[Visual identification of the recurrent laryngeal nerve during thyroidectomy]. / Identificazione visiva del nervo laringeo ricorrente durante tiroidectomia.

INTRODUCTION: Injuries to the recurrent laryngeal nerve (RLN) are always a possible complication of thyroidectomy, in spite of various technical proposals aimed at reducing these risks. The aim of this study is the description of the technical methods used by us for identification. MATERIALS AND METHODS: One hundred seventy-five patients underwent thyroidectomy with a technique consisting in a systematic search of the RLN in the tracheoesophageal groove where it crosses the ITA avoiding ligatures, sections or electro-coagulation before making a definite identification of the nerve which then takes place and is then safeguarded until laryngeal insertion. RESULTS: In 95.4% of the cases total thyroidectomy was performed and in 4.6% of the cases a hemi-thyroidectomy, with a total of 342 identifications of the RLN. In two cases (1.14%) the laryngeal nerve was non-recurrent. There was no operative mortality. There were no bilateral lesions of the RLN, while unilateral lesions occurred in 2.8% of cases (5/175) of which 3 (1.7%) with temporary vocal deficit. DISCUSSION: We examined the different methods used to facilitate the identification of the nerve including: palpatory method, peri-tracheal excision, use of loupe magnification, intraoperative nerve monitoring (IONM). None of the procedures examined showed a genuine reduction to the risk of injury. The authors emphasize that the visual identification, using the methods they described, allows the visualization and preservation of the nerve for the majority of the cases. CONCLUSION: Taking into consideration that the various methods of preservation of the RLN have not significantly reduced the risk of injury, the visual identification with specific measures has made it possible to limit the damage to a very low number of cases.

[Integrated multidisciplinary treatment of colorectal neoplasms]. / Trattamento multidisciplinare integrato delle neoplasie colo-rettali.

In this retrospective study, the modality and advantages of the multidisciplinary diagnostic work-up and therapy regarding colorectal neoplasm were analysed. Over the period 2004-2008, 63 patients underwent multidisciplinary treatment for colorectal cancer. All patients underwent surgery (laparoscopic/open). Exeresis was supplemented by adjuvant chemotherapy in those cases beyond IIA stage; all cases of extraperitoneal rectal and anal canal neoplasms plus one case of carcinoma of the transverse colon, initially inoperable, underwent neoadjuvant radiotherapy plus chemotherapy. The treatment was initiated approximately 3 weeks after the diagnosis. Fifty-four percent of patients with colonic and upper rectal neoplasms were given adjuvant chemotherapy, starting around 4 weeks after surgery. Exeresis was performed in those patients with extraperitoneal rectal and anal canal neoplasms (12.7%) about 6-8 weeks after they had completed neoadjuvant therapy. At the end of the treatment, 76% of the overall total numbers of patients were in good condition (follow-up 4-50 months). The remaining 24% suffered recurrences about 13 months after the treatment for colonic and upper rectal neoplasm, and 8 1/2 months after treatment for extraperitoneal rectal/anal canal neoplasms. Seventy-five percent of the recurring cases underwent treatment again, with 50% success; the others are still undergoing treatment. The best therapeutic results were obtained by programmed integration of the various diagnostic-therapeutic steps according to an algorithm which we elaborated to evaluate all types of neoplasm at any stage of illness.