Objective To explore the protection of the structure and function around the upper pole of the thyroid gland by endoscopic thyroidectomy combined with nerve detection through the gasless unilateral axillary approach. Methods From January 2019 to June 2020, 48 thyroid patients who underwent the gasless unilateral axillary approach combined with the endoscopy and nerve detection technology in the Department of Head and Neck Surgery of Zhejiang Provincial People’s Hospital were reviewed as the endoscopic group, and 53 thyroid patients underwent open surgery combined with the endoscopy and nerve detection technology as the open group. The protection of the functional structure of the suprathyroid pole were compared. Results In terms of operation time, the endoscopic group was longer than that of the open group (67.5 min vs. 54.1 min, P=0.001). There was no statistical difference between the two groups in terms of postoperative hospital stay and blood loss (P>0.05). Forty-seven patients with the endoscopic thyroid surgery through the gasless unilateral axillary approach effectively detected the superior laryngeal nerve (47/48, 97.9%), which was higher than that of the open group (40/53, 75.5%), P=0.003, and the exposure rate of hypoglossal nerve descending branch in the endoscopic group was also higher [31.3% (15/48) vs. 3.8% (2/53), P=0.001]. In the endoscopic group, the superior parathyroid gland was kept in situ during the operation, and there was no change of voice and cough after the operation. In the open group, there were 2 cases of autologous transplantation of the upper pole parathyroid gland, 2 patients had voice changes, and 1 case had partial upper pole banded muscle incision. There was no significant difference in the incidence of nerve injury complications, the rate of autologous transplantation of the upper pole parathyroid gland and the rate of anterior cervical banded muscle injury between the two groups (P>0.05). In addition, there was no significant difference in the levels of parathyroid hormone, blood calcium, blood magnesium and blood phosphorus between the two groups before/after operation (P>0.05). Conclusion During the endoscopic thyroidectomy through the gasless unilateral axillary approach, the nerve monitoring technology is combined with the exploration and protection of the superior laryngeal nerve on the surface of the medial cricothyroid muscle of the upper pole of the thyroid, and the fine capsule anatomy technology is used to protect the superior parathyroid gland in situ, which can more effectively expose the external branch of the superior laryngeal nerve. It is conducive to the protection of the structures around the upper pole.
Objective To investigate the effect of radiotherapy after neoadjuvant chemotherapy and modified radical surgery on breast cancer specific survival (BCSS) of patients with stage cT1–2N1M0 breast cancer. Methods A total of 917 cT1–2N1M0 stage breast cancer patients treated with neoadjuvant chemotherapy and modified radical surgery from 2010 to 2017 were extracted from the The Surveillance, Epidemiology, and End Results (SEER) database. Of them 720 matched patients were divided into radiotherapy group (n=360) and non-radiotherapy group (n=360) by using propensity score matching (PSM). Cox proportional hazard regression model was used to explore the factors affecting BCSS. Results Patients were all interviewed for a median follow-up of 65 months, and the 5-year BCSS was 91.9% in the radiotherapy group and 93.2% in the non-radiotherapy group, there was no significant difference between the 2 groups (χ2=0.292, P=0.589). The results were the same in patients with no axillary lymph node metastasis, one axillary lymphnode metastasis, two axillary lymph node metastasis and 3 axillary lymph node metastasis group (χ2=0.139, P=0.709; χ2=0.578, P=0.447; χ2=2.617, P=0.106; χ2=0.062, P=0.803). The result of Cox proportional hazard regression analysis showed that, after controlling for Grade grade, time from diagnosis to treatment, efficacy of neoadjuvant chemotherapy, number of positive axillary lymph nodes, molecular typing, and tumor diameter at first diagnosis, radiotherapy had no statistically significant effect on BCSS [HR=1.048, 95%CI (0.704, 1.561), P=0.817]. Conclusions The effect of radiotherapy on the BCSS of patients with stage cT1–2N1M0 breast cancer who have received neoadjuvant chemotherapy and modified radical surgery with 0 to 3 axillary lymph nodes metastases is limited, but whether to undergo radiotherapy should still be determined according to the comprehensive risk of individual tumor patients.
ObjectiveTo explore the factors associated with non-sentinel lymph node (NSLN) metastasis in early breast cancer patients with 1-2 positive sentinel lymph nodes (SLN), seeking the basis for exempting some SLN-positive patients from axillary lymph node dissection. MethodsA total of 299 early breast cancer patients who were diagnosed with positive sentinel lymph node (SLN) biopsy and underwent axillary lymph node dissection at the Affiliated Hospital of Southwest Medical University from January 2019 to April 2023 were selected. Univariate analysis was performed on the clinical and pathological data of patients, and multivariate logistic regression analysis was conducted to identify factors related to axillary non-sentinel lymph node (NSLN) metastasis of patients with SLN positive in early breast cancer. GraphPad Prim 9.0 was used to draw receiver operating characteristic (ROC) curve, and the area under curve (AUC) of ROC was calculated to quantify the predictive value of risk factors. ResultsAmong the 299 breast cancer patients with 1-2 SLN positive, 101 cases (33.78%) were NSLN positive and 198 cases (66.22%) were NSLN negative. Univariate analysis showed that the number of positive SLN, clinical T staging and lymphovascular invasion were related to the metastasis of NSLN (P<0.001). Multivariate logistic regression analysis indicated that having 2 positive SLN [OR=3.601, 95%CI (2.005, 6.470), P<0.001], clinical T2 staging [OR=4.681, 95%CI (2.633, 8.323), P<0.001], and presence lymphovascular invasion [OR=3.781, 95%CI (2.124, 6.730), P<0.001] were risk factors affecting axillary NSLN metastasis. The AUCs of the three risk factors were 0.623 3, 0.702 7 and 0.682 5, respectively, and the AUCs all were greater than 0.6, suggesting that the three risk factors had good predictive ability for NSLN metastasis. ConclusionThe number of positive SLN, clinical T staging, and lymphovascular invasion are related factors affecting NSLN metastasis in early breast cancer patients with positive SLN, and these factors have guiding significance for whether to exempt axillary lymph node dissection.
ObjectiveTo evaluate the safety and efficacy of gasless endoscopic thyroidectomy via transaxillary approach in treating papillary thyroid cancer (PTC). MethodsThe patients who underwent gasless endoscopic thyroidectomy (Abbreviated as the “endoscopic group”) and neck open surgery (Abbreviated as the “open group”), in the Zhejiang Provincial People’s Hospital from January 2018 to June 2023, were collected. The intraoperative and postoperative outcomes of the patients in the two groups were compared after propensity score matching (PSM). Statistical analysis was conducted using SPSS 26.0 software, with a test level of α=0.05. ResultsAfter PSM, there were 409 patients in the endoscopic group and 421 patients in the open group. There were no statistically significant differences in the baseline data between the two groups (P>0.05), except for tumor location, vascular invasion, intraglandular dissemination, and preoperative levels of total triiodothyronine and thyroid hormone (P<0.05). Compared with the open group, the patients in the endoscopic group had less intraoperative blood loss (P<0.05), higher points of incision satisfaction and cosmetic effect (P<0.05), but the number of lymph nodes dissected was less (P<0.05) and the operation time was longer (P<0.05) in the endoscopic group. The incidence of postoperative overall complications had no statistically significant difference between the endoscopic group and open group (3.6% versus 5.8%, P=0.127). There was no statistically significant difference in the recurrence rate between the endoscopic group and open group within one year of follow-up (0.2% versus 0.5%, P=0.099). ConclusionsFrom the results of this study, the gasless endoscopic thyroidectomy is safety and reliability in treatment of PTC. It can achieve the same effect as traditional open thyroidectomy. However, it can also be seen that young female patients are more willing to choose gasless endoscopic thyroidectomy as long as their condition permits (such as early tumor stage, low invasiveness).
ObjectiveTo explore the feasibility and the practical value of conserving upper limb lymph nodes in axillary lymph node dissection (ALND) for early breast cancer. MethodsFrom August 2007 to January 2010, 124 patients with early breast cancer were studied and divided into two phases: phase one, from August 2007 to July 2008; phase two, from August 2008 to January 2010. Five milliliter of methylene blue was injected subcutaneously in ipsilateral forearm in all the patients before operation to locate the upper limb lymph nodes. Routine ALND was performed in 22 patients of phase one. The level Ⅱ lymph nodes and the upper limb lymph nodes were separated from the axillary lymph nodes, respectively. The lymph nodes of level Ⅱ were investigated by combining touch cytology with frozen section during operation. The lymph nodes of level Ⅰ, Ⅱ, Ⅲ, and the upper limb lymph nodes were investigated postoperatively by routine pathological examination to evaluate the feasibility of conserving the upper limb lymph nodes. One hundred and two patients in phase two were divided randomly by lottery into control group (30 cases), and conserving group (72 cases) in which upper limb lymph nodes were selectively conserved. The surgical procedure for control group was same as the phase one blue stained upper limb lymph nodes, in the conserving group were conserved selectively when the lymph nodes metastasis of level Ⅱ were not detected by combining touch cytology with frozen section during operation. The data were collected and analysed on pathological results of all patients and arm circumference was compared between control group and conserving group. Results Total 119 of 124 patients (96.0%) were found with blue stained upper limb lymph nodes. The concordance rate was 99.2% (123/124) between the intraoperative combining pathological method and the postoperative routine pathological examination. No upper limb lymph node metastasis was found in the phase one and the control group of phase two with level Ⅱ group negative. The incidence of arm lymphedema in the control group and the conserving group with level Ⅰ and Ⅱ lymph nodes dissection was 18.2% （4/22） and 20% （1/51）, respectively on 6 months after operation. The difference was statistically significant （χ 2=6,34， Plt;0.05）. ConclusionsMethylene blue being injected subcutaneously in ipsilateral upper limb can be used to show validly lymph nodes of upper limb in the axillary region. ALND with selectively conserving upper limb lymph nodes when level Ⅱ lymph nodes negative in metastasis, can prevent postoperative arm lymphedema.
ObjectiveTo investigate the risk factors of internal mammary lymph node (IMLN) metastasis in breast cancer patients, and to provide evidence for clarifying the TNM stage of tumors and formulating precise treatment plans. Methods The female patients who were admitted to the First Affiliated Hospital of Chongqing Medical University from February 2019 to January 2020 and diagnosed with breast cancer by tissue biopsy pathology based on the new tracer technology were retrospectively collected. All IMLNs were dissected. The associations of IMLN metastasis with patients’ age, tumor size (long diameter), tumor location, tumor grade, estrogen and progesterone receptor statuses, human epidermal growth factor receptor-2 (HER2) status, number of axillary lymph node (ALN) metastasis, and pathological molecular typing were analyzed. ResultsA total of 28 patients were included in this study. The visualization rates in the ALN and IMLN by the new tracer technique were 96.4% (27/28) and 35.7% (10/28), respectively. The pathological results of IMLN biopsy confirmed that 6 patients (The 6 cases were all displaying) had IMLN metastases, with an IMLN metastasis rate of 21.4%. The IMLN metastasis was related to the tumor location and ALN metastasis number of patients with breast cancer (P<0.05). That is to say, when the tumor located in the medial quadrant and the number of ALN metastasis was 4 or more, the IMLN metastasis rates were higher than those in the lateral quadrant (57.1% vs. 10.0%, P=0.028) and in the patients with ALN metastasis number <4 (50.0% vs. 11.1%, P=0.038). It was not found that IMLN metastasis was related to age, tumor size, tumor grade, estrogen and progesterone receptor statuses, HER2 status, and pathological molecular typing of patients with breast cancer (P>0.05). And the area of the receiver operating characteristic curve of the number of ALN metastasis for assessing IMLN metastasis was 0.697. ConclusionFrom the summarized results of cases in this study, the visualization rate of IMLN is higher based on the new tracer technology. When breast cancer locates in the medial quadrant and the number of ALN metastasis is 4 or more, it is recommended to actively carry out IMLN biopsy to clarify the results of pathological diagnosis, so as to accurately assess the tumor stage and formulate appropriate individualized treatment plan.
ObjectiveTo explore the therapeutic effect of gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma. MethodsThe clinicopathologic data of patients with unilateral papillary thyroid microcarcinoma who were treated by gasless endoscopic thyroidectomy via axillary posterior approach (observation group) or breast approach (control group) in the Xuzhou Central Hospital from January 2020 to February 2022 were collected. The operation time, accidental intraoperative bleeding, exposure time of recurrent laryngeal nerve, number of lymph node dissection, total hospital stay, and postoperative complications such as superior laryngeal nerve injury, cough due to drinking, temporary hoarseness, transient hypocalcemia, tunnel hematoma, and neck discomfort were compared between the two groups. Meanwhile, the cosmetic effects of the two groups were evaluated. ResultsA total of 87 patients who met the study conditions were enrolled in this study, including 47 cases in the observation group and 40 cases in the control group. There were no statistical differences in the baseline data such as gende, age, maximum tumor diameter, location of tumor, etc. between the two groups (P>0.05). Compared with the control group, the exposure time of recurrent laryngeal nerve was shorter (P<0.001) and the number of lymph node dissection was more (P=0.034), but the accidental intraoperative bleeding during operation was more (P=0.015) in the observation group. There were no statistical differences in the operation time and total hospital stay between the two groups (P>0.05). There were no superior laryngeal nerve injury and cough due to drinking in the two groups after operation, and there were no statistical differences between the two groups in the terms of postoperative temporary hoarseness, transient hypocalcemia, and tunnel hematoma (P>0.05), but it was found that the incidence of postoperative neck discomfort in the observation group was lower than that in the control group (P=0.043), and the postoperative cosmetic satisfaction score was also higher than that in the control group (P<0.001). ConclusionsFrom the results of this study, gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma is safe and feasible. It can quickly expose the recurrent laryngeal nerve and greatly improve the efficiency of lymph node dissection, as well as the cosmetic effect is better.