Gland surgery最新文献

Background: Extrathyroidal extension (ETE) and lymph node metastasis (LNM) are significant factors influencing the prognosis of papillary thyroid carcinoma (PTC). However, their relationship remains controversial. This study explores the connection between ETE and LNM by using propensity score matching (PSM) to guide individualized treatment.

Methods: A retrospective analysis was conducted on 1,045 PTC patients who underwent surgery between January 2023 and June 2024. PSM at a 1:1 ratio was used to balance confounding factors based on univariate and multivariate analyses to investigate the relationship between ETE and LNM.

Results: Among the 1,045 patients, 55.8% had LNM, and 16.1% had ETE. Univariate analysis showed that male sex, age <45 years, tumor size ≥8 mm, ETE, and multifocal were associated with LNM (P<0.05). Multivariate analyses identified male sex, age <45 years, tumor size ≥8 mm, and multifocal as independent risk factors for LNM (P<0.05). After PSM in the present data set, the difference in LNM rates between ETE and non-ETE groups did not reach statistical significance (P>0.05). Similarly, the relationship between LNM and ETE was analyzed. Univariate analysis showed that age <45 years, tumor location, tumor diameter ≥8 mm, multifocal and LNM were risk factors for ETE (P<0.05). Multivariate analysis indicated that age <45 years, tumor located at the isthmus, tumor diameter ≥8 mm and LNM were independent risk factors for ETE (P<0.05). After PSM, no significant difference in ETE was found between patients with and without LNM (P>0.05).

Conclusions: In this single-center, retrospective PSM cohort, we did not observe a significant association between the extent of ETE and LNM in patients with PTC. ETE does not appear to be a reliable indicator for guiding the extent of lymph node dissection. For patients with concurrent ETE, the lymph node dissection range should be personalized.

Background: Invasive ductal carcinoma (IDC) is the most common histological subtype of breast cancer, and axillary lymph node metastasis (ALNM) is a pivotal factor in clinical staging, prognostic assessment, and treatment planning. This study aims to develop and validate a deep learning (DL) model based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the prediction of ALNM in IDC patients.

Methods: This multicenter study conducted a retrospective analysis of DCE-MRI images from 520 patients diagnosed with IDC of the breast. The training and internal validation sets consisted of 411 patients from The First Hospital of Qinhuangdao, while the external testing set included 109 patients from the Maternal and Child Health Hospital of Qinhuangdao. Radiomics and DL features were extracted separately from the DCE-MRI images. We evaluated five models (Clinical, Radiomics, Radiomics-Clinical, DL, DL-Clinical) using radiomics features, DL features, and clinical features. Finally, the predictive performance of the models was evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC).

Results: The AUCs for the Clinical model and Radiomics model, which are machine learning models, and the DL-model, were 0.807, 0.840, and 0.865, respectively. The combined models incorporating clinical features, namely the Radiomics-Clinical and DL-Clinical models, achieved AUCs of 0.824 and 0.935, respectively. Among the five models, the DL-Clinical model demonstrated a significant advantage in predicting ALNM. Additionally, this model exhibited robust performance in both internal validation and external testing sets, with AUCs of 0.946 and 0.951, respectively.

Conclusions: The DCE-MRI-based DL-Clinical model provides a non-invasive adjunct tool for preoperative identification of ALNM in patients with breast IDC, thereby enhancing the efficacy of personalized treatment strategies and improving patient quality of life.

Background: A subset of breast cancer patients who achieved pathological complete response (pCR) after neoadjuvant therapy (NAT) still experience poor outcomes, including recurrence, metastasis, and death. This study aims to identify risk factors for adverse outcomes in pCR patients, construct predictive models, elucidate molecular subtype-specific prognostic determinants, and explore the peaks of death and progression events among different subtypes.

Methods: Female patients who received NAT and achieved pCR in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled in this research. This study aims to clarify independent prognostic factors of overall survival (OS) and event-free survival (EFS) by using Cox regression analyses as well as developing nomograms and random survival forest (RSF) machine learning model to predict prognoses of patients with pCR. Subgroup analysis was performed to clarify molecular subtype heterogeneity, and survival sequential analysis was conducted to identify survival and progression event peaks.

Results: Analyses based on SEER data identified age, T stage, N stage, molecular subtype, histological tumor type, surgical approach, and histological grade as independent predictors of OS [Concordance index (C-index) =0.723; 3-year area under the curve (AUC) =0.707], while EFS predictors included age, T stage, N stage, molecular subtype, histological tumor type, and grade (C-index =0.682; 3-year AUC =0.690). The C-index of OS and EFS nomograms were 0.723 (3-year AUC =0.711) and 0.682 (3-year AUC =0.691) respectively. The RSF model for mortality risk achieved a C-index of 0.721 (3-year AUC =0.73). Prognostic factors varied across molecular subtypes, though T/N stage was a common determinant. Survival sequential peaks for death events occurred at 36 months [triple-negative breast cancer (TNBC)], 114 months (Luminal), and 97 months [human epidermal growth factor receptor 2 (HER2)-positive subtype], while progression events' peaks were observed at 111 months (TNBC), 114 months (Luminal), and 84 months (HER2-positive subtype).

Conclusions: This study systematically revealed key clinicopathological factors influencing prognosis of pCR patients receiving NAT: tumor burden (T/N stage) emerged as a universal risk factor across molecular subtypes. Survival sequential analysis highlights subtype-specific surveillance priorities: intensified monitoring within 3 years for TNBC, focused follow-up at 7-8 years for HER2-positive subtype, and extended tracking for Luminal subtypes. Both nomograms and the RSF model demonstrated robust predictive performance, providing theoretical and practical tools for precision prognosis management in breast cancer.

Background: Thyroidectomy is a primary treatment for thyroid diseases, with low mortality but a 3-5% complication rate. Delayed tracheal rupture, though rare, is a life-threatening complication causing severe respiratory compromise and mediastinal infections. This case report of three post-thyroidectomy delayed tracheal ruptures shares clinical experiences to improve recognition, management, and preventive strategies.

Case descriptions: Case 1: A 47-year-old male presented on postoperative day (POD) 5 with dyspnea and subcutaneous emphysema. Computed tomography (CT) confirmed tracheal wall disruption, which was managed surgically with muscle flap packing and prolonged drainage. Case 2: A 53-year-old female developed an irritating cough on POD 9. Imaging revealed tracheal cartilage defects, which were repaired via rotational muscle flap. Case 3: A 54-year-old female experienced rapid-onset stridor and septic shock on POD 2. Despite repeated interventions (thoracostomy, intensive care, and anti-infective therapy), she developed progressive pneumomediastinum and two tracheal fistulae, ultimately requiring surgical re-exploration and prolonged ventilator support. All cases required multidisciplinary management, with varying recovery timelines and outcomes.

Conclusions: Delayed tracheal necrosis carries significant morbidity and mortality risks. Prevention hinges on meticulous preoperative evaluation, intraoperative avoidance of tracheal vascular compromise and thermal injury, and heightened postoperative vigilance for warning signs like dyspnea or subcutaneous emphysema. Management should be tailored to severity, ranging from conservative measures to urgent surgical repair. Early multidisciplinary intervention, including aggressive infection control and airway stabilization, is critical to optimize outcomes in this high-stakes complication.

Background: In the United States (U.S.) population, thyroid cancer incidence, aggressiveness, and survival have been shown to vary by patient age at diagnosis and biological sex. Surgery is a primary treatment for low-risk thyroid cancer and surgical outcomes can greatly influence patient outcomes and survival. It is unknown whether patients differ in postoperative outcomes of thyroid cancer surgery by age at diagnosis and sex. We aimed to study the topic in the U.S. Military Health System (MHS) to address this gap in knowledge.

Methods: We used the Military Cancer Epidemiology (MilCanEpi) database to study a cohort of patients aged 18 years and older diagnosed with T1-2N0M0 papillary thyroid cancer between 2001 and 2014 who received thyroidectomy surgery. We estimated the adjusted risk ratio (ARR) and 95% confidence intervals (CIs) in association with patient age at diagnosis and biological sex for 30-day general and local thyroid complications and hospital readmissions using multivariable Poisson regression.

Results: The study included 2,041 patients with 2.3% experiencing a general complication, 12.1% a thyroid complication, and 13.9% a readmission within 30 days after surgery. Overall, rates of general and thyroid complications as a whole were not statistically different for patients aged 40-49 or 50 years and older relative to age 18-39 years in multivariable models. However, patients 50 years or older had a statistically lower risk of hypoparathyroidism (ARR =0.37; 95% CI: 0.19-0.73) and also lower rates of readmission (ARR =0.68; 95% CI: 0.49-0.93) compared to patients aged 18-39 years. There were no statistically significant differences in the outcomes for men compared to women.

Conclusions: In the MHS, we observed some variation in risk of complications and readmissions by patient age at diagnosis for those undergoing thyroidectomy for T1-2N0M0 papillary thyroid cancer. More research is needed to understand the factors underlying lower risk of complications among older adults, or conversely, higher risk for complications among young adult patients with papillary thyroid cancer.

Background: Pancreaticoduodenectomy is the primary treatment modality for pancreatic and periampullary malignancies. Postoperative collections in the surgical area are common complications, and the management of such collections often requires ultrasound-guided percutaneous drainage. However, when collections occur in challenging areas, conventional methods usually prove ineffective. Therefore, alternative approaches are needed. This study aims to evaluate the efficacy and safety of an improved ultrasound-guided percutaneous drainage technique for managing collections in challenging areas following pancreaticoduodenectomy.

Methods: This retrospective study included 31 patients who underwent pancreaticoduodenectomy at the Qingchun Campus of The First Affiliated Hospital of Zhejiang University School of Medicine from January 2023 to September 2024 and developed fluid collections in challenging locations. All patients provided written informed consent before the procedure. Three different techniques were employed based on the location of the collections. Hydrodissection uses saline to separate tissues, creating a safe needle pathway. Modified trocar technique blunts the catheter tip by withdrawing the trocar stylet, reducing the risk of damage to adjacent organs. The transhepatic method involves passing a catheter through the liver to reach the target collection. After successful catheter placement, we evaluated and compared the technical and clinical success rates of the three methods and analyzed the associated complications.

Results: A total of 31 patients with fluid collections in challenging areas were included in this study. Among these, the transhepatic method was the most frequently used technique (77.42%), followed by hydrodissection (12.90%) and the modified trocar technique (9.68%). Notably, all procedures achieved 100% technical success. The overall clinical success rate was 83.87% (26/31), with no statistically significant differences observed among the methods. No severe complications were reported in any of the cases.

Conclusions: Ultrasound-guided drainage is a safe and effective procedure for managing fluid collections in challenging locations following pancreaticoduodenectomy.

Background: Radiofrequency ablation (RFA) for huge thyroid nodules often requires multiple sessions to achieve long-term efficacy. We present our experience with a stepwise approach utilizing a nodule margin-preserving ablation, termed the Eggshell technique, in the treatment of a thyroid nodule exceeding 9 cm in diameter.

Case description: A 44-year-old woman presented with compressive symptoms due to a large left thyroid solid nodule measuring 5.81 cm × 3.19 cm × 9.26 cm, with a volume of 90.84 mL. Cytopathology, including core needle biopsy, confirmed Bethesda Category II in two separate evaluations. RFA was performed under local anesthesia using the Eggshell technique, which preserved the nodule margin while ablating the internal tissue. The procedure lasted 83 minutes, delivering a total energy of 38.59 kJ. At 6 months, the nodule volume decreased to 29.75 mL [volume reduction ratio (VRR) 67.25%]. After three additional sessions, the volume further reduced to 1.59 mL (VRR 98.25%) at 42 months. The patient experienced minimal pain (pain score 1), with no hemorrhage, post-ablation edema, or nodule rupture. Serial ultrasonography allowed precise visualization of residual tissue, optimizing the timing of subsequent ablations.

Conclusions: This case suggests that the Eggshell technique, an evenly margin-preserving RFA strategy, may be a valuable option for managing huge thyroid nodules that inevitably require multiple sessions. By minimizing patient discomfort and complications, and facilitating decision-making during follow-up, this approach can complement conventional RFA techniques for large nodules.

Background: The 2015 American Thyroid Association (ATA) guidelines recommended hemithyroidectomy as an acceptable treatment for patients with differentiated thyroid cancer (DTC) tumors 1-4 cm. The primary objectives of this study were to trace the accumulation of evidence supporting hemithyroidectomy prior to the release of the 2015 ATA guidelines and to synthesize the available data on surgical outcomes for hemithyroidectomy and total thyroidectomy.

Methods: PubMed was systematically searched for studies comparing hemithyroidectomy and total thyroidectomy among adult patients with DTC ≥1 cm, focusing on patient outcomes including recurrence rates, overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS). Fixed-effects or random-effects models were applied as appropriate to estimate risk ratios (RRs) and hazard ratios (HRs) based on the Woolf test. Cumulative meta-analyses were also performed to illustrate changes in pooled estimates as studies were added incrementally by year of publication.

Results: The 14 studies, including 176,238 patients, were analyzed. Of these, 88.4% underwent total thyroidectomy and 11.6% (n=20,435) underwent hemithyroidectomy, with a mean follow-up time of 8 years. We found no significant differences between hemithyroidectomy and total thyroidectomy in recurrence rates [RR: 1.036, 95% confidence interval (CI): 0.698-1.538], OS (RR: 0.995; 95% CI: 0.985-1.006), or DSS (RR: 1.001; 95% CI: 0.998-1.005). Total thyroidectomy was associated with marginally better DFS compared to hemithyroidectomy (RR: 0.980, 95% CI: 0.963-0.997).

Conclusions: This systematic review and meta-analysis found that total thyroidectomy was associated with slightly greater DFS relative to hemithyroidectomy, but no statistically significant differences were observed in recurrence, OS, and DSS between the two procedures. The accumulation of evidence supporting hemithyroidectomy may have prompted the ATA to revise their guidelines and encouraged surgeons to increasingly consider hemithyroidectomy as a safe procedure for treating patients with DTC ≥1 cm.