tumor removal with sternotomy. (3) Extension operation with sternum or/and clavicle bones removal. The number of those cases who survived 1, 3, 5, 10 years were 10, 8, 6, 4 respectively. Radical removal of tumors was achieved in 9 cases. The complications occurred were: 2 cases of chylous fistula; 2 cases of vocal paralysis; 1 case of thyrocervical trunk artery bleeding; 1 case of phrenic nerve paralysis; 1 case of pneumothorax. CONCLUSIONS: Surgery can be adopted for treating thyroid carcinoma with the upper mediastinal invasion, and it can have a good long-term prognosis.

[Phonation reconstruction and function assessment after total and near-total laryngectomy].

BACKGROUND & OBJECTIVE: Total laryngectomy is a common surgery pattern for treating laryngeal and hypopharyngeal cancer, but patients will lost phonation function after operation. This study was to retrospectively analyze usage of modified Amatsu, and modified Pearson operation in treating laryngeal and hypopharyngeal cancers, and to analyze phonation function by subjective and objective assessment. METHODS: Clinical data of 69 patients with laryngeal or hypopharyngeal cancer treated by total or near-total laryngectomy (modified Amatsu or modified Pearson operation) in our department from 1996 to 2003 were retrospectively analyzed. Phonation function of 69 patients was evaluated by acoustic analysis and Jiyan classification method, and compared with phonation quality of patients received vertical hemilaryngectomy (VHL) and healthy people. RESULTS: No patient appeared obvious aspiration. Four cases with post-operative radiotherapy all regained phonation function. The 3-year survival rate was 88% (22/25); 5-year survival rate was 80% (4/5). Results of acoustic assessment, and Jiyan classification method indicated that phonation function of patients received modified Amatsu or modified Pearson operation could meet daily requirements. CONCLUSIONS: Modified Amatsu and modified Pearson operations can be learnt and applied easily for phonation reconstruction after laryngectomy. They may be optional surgery patterns, especially modified Pearson operation.

[Surgical treatment of advanced thyroid carcinoma with aero-digestive invasion].

OBJECTIVE: To study the surgical management of the advanced thyroid carcinoma with aero-digestive invasion. METHODS: To analyze 18 cases of advanced thyroid carcinoma which had aerodigestive invasion retrospectively, the patients were treated from 1988 to 1998. RESULTS: The rate of aerodigestive invasion occur was 3.5% (18/516), The inner cavity invaded rate was 2.7% (14/516). The most invaded organ was trachea; The others were esophagus and larynx, pharynx; Two and/or more organs invaded rates were 44. 4% (8/18). The cases that survived 1, 3, 5 and 10 year were 17, 14, 9 and 6. The 5 years survival rates of the differentiated thyroid cancer (61.5%) were more higher than the undifferentiated thyroid cancer (20.0%), but there were no statistical difference between them (P > 0.05) and the same in clinical stage (P > 0.05). CONCLUSIONS: Intraluminal extension is a more serious problem in which usually extensive resection of the aerodigestive tract is required. Effective surgical treatment combined with postoperative auxiliary management for this kind of patients may achieve a good long term results.

[Application of frontal-lateral laryngectomy in laryngeal cancer treatment].

OBJECTIVE: Thirty-eight patients of laryngeal cancer were treated by extended frontal-lateral laryngectomy and the results were evaluated. METHODS: Thirty-eight patients with laryngeal cancer were treated by frontal-lateral laryngectomy and the laryngeal defects were reconstructed by epiglottic flap, bi-pedicle and bi-muscle flap and epiglottic flap plus bi-pedicle and bi-muscle flap from February 1988 to February 2000. There were 29 males and 9 females, ranging in age from 32 to 72 years old. Radical neck dissection was performed in 12 patients. 36 cases belonged to glottic cancer and 2 was superglottic cancer (T2 16, T3 22). RESULTS: The aspiration was light and the majority of cases began to eat in 10-15 days after operation. The decannulation rate was 97.3% (37/38). Wound infection occurred in 3 cases, but pharyngocutaneous fistula was not found. The three and five years survival rates were 86.1% (31/36) and 83.9% (26/31) respectively. CONCLUSION: This procedure present an ideal effect and is worthy to be recommended, but only the indication is limited.