The association between thyroid malignancy and chronic lymphocytic thyroiditis: should it alter the surgical approach?

BACKGROUND: The relation between thyroid neoplasms and chronic lymphocytic thyroiditis (CLT) is controversial. While it is accepted that focal lymphocytic thyroiditis develops secondarily to malignancy, it is not clear whether diffuse lymphocytic thyroiditis has a tendency to develop into thyroid cancer. The aim of this study was to investigate the relation between CLT and malignant tumours of the thyroid and evaluate the surgical approach to CLT cases. MATERIAL AND METHODS: In this study, 917 patients operated on for thyroid diseases were investigated retrospectively. Seventy-seven (8.4%) patients histopathologically diagnosed as having CLT (either non-specific or Hashimoto's thyroiditis) were investigated for any concurrent malignant neoplasm. Fifteen patients in whom CLT and thyroid malignancy were coexisting were included in the study. RESULTS: In the pathological evaluation of 917 cases, malignancy in the thyroid was found in 97 (10.6%) cases. Seventy-seven cases were categorised as CLT. Of these 77, 16 (20.8%) were Hashimoto's thyroiditis (specific CLT) and the other 61 (79.2%) were non-specific CLT. In 15 cases, thyroid malignancy was found to be concurrent with CLT. Of the malignities, nine (60%) were papillary carcinoma, three (20%) medullar carcinoma, one (6.6%) follicular carcinoma, one (6.6%) Hurthle cell carcinoma, and one (6.6%) lymphoma. In our series, the rate of the development of malignancy against the background of CLT was 19.48%, while the rate in the groups without CLT was 9.76%, with a statistically significant difference between the groups (p = 0.008). CONCLUSIONS: CLT cases should be evaluated more carefully in terms of malignancy. If a nodule is detected on thyroiditis, the minimal surgical intervention should be lobectomy. Total thyroidectomy should be considered as preferable to subtotal thyroidectomy because of its many advantages such as controlling thyroiditis, removing the probability of reoperation, and hormonal stability.

Sexual dysfunction after curative radical resection of rectal cancer in men: the role of extended systematic lymph-node dissection.

BACKGROUND: This study was designed to determine the incidence and patterns of sexual dysfunction after curative radical resections (CRR) with or without extended systematic lymph-node dissection (ESLND) for rectal cancer Material/Methods: A total of 91 patients with rectal cancer were reviewed with respect to surgical procedures and postoperative sexual functions using the International Index of Erectile Function (IIEF), a 15-item self-administered questionnaire. CCR (abdomino-perineal resections or sphincter-saving anterior resections) was performed in 78 patients (Group I) and ESLND plus CRR in 13 patients (Group II), and sexual functions were also evaluated in the colostomy and non-colostomy subgroups. RESULTS: In the postoperative period, the five domains of IIEF scoring decreased significantly from the preoperative scores in both groups (p<0.05), but the postoperative decreases were not significant between groups I and II (p>0.05). Having a permanent colostomy decreases IIEF scores in all colostomized patients. CONCLUSIONS: CRR and CRR+ESLND both decrease sexual function and lymph-node dissection is not considered to have any additive effect on this decrease. In addition to standard surgery, anxiety about having a malignant disease and permanent colostomy may play an important role in male sexual dysfunction.

Local recurrence and survival rates after extended systematic lymph-node dissection for surgical treatment of rectal cancer.

BACKGROUND/AIMS: Extended systematic lymph-node dissection (ESLND) is a surgical procedure aimed at decreasing the local recurrence rate of rectal cancer and increasing the survival rate. However, it is criticized because it has not shown the expected effects on survival, and it has been shown to increase the proportion of complications in rectal cancer surgery. This study was designed to determine incidence and patterns of recurrence after curative resection with or without ESLND for rectal cancer. METHODOLOGY: A total of 184 patients with rectal cancer were reviewed with respect to surgical procedures, local recurrence and survival rates. RESULTS: 170 of 184 patients with rectal cancer were administered curative surgical resection. ESLND was added to the surgical procedure of 24 of these 170 patients. The local recurrence rate of the patients who did not receive lymph-node dissection was 15%, and the survival rate over 5 years was 58.9%. The local recurrence rate of the patients receiving ESLND was 12.5%, and the survival rate over 5 years was found to be 55.7% (p>0.05). CONCLUSIONS: Because ESLND is a procedure added on to curative resection in the surgical treatment of rectal cancer, it increases the general anesthesia and length of surgery, and it is possible that some complications due to the operation itself may arise. In the current study and in a large amount of research in the literature, a statistically significant effect on the survival rate has not been found. In conclusion, the opinion has been reached that ESLND does not have an important benefit in the curative surgical treatment of rectal cancer.