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1.
Zhonghua Zhong Liu Za Zhi ; 42(3): 247-251, 2020 Mar 23.
Artigo em Chinês | MEDLINE | ID: mdl-32252205

RESUMO

Objective: To investigate the causes and influencing factors of unplanned reoperation in head and neck neoplasms. Methods: A retrospective analysis was conducted on the clinical data of the operation treated patients with head and neck neoplasm in Cancer Hospital Chinese Academy of Medical Sciences from 2016 to 2018. Results: Among 15 113 cases of head and neck neoplasms, 122 cases underwent unplanned reoperation, with an incidence of 0.81%. Unplanned reoperation mainly occurred within 24 hours after operation. The main causes of reoperation were bleeding (65.57%), lymphatic fistula (15.57%) and vascular crisis (9.84%). Sex, surgical site, grade of the first operation, grade of incision and grade of American Society of Anesthesiologists were associated with unplanned reoperations. The first surgical sites with higher probability of unplanned reoperation were tonsils (15.79%), gingiva (8.93%), oropharynx (8.33%), hypopharynx (4.79%) and tongue (3.17%), respectively. Unplanned reoperation resulted in an average expand of 121.66% in hospitalization time and 99.35% in hospitalization expenses. Conclusions: Unplanned reoperation increases hospital operating costs and patients' burden. We should pay close attention to the situation of patients within 24 hours after operation, and focus on preventing bleeding, lymphatic fistula and vascular crisis.We should make adequate preoperative evaluation and preparation for elderly male patients with high surgical grade, surgical incision and ASA grade, especially for the patients whose surgical sites were tonsil, gingiva, oropharynx, hypopharynx and tongue.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Reoperação/estatística & dados numéricos , Idoso , Perda Sanguínea Cirúrgica , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Incidência , Tempo de Internação , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
2.
Zhonghua Bing Li Xue Za Zhi ; 49(2): 129-133, 2020 Feb 08.
Artigo em Chinês | MEDLINE | ID: mdl-32074724

RESUMO

Objective: To investigate the clinicopathological characteristics, histogenesis, immunophenotypes, molecular genetic characteristics, diagnosis and differential diagnosis of calcifying fibrous tumors (CFT). Methods: A total of 32 cases of CFT (22 cases from Henan Provincial People's Hospital and 10 cases from PLA Army Medical Center) diagnosed between June 2009 and February 2019 were reviewed. The clinical and pathologic data were analyzed. Results: There were 12 male and 20 female patients, aged from 15 to 63 years (mean 40.8 years). Eleven cases occurred in stomach, four cases in retroperitoneum, four cases in ovary, two cases in scrotum, two cases in mediastinum, two cases in head and neck, one case each in thoracic cavity, lung, adrenal gland, kidney, sigmoid colon, epididymis and mesosalpinx. All the tumors were solid masses with clear boundaries. The maximal dimension of the tumors ranged from 0.6 to 10.0 cm. Microscopically, there was hypocellular stromal sclerosis and wavy storiform coarse collagen with superimposed scattered or patchy lymphocytes and plasma cells; calcification or gravel formation were also detected. Immunohistochemistry showed that spindle cells were positive for vimentin and some were positive for CD34; and they were negative for calponin, SMA, desmin, S-100 protein, SOX10, STAT6, ß-catenin, ALK, CD117, DOG1, CKpan, and EMA. No ALK rearrangement was detected by FISH in all cases. No C-KIT and PDGFRA mutation was detected in all the tested 11 cases of stomach, four cases of retroperitoneal and one case of sigmoid colon CFT. MDM2 was not amplified by FISH in all four tested cases of retroperitoneal CFT. Conclusions: CFT is a rare benign tumor of fibroblastic cell origin. The diagnosis mainly depends on histomorphologic analysis and immunophenotyping. CFT should be differentiated from other benign and malignant spindle cell mesenchymal tumors.


Assuntos
Neoplasias de Tecido Fibroso , Adolescente , Adulto , Biomarcadores Tumorais , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-kit , Neoplasias Retroperitoneais , Vimentina , Adulto Jovem
3.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 837-842, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795545

RESUMO

Objective: To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods. Methods: A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression. Results: The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively). Conclusions: Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Esôfago/cirurgia , Faringectomia/mortalidade , Faringe/cirurgia , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Neoplasias Esofágicas/sangue , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Fatores de Risco
4.
Zhonghua Zhong Liu Za Zhi ; 41(7): 535-539, 2019 Jul 23.
Artigo em Chinês | MEDLINE | ID: mdl-31357842

RESUMO

Objective: To analyze the long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery. Methods: Patients with stage Ⅲ/Ⅳ pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery during 1999 to 2000 were retrospectively analyzed. Data including concurrent chemotherapy or not, postoperative pathological diagnosis, postoperative complications, recurrence and survival were collected. Twenty patients were treated with preoperative radiotherapy while 14 patients with preoperative chemo-radiotherapy. Results: Among 31 cases of postoperative pathological diagnosed as pyriform sinus, 12 (38.7%) cases without tumor residue, 7 (22.5%) cases with severe radiation response and 12 (38.7%) cases with tumor residue. The 5-year cumulative local recurrence rate, regional recurrence rate and distant metastasis rate was 14.5%, 13.7% and 23.5%, respectively. Five-year cumulative overall survival rate and recurrence-free survival rate were 69.6% and 65.4%, respectively. Nine deaths were attributed to distant metastasis (8 cases) and regional recurrence (1 case). Conclusion: Most patients with pyriform sinus squamous cell carcinoma acquire long-term survival after treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery, and distant metastasis is the main cause of death.


Assuntos
Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Terapia Combinada/métodos , Neoplasias Hipofaríngeas/patologia , Neoplasias Hipofaríngeas/terapia , Laringe/fisiopatologia , Seio Piriforme/patologia , Radioterapia Adjuvante , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Humanos , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Faringectomia/métodos , Complicações Pós-Operatórias , Seio Piriforme/efeitos da radiação , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
6.
Artigo em Chinês | MEDLINE | ID: mdl-29902846

RESUMO

Objective: To explore whether early oral feeding after total laryngectomy is safe and effective by evaluating the incidence of pharyngocutaneous fistula (PCF) and the hospital duration. Methods: A retrospective cohort study was conducted, including 52 patients underwent total laryngectomy, plus partial tongue base resection (n=2), partial pharyngectomy (n=1), or pedicle flap (n=2) between January 2012 and October 2017. Patients who had a history of preoperative radiotherapy, chemotherapy or chemoradiotherapy, previous surgery for larynx or pharynx and who had severe complications were excluded. Early oral feeding started between 48 h and 72 h postoperatively, while delayed oral feeding started within postoperative day 8-10. The incidences of PCF in two groups were compared to evaluate whether PCF and early oral feeding was related. Multi-variables analysis was conducted to evaluate risk factors for PCF. Results: PCF rate was 19.2% among all patients, 11.1% in patients with early oral feeding and 23.5% in patients with delayed oral feeding. No significant statistically difference in PCF rate was found between two groups (χ(2)=0.506, P=0.477). Multi-variables analysis showed that oral feeding time (early or delayed) was not a independent risk factor of PCF (Two classification response variable Logistic regression, P=0.200, OR=0.242, 95%CI[0.028-2.118]). But low preoperative albumin level was observed as an independent risk factor for PCF (P=0.039, OR=0.848, 95% CI [0.726-0.992]). A negative correlation was observed between preoperative albumin level and PCF. And also there was not a significant difference in hospital duration between patients with early oral feeding and delayed oral feeding(U=268, P=0.464). Conclusion: For patients total laryngectomy with no previous history of radiotherapy, chemotherapy, chemoradiotherapy, early oral feeding after surgery is safe and effective.


Assuntos
Fístula Cutânea/epidemiologia , Ingestão de Alimentos , Fístula/epidemiologia , Laringectomia/efeitos adversos , Doenças Faríngeas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Quimiorradioterapia , Fístula Cutânea/etiologia , Fístula/etiologia , Humanos , Incidência , Neoplasias Laríngeas , Laringectomia/reabilitação , Laringe/cirurgia , Doenças Faríngeas/etiologia , Faringectomia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Pesquisa , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos
8.
Zhonghua Zhong Liu Za Zhi ; 39(10): 764-767, 2017 Oct 23.
Artigo em Chinês | MEDLINE | ID: mdl-29061021

RESUMO

Objective: To evaluate the efficacy and safety of the application of dye-tattooing under ultrasound guidance in preoperative localization of neck recurrences from thyroid cancer. Methods: Between October 2014 to September 2016, 25 patients with 34 lesions were enrolled. There were 22 cases of papillary thyroid carcinoma and three cases of medullary thyroid carcinoma, all of which could not be detected by computed tomography. Surgeons located the recurrent lesions using dye-tattooing under ultrasound guidance along with radiologist three days before the operation. Results: All lesions were successfully located (100%), 32 of which were located directly and two of which were located indirectly. Postoperative pathological examination confirmed 25 metastases of papillary thyroid carcinoma, two metastases of medullary thyroid carcinoma, and seven cases of false positives. The accuracy of ultrasound diagnosis was 79.4%. After 15 months of follow-up, neither tumor residual nor recurrences was detected according to imaging tests. Conclusions: Dye-tattooing under ultrasound guidance represents a reliable and safe method for localization of neck recurrences from thyroid cancer. The cooperation between experienced surgeons and radiologists will be crucial to successful location.


Assuntos
Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Papilar/diagnóstico por imagem , Corantes , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Tatuagem/métodos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia de Intervenção , Feminino , Humanos , Metástase Linfática , Masculino , Período Pré-Operatório , Tatuagem/efeitos adversos , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção/efeitos adversos
9.
Zhonghua Zhong Liu Za Zhi ; 39(8): 613-617, 2017 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-28835085

RESUMO

Objective: To discuss the strategy of therapeutic management of T3 supraglottic carcinoma. Methods: A retrospective analysis of 459 patients with T3 supraglottic carcinoma treated in our hospital was performed. We evaluated the results of different managements, including surgery alone, preoperative radiotherapy, postoperative radiotherapy and radiotherapy alone. The extent of the lesion was also put into analysis. Statistical analysis of the overall survival (OS), cause-specific survival (CSS), local control (LC), regional control(RC), function-conservation (FC) were performed with the statistical package from SPSS. Results: In all patients, the rates of 5-year OS, CSS, LC, RC and FC were 64.2%, 71.2%, 87.8%, 78.8% and 64.5% respectively. The OS, LC and FC of the patients treated by surgery alone, preoperative radiotherapy and postoperative radiotherapy had no significant difference, and were remarkably better than that of patients treated by radiotherapy alone (P<0.001). In 412 patients treated by surgery, 300 patients received function-conservation laryngectomy. 209 patients (50.7%, 209/412) survived and maintained well-function of larynx for 5 years, which was significantly better than those in the radiotherapy alone group (27.7%, 13/47). The patients with the lesion invading the pre-epiglottic space but limited in supraglottic area had better OS (70.2%), LC (93.5%) and FC (85.1%). The rate of 5-year neck lymphatic metastasis was 56.2%(258/459), and the 5-year OS of patients with N0, N1, N2 and N3 stage were 76.0%, 66.2%, 50.5% and 13.0% respectively. Conclusions: Surgical treatment was the best therapeutic approach for T3 supraglottic laryngeal carcinoma. Most patients with T3 lesions are suitable for function-conservation laryngectomy. Surgical procedure was determined by tumor invaded location and extension. The combined therapy of surgery and radiotherapy had no significant advantage.


Assuntos
Carcinoma/radioterapia , Carcinoma/cirurgia , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Carcinoma/mortalidade , Carcinoma/patologia , Humanos , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Laringectomia/métodos , Laringe , Metástase Linfática , Pescoço , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão , Radioterapia Adjuvante , Estudos Retrospectivos , Análise de Sobrevida
10.
Zhonghua Zhong Liu Za Zhi ; 39(8): 624-627, 2017 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-28835087

RESUMO

Objective: To investigate the value of secondary cervical lymph node dissection in papillary thyroid carcinoma (PTC). Methods: PTC patients with recurrence re-operated in a previously dissected area at our hospital during 2000-2016 were included in this analysis. Patients were divided according to the operative interval of 6 months. The level and number of lymph node metastasis and the number of lymph node dissection were analyzed to calculate the ratio of lymph node metastasis. Results: A total of 336 PTC patients received 360 side lateral cervical lymph nodes dissection. The ratio of recurrence in unilateral lateral neck is 92.9%(312/336). The ratio of recurrence in multiple levels (more than two regions) were 47.5% (171/360). The recurrence ratio of level Ⅱ, Ⅲ, Ⅳ and Ⅴ were 55.6%(200/360), 44.2%(159/360), 59.7%(215/360) and 10.3%(37/360), respectively. Lymph node metastases were inclined to level Ⅱ (33.6%) and Ⅳ (35.8%). The mean number of lymph node dissection and metastasis in the group of operative interval ≤ 6 months was 26.56 per case and 4.37 per case, respectively. The mean number of lymph node dissection and metastasis in the group of operative interval >6 months was 16.80 per case and 3.20 per case, respectively. The number of lymph node dissection and metastasis between these two groups were significantly different (P=0.001, P<0.001). Conclusions: Lymph node metastasis of PTC patients with secondary cervical lymph node dissection are inclined to level Ⅱ and level Ⅳ. Moreover, multi-level metastasis is not rare. Level Ⅱ and level Ⅳ require more attention in the first operation. Most of the patients undergo reoperation because of residual lymph nodes from the previous treatment. Normalization and completeness of the initial dissection are particularly important to PTC patients.


Assuntos
Carcinoma Papilar/patologia , Linfonodos/patologia , Esvaziamento Cervical , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/cirurgia , Humanos , Linfonodos/cirurgia , Metástase Linfática , Pescoço , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Reoperação , Neoplasias da Glândula Tireoide/cirurgia
12.
Artigo em Chinês | MEDLINE | ID: mdl-28635212

RESUMO

Objective: To analyse the postoperative metastasis or recurrence of cervical lymph nodes in individual neck levels for papillary thyroid carcinoma and to evaluate the outcomes and complications of re-surgery. Methods: A retrospective cohort study of 259 patients who underwent lymph node dissection for PTC relapse from January 2010 to June 2011. Lymph node metastases in each of neck levels were detected, postoperative complications were evaluated, and the patients were followed up with examining thyroglobulin levels to assess the therapeutic effect.Continuous variables were compared with t test.Categorical variables were compared with Fisher's exact test. Results: Lymph node metastasis was found in 259 cases and lymph node metastasis rates in levels Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ were 43.2%, 50.2%, 45.6%, 8.1% and 59.1% respectively. In 44 cases received the neck dissection of level Ⅱ, the metastasis rates in the levels Ⅱa and Ⅱb were respectively (52.3% vs 18.2%, P=0.887). Recurrence in unilateral lateral neck was more common than that in bilateral lateral neck (73.1% vs 20.6%, P<0.001). The lymph nodes in lateral neck were more likely to metastasize than those in central region (80.7% vs 59.1%, P<0.001). There were 47 cases (18.1%) had postoperative complications, including 10 cases with permanent hypocalcemia. Conclusions: The scope of re-operation for neck metastasis or recurrence in papillary thyroid carcinoma should include the dissection of levels Ⅱ-Ⅳ and Ⅵ. The incidence of postoperative complications for re-surgery is high, and re-surgery should be performed by experienced surgeon.


Assuntos
Carcinoma Papilar/cirurgia , Linfonodos/patologia , Esvaziamento Cervical , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Neoplasias da Glândula Tireoide/cirurgia , Carcinoma Papilar/sangue , Carcinoma Papilar/patologia , Feminino , Humanos , Hipocalcemia/etiologia , Metástase Linfática , Masculino , Pescoço , Recidiva Local de Neoplasia/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/patologia
13.
Artigo em Chinês | MEDLINE | ID: mdl-28441802

RESUMO

Objective: To analyze the incidences of complications after central compartment reoperation for recurrent/persistent differentiated thyroid cancer, and to investigate the safety and feasiblity of central compartment reoperation. Methord: A total of 109 patients who underwent central compartment reoperation for recurrent/persistent differentiated thyroid cancer from January 1, 2011 to March 31, 2016 in Cancer Hospital, Chinese Academy of Medical Sciences was analysed retrospectively, and the incidences of reoperation-related complications were evaluated. Results: Among 109 patients, only 10 (9.2%) patients were treated initially in our hospital and remaining patients (90.8%) treated initially in the other hospitals. Surgical approaches for thyroid beds: 61 patients (56.0%) underwent supplemented total thyroidectomy, 3 patients (2.8%) for removal of recurrent thyroid cancer, 2 patients (1.8%) with supplemented total thyroidectomy and removal of recurrent thyroid cancer, and 12 cases (11.0%) had bilateral thyroid lobectomy. Central compartment lymph node dissection: 66 patients (60.6%) underwent bilateral central neck dissection, 40 patients (36.7%) with unilateral central neck dissection. A total of 16 patients (14.7%) had complications. Transient and permanent vocal fold paralysis developed in 9(8.3%) and 2(1.8 %) patients, respectively. Transient and permanent hypoparathyroidism occurred in 2(1.8%) patients and 11 patients (10.1%), respectively. Postoperative bleeding happened in 1 patient (0.9%). with follow-up from 7 to 61 month, median follow-up was 17.2 months. All patients survived, with recurrence in 3 (2.8%) patients. Conclusions: It seems the incidences of complications for thyroid carcinoma reoperation in central compartment is low for the experienced surgeon. The reoperation was safe and feasible.


Assuntos
Adenocarcinoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Feminino , Humanos , Hipoparatireoidismo/etiologia , Masculino , Esvaziamento Cervical , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tireoidectomia/efeitos adversos , Tireoidectomia/estatística & dados numéricos , Paralisia das Pregas Vocais/etiologia
14.
Zhonghua Zhong Liu Za Zhi ; 39(3): 207-210, 2017 Mar 23.
Artigo em Chinês | MEDLINE | ID: mdl-28316221

RESUMO

Objective: To investigate the value of jugulo-omohyoid lymph nodes (JOHLN) in predicting occult lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC). Methods: The clinicopathological data of 136 out of 2 100 PTC patients, who had a high risk of lateral neck lymph node metastasis and treated by us from January 2010 to December 2015, were retrospectively analyzed. Super selective neck dissection (SSND, level Ⅲ and Ⅳ)was performed and JOHLNs were sent for frozen section in all the 136 cases. The clinicopathological data was analyzed and the significance of JOHLN in predicting lateral cervical LNM was calculated using the SPSS software package. Results: Of the 136 patients, total thyroidectomy was performed in 76 cases (55.9%) and unilateral lobectomy plus isthmus was performed in the other 60 cases (44.1%). SSND was performed in 72 patients (52.9%), level Ⅱ-Ⅳ dissection in 15 (11.0%), and level Ⅱ-Ⅴ dissection in 49 (36.0%). According to the pathological results, 38 patients were pN0(27.9%), 18 (13.2%) were pN1a and 80 (58.8%) were pN1b. The lymph node metastasis(LNM) rates at level Ⅱ-Ⅵ were 19.9%, 43.4%, 42.6%, 2.9%, and 59.6%, respectively. The sensitivity, specificity and accuracy of JOHLN in predicting lateral neck metastasis were 58.8%, 62.9%, and 76.7%, respectively. The rates for predicting level Ⅱ metastasis were 81.5%, 43.2%, and 59.4%, respectively. None of the patients died in the follow-up. Only 1 recurrence was found in level Ⅱ and regional control was achieved after level Ⅱ and Ⅴ dissection. Conclusions: JOHLN has a high accuracy for predicting lateral cervical lymph node metastasis and high sensitivity for level Ⅱ metastasis. For patients with high risk of lateral cervival metastasis, super-selective neck dissection including level Ⅲ and Ⅳ can confirm the stage and reduce the risk of reoperation. Dissection for level Ⅱ, Ⅲ, and Ⅳ is recommended.


Assuntos
Carcinoma Papilar/secundário , Linfonodos/patologia , Esvaziamento Cervical/métodos , Neoplasias da Glândula Tireoide/patologia , Feminino , Secções Congeladas , Humanos , Metástase Linfática , Masculino , Pescoço , Estudos Retrospectivos , Sensibilidade e Especificidade , Tireoidectomia
15.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 51(10): 740-745, 2016 Oct 07.
Artigo em Chinês | MEDLINE | ID: mdl-27765102

RESUMO

Objective: To analyze the clinical results of gastric pull-up reconstruction following total pharyngoesophagectomy. Methods: A total of 90 patients with hypopharyngeal or cervical esophageal cancinoma who underwent gatric pull-up reconstruction after pharyngoesophagectomy between June 2006 and June 2015 were reviewed retrospectively. Clinical data were analyzed. Rates of survival, recurrence and complicates were calculated with SPSS software. Results: Of 90 patients, 8 patients had hypopharyngeal cancinoma invading cervical esophagus, 51 patients had cervical esophageal carcinoma, and 31 patients had hypophageal and esophageal multiple parimary carcinomas. Forty patients were treated with surgery alone, 29 patients with planned surgery, and 21 patients with salvage surgery. After follow up of 6-104 months with a median of 22 months, 54 patients died and the total 3-year survival rate was 36.3%. Seventeen patients developed local recurrences and 10 patients cervical or mediastinal lymph node metastasis (LNM). The 3-year survival rates of patients with and without recurrence or LNM were respectively 5.9%, and 45.7% (χ2=11.564, P=0.001). Twenty-three patients developed distant metastasis. The 3-year survival rate of patients with and without distant metastasis were respectively 22.9% and 41.8% (χ2=4.534, P=0.033). Multivariate analysis showed local recurrence and distant metastasis as predictors for poor survival. The rates of perioperative mortality and anastomotic fistula were 3.3% (3/90) and 13.3%(12/90), respectively. Conclusions: Gastric pull-up reconstruction is a relatively safe and effective method for esophageal reconstruction after removal of hypopharyngeal or cervical esophageal carcinoma. Some patients could achieve good survival with low mortality and acceptable morbidity after multidisciplinary treatments.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esôfago/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estômago/cirurgia , Idoso , Carcinoma de Células Escamosas/mortalidade , Neoplasias Esofágicas/mortalidade , Esofagectomia , Feminino , Humanos , Neoplasias Hipofaríngeas/mortalidade , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Faringectomia , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Terapia de Salvação , Taxa de Sobrevida
16.
Artigo em Chinês | MEDLINE | ID: mdl-27480304

RESUMO

OBJECTIVE: To evaluate the relationship between different RET mutations and the aggressiveness of hereditary medullary thyroid cancer (HMTC) or the presentation of other endocrine disorders in patients with multiple endocrine neoplasia type 2 (MEN2). METHODS: A total of 73 thyroid medullary carcinoma patients from 22 Chinese kindreds who were treated in our center from 2010 to 2015 were enrolled. RET genes in the patients and their relatives were screened. RESULTS: According to the clinical data and 2015 American Thyroid Association (ATA) guidelines, patients were classified into 3 RET mutation risk groups: Modest, 24 cases; High, 48 cases; and Highest, 1 case. Multivariate analysis showed an increased likelihood of MTC stage III or IV at diagnosis with increasing of age and risk. The likelihood increased 11.6% per year of age at surgery (95% confidence interval, 1.040-1.198; P=0.002). The likelihood in patients with high risk was 7.9 times higher than patients with modest risk (95% confidence interval, 1.607-38.717; P=0.003). Aside from one patient with MEN2B, other 72 patients were MEN2A, of them, 28 cases from 7 kindreds with classical MEN2A (codon 634 & 618), 14 cases from 3 kindreds with cutaneous lichen amyloidosis (codon 634), 4 cases from 1 kindred with Hirschsprung's disease (codon 620), and 26 cases from 10 kindreds with familial MTC. CONCLUSION: The aggressiveness of HMTC and the presentation of other endocrine diseases are related to specific RET mutations. For RET mutation carriers, MTC and other endocrine diseases should be diagnosed and treated early based on the RET genotypes.


Assuntos
Carcinoma Medular/congênito , Genótipo , Neoplasia Endócrina Múltipla Tipo 2a/genética , Mutação , Fenótipo , Proteínas Proto-Oncogênicas c-ret/genética , Neoplasias da Glândula Tireoide/genética , Grupo com Ancestrais do Continente Asiático , Carcinoma Medular/genética , Estudos de Associação Genética , Humanos , Neoplasia Endócrina Múltipla Tipo 2a/classificação , Neoplasia Endócrina Múltipla Tipo 2a/complicações , Neoplasia Endócrina Múltipla Tipo 2b/genética , Análise Multivariada
17.
Zhonghua Yi Xue Za Zhi ; 96(1): 53-7, 2016 Jan 05.
Artigo em Chinês | MEDLINE | ID: mdl-26792609

RESUMO

OBJECTIVE: To systematically evaluate the security of hormone replacement therapy (HRT) among postoperative patients with endometrial carcinoma (EC). METHODS: A systematic review and Meta-analysis of studies on security of HRT among EC patients after operation was done by Revman 5.2 software. Studies were mainly searched from the CENTRAL, Medline, Embase, Ovid, Wanfang, CNKI databases. RESULTS: A total of 7 studies with 2 038 stageⅠand stageⅡ endometrial carcinoma patients were included. The quality of 6 studies included were medium, and 1 study was high. The endometrial carcinoma patients on HRT did not have a statistically increased incidence in the EC recurrence (RR=0.69, 95%CI (0.42-1.15), P=0.16) and cancer-induced death (RR=0.55, 95%CI (0.25-1.21), P=0.14). Subgroup analysis for the start of HRT within 6 months from time of surgery group and only estrogen replacement therapy group found no statistical different in the risk of the EC recurrence and cancer-induced death, compared with control group. No statistically increased risk of the EC recurrence was observed for estrogen plus progestin replacement therapy group. CONCLUSION: There is no statistical difference in the recurrence rate and cancer-induced death rate of EC whether the early stage postoperative patients used HRT or not.


Assuntos
Neoplasias do Endométrio , Terapia de Reposição de Estrogênios , Feminino , Humanos , Recidiva Local de Neoplasia , Período Pós-Operatório
18.
Eur J Gynaecol Oncol ; 37(4): 517-521, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-29894077

RESUMO

OBJECTIVE: The aim of this study was to explore a panel of useful markers in differential diagnosis of primary endocervical adenocarcinoma (ECA) and endometrial adenocarcinoma (EMA). Materials anid Methods: Thirty-three ECAs and 31 EMAs were collected and examined for high-risk human papillomavirus (hr-HPV) (16/18) DNA using in situ hybridization, and for p16, vimentin, ER, PR expression using immunohistochemistry (IHC). RESULTS: Detection rate of hr-HPV (16/18) DNA in ECA (72.7%, 24/33) was significantly higher than that in EMA (12.9%, 4/31) (p < 0.01). Twenty-four of 33 (72.7%) cases of ECA, but only five of 31 (16.1%) cases of EMA showed high expression of pl6. Twenty-three of 24 (95.8%) hr-HPV DNA-positive ECA and all four (100.0%) hr-HPV DNA-positive EMA showed high levels of pl6 expression. High expression rates of vimentin (90.3%, 28/31), ER (58.1%, 18/31), and PR (71.0%, 22/31) in EMA were significantly higher than those in ECA, respectively (p < 0.01). CONCLUSION: Detection of hr-HPV DNA combined with immunohistochemical expressions of pl6, vimentin, ER, and PR have important value in differential diagnosis between ECA and EMA.


Assuntos
Adenocarcinoma/diagnóstico , Biomarcadores Tumorais/análise , Inibidor p16 de Quinase Dependente de Ciclina/análise , Neoplasias do Endométrio/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Vimentina/análise , Adenocarcinoma/química , Neoplasias do Endométrio/química , Feminino , Humanos , Imuno-Histoquímica , Neoplasias do Colo do Útero/química
19.
Int J Oral Maxillofac Surg ; 41(8): 958-64, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22579955

RESUMO

Primary salivary gland-type carcinomas of the nasopharynx (SNPC) are a rare malignancy with diverse clinical behaviour and different prognoses. Previous studies have reported on limited patient populations, and few long-term studies have outlined outcomes and prognostic factors. Controversy exists regarding the treatment policy for SNPC. The aim of this study was to define management approaches, therapeutic outcomes, and prognostic factors for SNPC. The medical records of 54 patients with SNPC at one institution between 1963 and 2006 were reviewed. Patient records were analysed for management approaches, outcomes, and prognostic factors. After a median follow-up of 61.3 (1.8-245.2) months, the 2-, and 5-year overall survival rates (OS), loco-regional failure free survival rates (LRFFS) and distant failure free survival rates (DFFS) were 84.6% and 61.3%, 74.4% and 55.4%, and 92.0% and 70.0%, respectively. Multivariate analyses indicated that lymph node metastases, date of treatment, and surgical treatment were independent factors for DFFS, whereas histological subtypes and distant metastases were independent factors affecting OS. The optimal treatment policy for patients with SNPC might be surgery plus radiotherapy.


Assuntos
Carcinoma/terapia , Neoplasias Nasofaríngeas/terapia , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Adenocarcinoma/terapia , Adulto , Idoso , Carcinoma/secundário , Carcinoma/cirurgia , Carcinoma Adenoide Cístico/secundário , Carcinoma Adenoide Cístico/cirurgia , Carcinoma Adenoide Cístico/terapia , Carcinoma Mucoepidermoide/secundário , Carcinoma Mucoepidermoide/cirurgia , Carcinoma Mucoepidermoide/terapia , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/secundário , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/cirurgia , Terapia Neoadjuvante , Gradação de Tumores , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias das Glândulas Salivares/patologia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
20.
Cancer Radiother ; 16(3): 179-82, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22521871

RESUMO

PURPOSE: This study was to evaluate the influence of radiotherapy on the selenium serum levels of non-small cell cancer patients with brain metastases. PATIENTS AND METHODS: This prospective study included 95 non-small cell cancer patients with brain metastases treated by radiotherapy from December 2007 until November 2010. Plasma selenium levels were determined before and at the end of the radiotherapy. Age, body mass index (BMI), prior chemotherapy, pathological type and personal habits (smoking and alcoholism) were recorded for each patient. RESULTS: The mean age was 63 years; the mean BMI was 27.6. Seventy-six patients (80%) were non-smokers. Sixty-two patients (65.3%) showed no drinking habits and 8 (8.4%) have no prior chemotherapy. Thirty-nine patients (41.1%) were adenocarcinoma, 51 (53.7%) were squamous cell carcinoma and five (5.3%) were large cell carcinoma. At the beginning of radiotherapy, the mean selenium level for all patients was 90.4 µg/l and after radiation this value dropped to 56.3 µg/l. Multivariate analysis showed statistically significant difference in the plasma selenium concentration before and after radiotherapy for age (P<0.001), BMI (P<0.001), smoking (P<0.001), alcoholism (P<0.001), prior chemotherapy (P<0.001) and pathological type (P<0.001). CONCLUSION: Significant reduction in plasma levels of selenium was recorded in patients undergoing radiotherapy, suggesting attention to the nutritional status of this micronutrient and other antioxidant agents.


Assuntos
Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/secundário , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Pulmonares , Selênio/sangue , Adenocarcinoma/sangue , Adenocarcinoma/radioterapia , Adenocarcinoma/secundário , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/sangue , Índice de Massa Corporal , Neoplasias Encefálicas/radioterapia , Carcinoma de Células Grandes/sangue , Carcinoma de Células Grandes/radioterapia , Carcinoma de Células Grandes/secundário , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma de Células Escamosas/sangue , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/secundário , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Fumar/sangue
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