Comparison of recurrence and complication by different thyroidectomy in the treatment of differentiated thyroid carcinoma as initial treatment: a meta-analysis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the total thyroidectomy or subtotal resection and gland lobe and isthmus lobectomy as initial treatment to TNM stage I and II differentiated thyroid cancer. The difference between recurrence rate and surgical complications were analysed.</p><p><b>METHODS</b>The literatures published between 1972-2012 were searched in Pubmed, Medline, Wanfang database, Chinese Biomedical Literature Database, Chinese scientific Journals database and China National Knowledge Infrastructure. According to the inclusion and deletion criteria, 17 articles were included to compare the postoperative recurrence and complications in randomized controlled or case-control studies, involving 13 articles in recurrence rate and 11 articles in complications.RevMan5.0 software package was used to perform meta-analysis.</p><p><b>RESULTS</b>Thirteen articles involved with the recurrence rate, the total case number was 3511. Among these cases, 414 recurred, overall recurrence rate was 11.59%, of which, 150 recurred cases in total or subtotal resection group (experimental group), the recurrence rate was 6.51%; 264 recurred cases in gland lobe lobectomy plus isthmus group (control group), the recurrence rate was 21.83%. Comparing the two groups, the odds ratio (OR) and their 95% confidence interval (95%CI) was 0.26 [0.21,0.33], Z value was 11.33, P < 0.01, which showed that the recurrence rate in experimental group was significantly lower than that in control group.Eleven articles involved with the complications, the total case number was 2388, 166 cases had postoperative complications. The complication rate was 6.95%, of which, 109 cases in experimental group, the complication rate was 8.52%; 57 cases in control group, the complication rate was 5.15%. Compared with the two groups, OR values and their 95%CI was 3.63 [2.47, 5.33], Z was 6.58, P < 0.01, the experimental group had significantly higher incidence of complications.</p><p><b>CONCLUSION</b>For I and II differentiated thyroid cancer, total thyroidectomy or subtotal resection may reduce the chance of recurrence, but the postoperative complications is higher; while gland lobe and isthmus lobectomy has lower postoperative complications, but may increase the risk of relapse.</p>

Evidence for determining the safe surgical margin for pleomorphic adenoma of parotid gland / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the treatment outcomes, complications and histopathologic features between conventional parotidectomy and functional regional parotidectomy in the treatment for pleomorphic adenoma of parotid gland and to provide clinical, and pathological evidence for determining the safe surgical margin.</p><p><b>METHODS</b>Of 109 patients, 60 patients received conventional parotidectomy and 49 patients received functional regional parotidectomy. The rates of tumor recurrence and complications were compared between the groups of patients.</p><p><b>RESULTS</b>There was no significant difference in the incidence of tumor recurrence, the facial paralysis and sialosyrinx between two groups. The rates of Frey's syndrome, numbness of auricular region, and facial asymmetry were 30.0%, 61.7%, and 38.3% in the patients with conventional parotidectomy respectively, while the rates were 6.1%, 30.6%, and 8.2% in the patients with functional regional parotidectomy, with significant statistically difference, respectively (P < 0.05). Of 109 patients, 33 with incomplete capsule, 29 with capsule penetration, 25 with pseudopodia, and 13 with satellite nodules. There was no significant difference in the depth of tumor infiltration between two groups of patients. For the tumor smaller than 2 cm, the depth of infiltration in conventional group was from 0.061 to 1.122 mm, functional group was from 0.442 to 3.127 mm (Z = -1.093, P = 0.057); for the tumors between 2 - 4 cm, the depth in conventional group was from 0.081 to 7.908 mm, functional group was from 0.082 to 6.632 mm (Z = -0.214, P = 0.831); for the tumor larger than 4 cm, the depth of infiltration was from 0.340 to 8.476 mm.</p><p><b>CONCLUSIONS</b>Compared with conventional parotidectomy, functional regional parotidectomy has good outcomes and less complications. The surgical margins of pleomorphic adenomas of the parotid gland should be determined by the size of tumor. The 1 cm-surgical margins are safe for the tumors less than 4 cm, and the tumors more than 4 cm should be treated with superficial parotidectomy.</p>

Results of a screening program on high incidence area of esophageal cancer in Yanting Sichuan from 2006 to 2011 / 中华流行病学杂志

Objective To study the prevalence of esophageal cancer and various lesions of esophagus in high risk areas through a screening program for early diagnosis and treatment.Methods Random cluster sampling method was used to select some portions of a natural village as screening object in the high risk areas of esophageal cancer,from 2006 to 2011.Endoscope iodine staining and index biopsy screening methods were used on people with high risk and followed by pathological exams for confirmation.Results The detection rates regarding mild esophageal hyperplasia,moderate and severe esophageal hyperplasia were 5.33％ (803/15 065),1.28％( 193/15 065 ),0.68％( 102/15 065 ) respectively while the detection rates on carcinoma in situ,intramucosal carcinoma and invasive cancer were 0.15％(22/15 065),0.06％(9/15 065),0.29％(43/15 065)respectively.The detection rate in male esophageal hyperplasia was higher than in female.People younger than 65 years old,the detection rates on mild,moderate or severe esophageal hyperplasia and invasive cancer showed an increase with age,with the 60- year-olds group reaching the highest.The detection rates on the above said diseases were 7.72％( 198/2565 ),2.07％(53/2565),1.29％( 33/2565 ),0.51％ ( 13/2565 ) respectively.The detection rates on mild,moderate or severe esophageal hyperplasia varied in different years and with statistically significant differences (P＜0.001) but did not show any obvious trend of changing.Geographical distribution of mild esophageal hyperplasia,moderate esophageal hyperplasia,severe esophageal hyperplasia also significantly varied in different villages (P＜0.001).The highest detection rate in the mountainous villages was seen the highest while the detection rate of village from hilly areas was the lowest.Conclusion There were considerable numbers of patients with precancerous lesions in the general population from the high risk areas.The detection rate of esophageal cancer in the mountain residents was higher than the rate in the hilly areas.Men and the elderly were the key populations calling for esophageal cancer prevention programs to be carried out.

Meta-analysis of surgical techniques for preventing Frey syndrome and a concave facial deformity after parotidectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the curative effects on surgical methods for the prevention of Frey syndrome and a concave facial deformity after parotidectomy.</p><p><b>METHODS</b>A literature search was performed using the Wianfang Database, Chinese Biomedical Literature Disk Database, Chinese Digital Hospital Library and Chinese Scientific Journals Database of VIP from January 1989 to December 2008. Twenty-six Chinese language controlled studies involving surgical techniques for prevention of Frey syndrome and the concave facial deformity after parotidectomy were identified. Review manager 4.2 software was applied for Meta analysis.</p><p><b>RESULTS</b>Meta-analysis for surgical techniques to prevent symptomatic Frey syndrome, a positive starch-iodine test, and contour deformity, favored intervention with a cumulative odds ratio (OR) of 0.14 [95% confidence interval (CI), 0.07-0.25]; OR, 0.21 (95% CI, 0.17-0.26); and OR, 0.09 (95% CI, 0.04-0.19), respectively. There was a significant difference in the incidence of these complications between surgical treatment groups and control groups (Z = 6.42, Z = 13.70, Z = 6.43, all P < 0.05). The application of a sternocleidomastoid muscle flap decreased the incidence of symptomatic Frey syndrome (Z = 2.33, P < 0.05), positive starch-iodine test (Z = 7.48, P < 0.05) and contour deformity (Z = 7.78, P < 0.05). The application of acellular dermal matrix decreased the incidence of symptomatic Frey syndrome (Z = 6.02, P < 0.05) and positive starch-iodine test (Z = 5.72, P < 0.05) but did not decrease the incidence of contour deformity (Z = 1.27, P > 0.05).</p><p><b>CONCLUSIONS</b>Meta-analysis of operative techniques to prevent symptomatic Frey syndrome, a positive starch-iodine test, and facial asymmetry suggests that such methods are likely to reduce the incidence of these complications and improve the quality of life after parotidectomy.</p>