A Nationwide Survey to Assess the Practices and Patterns of Use of Intraoperative Nerve Monitoring During Thyroid Surgery Among Surgeons in India.

There is still equipoise for the routine use of intraoperative nerve monitoring (IONM) for thyroid surgeries; however, some surgeons tend to use it for various reasons. In our study, we did a national survey to assess the patterns and practice of the use of IONM among surgeons during thyroid surgery in India. A questionnaire survey was sent to surgeons (head and neck surgical oncologists, general surgical oncologists, endocrine surgeons and otolaryngologists) in different zones in India via email, and their responses were analysed. One hundred and one responses were received. The majority of the respondents were head and neck surgical oncologists (n = 56, 55.4%). Forty-three (42.6%) respondents used IONM during thyroid surgeries in this survey. Surgeons with ≤ 15 years of experience performing thyroid surgeries (p = 0.02) and surgeons performing > 50 thyroid surgeries also tended to use IONM. Mostly IONM was used for surgeries on thyroid malignancies (p = 0.016). The respondents used IONM for more than one reason such as medicolegal purposes and surgeon comfort among others. IONM was most often used during redo surgeries (n = 46, 45.5%) and in patients with already one fixed cord (n = 39, 38.6%). The majority felt IONM was not cost-effective (n = 53, 52.5%). The use of IONM during thyroid surgery in our survey was nearly 43%. It was used mostly for surgery for thyroid malignancies, and it was found to be used for more than one reason and indications such as redo surgeries (most commonly). Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-023-01818-5.

Sentinel lymph node biopsy in early oral cancers: are we ready for it yet? Results from a survey among Indian surgeons treating oral cancers.

OBJECTIVE: Emerging evidence has shown that sentinel node biopsy (SNB) is an oncologically safe option in patients with early oral cancer compared with elective neck dissection (END). However, its use on a routine basis could be associated with many challenges. STUDY DESIGN: This online survey was conducted among the Indian surgeons treating patients with oral cancer to understand and comprehend the incidence and patterns of usage of SNB in their practice, their approach toward the use of SNB, and the possible challenges they face or perceive in its routine use in patients with early oral cancer. RESULTS: We received 352 responses with a response rate of 47.63%. Most of the respondents (82.6%) were managing N-zero necks with END, only 15.1% (n = 53) respondents practiced SNB currently. Most respondents believed that SNB offered the advantage of better shoulder function compared with END (76.4% [n = 269]). The deterrents considered for routine use of SNB in early oral cancer were additional costs (71.9% [n = 253]), the unavailability of necessary expertise and infrastructure (87.2% [n = 307]), SLNB being a more time-consuming treatment (58.8% [n = 207]), a higher false negative rate (74.1% [n = 261]), and the possible need of a second surgery (82.4% [n = 290]). CONCLUSIONS: Though SNB presently could be considered as an alternative treatment option, there seem to be various issues that need to be addressed before it can be adopted as a standard of care across centers.

Molecular markers in well-differentiated thyroid cancer.

PURPOSE: Thyroid nodules are of common occurrence in the general population. About a fourth of these nodules are indeterminate on aspiration cytology placing many a patient at risk of unwanted surgery. The purpose of this review is to discuss various molecular markers described to date and place their role in proper perspective. This review covers the fundamental role of the signaling pathways and genetic changes involved in thyroid carcinogenesis. The current literature on the prognostic significance of these markers is also described. METHODS: PubMed was used to search relevant articles. The key terms "thyroid nodules", "thyroid cancer papillary", "carcinoma papillary follicular", "carcinoma papillary", "adenocarcinoma follicular" were searched in MeSH, and "molecular markers", "molecular testing", mutation, BRAF, RAS, RET/PTC, PAX 8, miRNA, NIFTP in title and abstract fields. Multiple combinations were done and a group of experts in the subject from the International Head and Neck Scientific Group extracted the relevant articles and formulated the review. RESULTS: There has been considerable progress in the understanding of thyroid carcinogenesis and the emergence of numerous molecular markers in the recent years with potential to be used in the diagnostic algorithm of these nodules. However, their precise role in routine clinical practice continues to be a contentious issue. Majority of the studies in this context are retrospective and impact of these mutations is not independent of other prognostic factors making the interpretation difficult. CONCLUSION: The prevalence of these mutations in thyroid nodule is high and it is a continuously evolving field. Clinicians should stay informed as recommendation on the use of these markers is expected to evolve.

Retiform hemangioendothelioma over forehead: A rare tumor treated with chemoradiation and a review of literature.

Retiform hemangioendothelioma (RH) is low grade tumor of skin and subcutaneous tissue. It needs to be differentiated from angiosarcoma as RH has excellent prognosis. It is usually seen in young adults on extremities. Sometimes it may mimic benign conditions and can delay treatment. Surgery has been mainstay of its treatment with or without adjuvant radiation. We present first case of RH on face. This is only second case being treated with definitive chemoradiation. So it's important to distinguish RH from angiosarcoma due to treatment implications as well.

Small-molecule inhibition of oncogenic eukaryotic protein translation in mesothelioma cells.

Deranged cap-mediated translation is implicated in the genesis, maintenance and progression of many human cancers including mesothelioma. In this study, disrupting the eIF4F complex by antagonizing the eIF4E-mRNA-cap interaction is assessed as a therapy for mesothelioma. Mesothelioma cells were treated with 4Ei-1, a membrane permeable prodrug that when converted to the active drug, 7-benzyl guanosine monophosphate (7Bn-GMP) displaces capped mRNAs from the eIF4F complex. Colony formation was measured in mesothelioma treated with 4Ei-1 alone or combined with pemetrexed. Proliferation was examined in cells treated with 4Ei-1. Binding to a synthetic cap-analogue was used to study the strength of eIF4F complex activation in lysates exposed to 4Ei-1. 4Ei-1 treatment resulted in a dose dependent decrease in colony formation and cell viability. Combination therapy of 4Ei-1 with pemetrexed further reduced colony number. Formation of eIF4F cap-complex decreased in response to 4Ei-1 exposure. 4Ei-1 is a novel prodrug that reduces proliferation, represses colony formation, diminishes association of eIF4F with the mRNA cap, and sensitizes mesothelioma cells to pemetrexed.

Prospective study of 583 neck dissections in oral cancers: implications for clinical practice.

BACKGROUND: Determining the level of nodal metastases may help decrease the extent of neck dissections and reduce morbidity. METHODS: A prospective study of neck dissections in patients with oral cancer was conducted. Each nodal level was delineated, sent for histopathology, and reported level-wise. Incidence of overall and isolated metastatic nodes at different levels was calculated. Logistic regression was used to find factors predicting metastases to levels IIB and V. RESULTS: Five hundred eighty-three neck dissections were prospectively evaluated. A total of 95.7% metastases occurred at levels I to IV. Overall incidence of metastases to levels IIB and V was 3.8% and 3.3%, respectively. Multivariate analysis revealed IIA positivity as an independent predictive factor for metastases to both IIB and V. CONCLUSION: This study of lymph node mapping in patients with oral cancer showed a predictable pattern of lymph node metastasis according to primary site. Selective neck dissection (levels I-IV) in patients with oral cancers may be adequate. Determining status of level IIA is important to guide dissection of levels IIB and V.

Practice of laryngectomy rehabilitation interventions: a perspective from India.

PURPOSE OF REVIEW: Total laryngectomy remains the treatment for a significant number of locally advanced cancers (T4) or as a salvage procedure following failure of chemoradiotherapy. Loss of natural voice is the most important disadvantage of this surgery, and impacts quality of life. In the past few decades, there has been emphasis on rehabilitative efforts after laryngectomy. Laryngectomy rehabilitation is practiced globally, and is subject to regional problems and constraints. This calls for better understanding of experiences of differing geographical regions, and the impact of the local socioeconomic conditions on post-laryngectomy rehabilitation. RECENT FINDINGS: Current world literature focuses on advances in voice prosthesis, which would lead to better rehabilitation as well as improve the life of prostheses. The current review focuses on voice rehabilitation post-laryngectomy: the existing world literature, and how it has impacted prosthetic voice rehabilitation in India, within the local constraints. SUMMARY: The practice of prosthetic voice rehabilitation is well established in the Indian scenario, with results favorably comparing to world literature. However, few centers have the expertise and support staff to implement an effective post-laryngectomy rehabilitative program. There is need for assessment in a structured manner of outcomes and economic benefits of post-laryngectomy rehabilitation.

Minor salivary gland tumors of the sinonasal region: results of a retrospective analysis with review of literature.

BACKGROUND: Minor salivary gland tumors of the sinonasal region are rare. Minor salivary gland tumors of this region behave differently from other subsites in the head and neck. The objective of our study was to analyze the survival and prognostic factors in patients with minor salivary gland tumors of the sinonasal region. METHODS: We carried out a retrospective review of patients with minor salivary gland tumors of the sinonasal region. All slides were reviewed by an independent pathologist. Survival was analyzed using the Kaplan-Meier method and Cox multivariate regression to identify prognostic factors. RESULTS: In all, 163 patients were identified from our registry. The 5-year disease-free and overall survival rates were 48.3% and 83.3%, respectively. Tumor grade, nodal status, and adjuvant radiotherapy were significant predictors of disease-free survival (DFS), on multivariate analysis. CONCLUSIONS: Minor salivary gland tumors have a good overall survival in spite of high recurrence rates. Tumor grade, nodal status, and adjuvant radiotherapy are independent predictors of DFS.

Pediatric thyroid cancers: an Indian perspective.

Pediatric thyroid cancer is a rare entity accounting for less than 5% of all thyroid cancers. This intriguing disease is characterized by advanced presentation, coupled with frequent lymph nodal metastases and often pulmonary metastases. It perhaps exhibits a distinct biology and behaviour, because in spite of its aggressiveness, survival is extremely good. This mandates meticulous treatment decisions that are well executed, because the complications of therapy in patients with good survival may spell prolonged morbidity. Being an unusual disease, it is unlikely that level I evidence guiding the management will come forth. There have been controversies regarding management, and the current consensus comes from large prospective studies. There have been only a few studies from India detailing pediatric thyroid cancers. In the current discussion, we review the existing evidence about pediatric thyroid cancers, and try to have an Indian perspective at the problem.

Benign jaw tumors.

The jaw bones may develop the same types of tumors as the other bones of the body but may also develop tumors arising from the alveolar processes (epulis) and the developing teeth (odontomes). They are usually benign in nature and can affect the functions of mastication, swallowing and cause facial deformity. They make about 3% of all bone tumors with a tendency for a local recurrence if a wide excision is not contemplated at the first attempt. Local destruction caused by the tumor can mimic a malignancy; however with imaging we can get a fair idea about the treatment planning. We present a series of 6 cases of such nature for their variety, diagnostic challenge they posed and different reconstruction methods used for better cosmesis.