Long-Term Efficacy of Ethanol Ablation as Treatment of Metastatic Lymph Nodes From Papillary Thyroid Carcinoma.

CONTEXT: Ethanol ablation (EA) is considered an alternative to surgery for metastatic lymph nodes from papillary thyroid carcinoma (PTC) in selected patients. OBJECTIVE: The aim of this study was to evaluate the long-term efficacy and safety of this treatment. DESIGN AND SETTING: Adult patients with PTC who had received EA in lymph node metastasis at a tertiary referral center, and were included in a published study from 2011, were invited to participate in this follow-up study. METHODS: Radiologic and medical history were reviewed. Ultrasound examination of the neck was performed by radiologists, and clinical examination was performed by an endocrine surgeon. Response was reported according to predefined criteria for satisfactory EA treatment. Adverse events associated with EA were evaluated. Cause of death was reported for deceased patients. RESULTS: From the 2011 study, 51 of 63 patients were included. Forty-four patients were reexamined (67/109 lesions) and 7 patients were deceased. Median follow-up time from primary surgery was 14.5 years. Median follow-up from the latest performed EA in the 2011 study was 11.3 years. Local control was permanently achieved in most patients (80%). Recurrence within an ablated node was registered in 13 metastases in 10 patients. Seven of these patients also had recurrent disease elsewhere in the neck. No major side effects were reported. CONCLUSION: EA is a minimally invasive procedure with a low risk of complications. Our data suggest that EA is a safe and efficient treatment, providing excellent results for a large group of patients in the long term.

Outcome and quality of life in patients operated on with radical cystectomy and three different urinary diversion techniques.

OBJECTIVE: To assess outcome and quality of life (QoL) aspects among patients treated with three different diversion techniques: Bricker, Studer or Hemi-Kock, after radical cystectomy. MATERIAL AND METHODS: Thirty-seven patients with Bricker conduit, 19 with Studer neobladder and 16 with Hemi-Kock neobladder answered a questionnaire concerning QoL, general health, relationship with partner, sexual function, satisfaction with information and follow-up, etc. Response rates were 79% (37/47), 100% (18/18) and 86% (19/22), in Bricker, Studer and Hemi-Kock patients respectively. Medical records were reviewed to assess cancer type, grade and stage. RESULTS: Both Studer and Bricker patients reported a high mean value of QoL (p>0.05). QoL was not influenced by tumour stage (pTa-T2 versus pT3-4) (p>0.05). After surgery, more Studer patients (78%) experienced practical problems compared with Bricker patients (40%) (p=0.01). Studer patients reported a higher influence on the everyday life compared with Bricker and Hemi-Kock patients (p<0.01 and p=0.05, respectively). Leakage in day-time was reported by 53% of Studer patients and 16% of Hemi-Kock patients (p=0.03). Moreover, all Studer patients had leakage at night compared with 58% of Hemi-Kock (p<0.01). The follow-up time after surgery was 56 months for Hemi-Kock patients compared with 26 months for Studer patients. Erectile dysfunction was reported by 81% of the men, with no difference between the methods of diversion. CONCLUSIONS: Patients in all diversion groups rated their QoL as high. Type of urinary diversion was not associated with any statistically significant difference in QoL outcome. However, Studer patients reported less favourable outcome regarding urinary continence compared with Hemi-Kock patients, probably owing to factors as shorter follow-up and surgical skill and experience. The results regarding urinary continence may explain why Studer patients reported more practical problems and a higher influence on their everyday life than Bricker and Hemi-Kock patients.