Gland surgery最新文献

Background: For patients with recurrent thyroid cancer, traditional open re-operative surgeries often leave conspicuous cervical scars, significantly impacting patients' long-term quality of life. The potential for robotic surgery to enhance the aesthetic outcomes of re-operative surgery and improve the quality of life for these patients has rarely been studied. This study aimed to assess the feasibility and effectiveness of robotic reoperation for recurrent thyroid cancer following initial surgery, offering a viable surgical alternative tailored to patients with heightened aesthetic concerns.

Methods: We conducted a retrospective analysis of patients with recurrent thyroid cancer who underwent robotic reoperation via the bilateral axillo-breast approach (BABA) at the 960th Hospital of People's Liberation Army between September 2018 and March 2024. The study design involved a comprehensive review of clinical data, including patient demographics, surgical outcomes, and postoperative complications.

Results: A cohort of 24 patients (18 females, 6 males) with a mean age of 34.13±10.06 years successfully underwent robotic BABA reoperation without conversion to open surgery. Two patients underwent completion total thyroidectomy (CTT) with central neck node dissection (CND), four underwent CTT with lateral neck dissection (LND), and the remaining 18 patients received LND alone. Histopathological examination revealed papillary thyroid carcinoma (PTC) in 23 patients and medullary thyroid carcinoma (MTC) in one patient. The mean number of lymph nodes retrieved from LND was 14.21±12.30, with 2.74±2.64 nodes harboring metastases. Postoperative complications were transient, including hypoparathyroidism in four patients and temporary vocal cord palsy in one patient, with no permanent complications reported. During an average follow-up period of 29.71±19.29 months, no recurrences were detected. Cosmetic satisfaction was assessed and yielded a median satisfaction score of 9.2.

Conclusions: Robotic BABA reoperation emerges as a feasible and safe surgical modality for managing recurrent thyroid cancer, offering effective treatment while catering to patients' high aesthetic demands.

Background: Hypoparathyroidism (HPO) is characterized by deficient secretion of parathyroid hormone (PTH), leading to hypocalcemia and disrupted calcium homeostasis. Current treatments rely on calcium and vitamin D supplementation, which do not adequately mimic physiological PTH function. Cell-based therapies offer a potential solution, but optimal culture conditions to preserve the functional properties of primary parathyroid cells remain unclear. This study aims to develop primary rat parathyroid cell cultures that maintain hormone secretion and calcium-sensing abilities and to evaluate their therapeutic potential in a rat model of HPO.

Methods: An HPO model was established in rats through surgical excision of the parathyroid glands. Primary parathyroid cells were isolated from these rats and sorted by flow cytometry using epithelial cell adhesion molecule (EpCAM) and calcium-sensing receptor (CaSR) markers. Four different culture media (CM) were tested to determine optimal conditions for sustaining cell functionality. The most effective CM was supplemented with Sonic Hedgehog (Shh), Activin A, and inhibitors of epithelial-mesenchymal transition (EMT). The cultured cells were then transplanted into HPO rats, and serum calcium and PTH levels were monitored to assess therapeutic efficacy.

Results: The optimized CM successfully preserved the hormone-secreting and calcium-sensing functions of primary parathyroid cells over multiple passages. Transplanted cells in HPO rats led to a significant increase in serum calcium and PTH levels compared to untreated controls. The restoration of these levels correlated with the alleviation of hypocalcemic symptoms, indicating effective functional integration of the transplanted cells.

Conclusions: Primary rat parathyroid cells cultured under optimized conditions retained essential functional properties and, upon transplantation, effectively restored calcium homeostasis in an HPO rat model. These results highlight the potential of using cultured primary parathyroid cells as a viable cell-based therapy for HPO, offering a promising alternative to conventional treatments.

Background: Breast cancer is one of the most prevalent oncological diseases worldwide, with mastectomy often necessary for treatment. Post-mastectomy breast reconstruction is essential for restoring physical integrity and improving patients' quality of life, especially in high-risk individuals with advanced age, obesity, diabetes, smoking habits, or a history of radiotherapy. Traditional submuscular reconstruction techniques are effective but often associated with higher rates of complications in this patient population. This study aimed to evaluate the efficacy and safety of a novel video-assisted procedure (VAP) for submuscular breast reconstruction, focusing on its ability to reduce complications and enhance outcomes.

Methods: A retrospective analysis compared 17 high-risk patients who underwent VAP with 127 patients treated using traditional non-video-assisted procedures (NVAP) between September 2022 and June 2024. Both groups were comparable in age, body mass index (BMI), and risk factors. Data on postoperative complications, including bleeding, wound dehiscence, and infections, were collected and analyzed. Statistical significance was determined using appropriate tests, with a P value <0.05 considered significant.

Results: The VAP group demonstrated significant reductions in complications compared to the NVAP group. No cases of postoperative bleeding were reported in the VAP group, while 8.66% of NVAP patients experienced bleeding. Wound dehiscence rates were also lower in the VAP group (5.88%) compared to the NVAP group (10.24%). The minimally invasive nature of VAP allowed for precise dissection and reduced tissue trauma without prolonging surgical times.

Conclusions: The findings suggest that VAP is a safer and more effective alternative for high-risk patients requiring submuscular breast reconstruction. By minimizing complications and enhancing both functional and aesthetic outcomes, VAP offers a promising innovation in reconstructive surgery. Larger, randomized trials are necessary to validate these results and establish VAP as a standard of care in diverse clinical settings.

Background: Papillary thyroid cancer (PTC) is increasingly treated with procedures. However, there is a lack of relevant systematic evaluation articles. Therefore, this study aims to explore the research landscape of PTC thermal ablation through bibliometric analysis.

Methods: We searched publications related to PTC thermal ablation therapy from January 1, 2000 to December 31, 2023, from the Web of Science Core Collection (WoSCC). Subsequently, bibliometric analyses were then performed using the R package "bibliometrix", as well as VOSviewer and CiteSpace software, to visualize data on countries, institutions, journals, authors, keywords, and references.

Results: A total of 283 publications from 17 countries were retrieved, and the number of publications had shown a steady increase over the past decade, with China, the USA and South Korea being the top three contributing countries. The Chinese People's Liberation Army General Hospital was the most prolific institution, with the International Journal of Hyperthermia being the most frequent publisher. The author with the highest number of publications was Yukun Luo. "Radiofrequency ablation" was identified as the most commonly used keyword, indicating a potential research hotspot for the future.

Conclusions: This bibliometric study comprehensively analyzed publications on PTC thermal ablation, providing valuable insights into the history and current status of this research field, while also offering guidance for future research directions.

Background: Volume replacement oncoplastic breast surgery (VR-OPS) allows breast conservation for women who would otherwise undergo mastectomy or compromise cosmetic outcomes with wide local excision (WLE). VR-OPS remains understudied in the literature. The aim of this study was to compare 7-year outcomes of VR-OPS vs. WLE.

Methods: This is a single-centre retrospective chart review compared VR-OPS (2012-2016) to WLE (2013-2014), analysing clinicopathological, treatment, surgical, and follow-up data.

Results: Eighty patients underwent WLE and 79 VR-OPS. No differences in smoking status, cancer type, or grade were observed between the groups. Women in the VR-OPS group were significantly younger, more likely to be node positive, and had larger tumours. Consequently, they received more neo-adjuvant chemotherapy and axillary surgery. VR-OPS resulted in significantly more clear margins [relative risk (RR) =0.3638; 95% confidence interval (CI): 0.1621 to 0.8162; P=0.01], translating to a decreased need for mastectomy (RR =0.2250; 95% CI: 0.0502 to 1.0089; P=0.06). There was also a significant decrease in the need for further breast surgery for symmetrisation after VR-OPS (RR =0.1266; 95% CI: 0.0162 to 0.9887; P=0.04). Although VR-OPS had slightly more post-op complications (RR =1.8228; 95% CI: 0.8982 to 3.6993; P=0.09), this was not statistically significant. Importantly there was no difference in long-term oncological outcomes specifically local-recurrence (RR =0.7949; 95% CI: 0.1152 to 5.484; P=0.81) and overall-survival (RR =0.6551; 95% CI: 0.2633 to 1.6302; P=0.36).

Conclusions: This study observed no significant differences in long-term local recurrence and survival between the VR-OPS and WLE groups. VR-OPS represents an oncologically safe surgical option especially for larger tumours.

Background: Accurate evaluation of the axillary lymph node (ALN) status is needed for determining the treatment protocol for breast cancer. This study aimed to build an artificial intelligence (AI) model to predict ALN metastasis based on pre-treatment dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) of breast cancer combined with radiomics algorithms.

Methods: Pre-treatment DCE-MRI dataset of 166 patients with pathologically confirmed breast cancer diagnosis from January 2017 to August 2020 was collected, and all patients were randomly divided into a training group and test group with a ratio of 7:3. Each patient underwent pre-enhancement as well as post-enhancement 1-6 MRI, and a total of 7,224 two-dimensional (2D) and 9,863 three-dimensional (3D) features were extracted, respectively. Radiomics models based on 2D, 3D, pre-enhancement, and the first post-enhancement images were established using the least absolute shrinkage selection operator (LASSO) algorithm based on machine learning, and the area under the curve (AUC), accuracy, sensitivity, and specificity of the models were calculated.

Results: The mean AUC, accuracy, sensitivity, and specificity of the 10-fold cross-validation of the 3D radiomics-based model were 82%, 82%, 83%, and 81%, respectively. The C-index of the combined model with combining radiomics features and clinical features was 90%, the AUC was 90%, the specificity was 91%, the sensitivity was 77% and the accuracy was 84%.

Conclusions: The comprehensive prediction model using DCE-MRI image combined with clinical features can accurately predict ALN metastasis in breast cancer.

Background: De-escalation of local treatments for breast cancer is progressing, with breast-conserving therapy (BCT) representing approximately 60% of all breast cancer cases in Japan. Nonsurgical therapies have emerged as a novel treatment option. Assessing the health-related quality of life (HRQOL) and patient satisfaction following breast cancer surgery holds significant clinical importance. This study aimed to evaluate satisfaction after cryoablation or BCT in patients with early-stage breast cancer.

Methods: Women with stage 0 or 1 breast cancer who underwent cryoablation or BCT between April 1 and June 30, 2022 were included. Exclusion criteria encompassed recurrence, axillary dissection, tumor diameter <15 mm, bilateral breast cancer, or pre-procedure irradiation. This study used the BREAST-Q questionnaire to assess patient HRQOL and satisfaction. The BREAST-Q questionnaire was administered postoperatively, and scores were compared using propensity score matching to adjust for baseline differences between the two groups.

Results: Post-operative satisfaction was compared between cryoablation and BCT groups in patients with early-stage breast cancer. Between April 1 and June 30, 2022, a total of 147 Asian female breast cancer patients underwent cryoablation (n=42) or BCT (n=105). Among the 112 patients with stage 0 or 1 disease, 36 were excluded, and the remaining 76 (35 from the cryoablation group and 41 from the BCT group) were included in the analysis. There were no significant differences in observation period, age, or body mass index (BMI) between the groups. All patients received post-operative radiation therapy. While about a quarter of BCT patients received post-operative chemotherapy, none in the cryoablation group did (26.8% vs. 0%, P=0.003). Patients who underwent cryoablation compared to BCT reported significantly higher satisfaction (71.0±18.6 vs. 56.3±16.5) in the primary outcome, with a mean follow-up of 4.2 and 4.0 years, respectively. This trend was consistent across all the other measures. Adjustment for patient characteristics showed higher satisfaction in the cryoablation group, including age, BMI, and follow-up period between surgery and the survey.

Conclusions: Cryoablation resulted in greater HRQOL and patient satisfaction than BCT for early-stage breast cancer. Our findings offer valuable insights underpinning treatment options for patients with early-stage, low-grade breast cancer.

Background: Human epidermal growth factor receptor 2 (HER2)-positive invasive breast cancer (BC) accounts for 15-20% of all cases, requiring HER2-targeted neoadjuvant therapy (NAT). Despite the success of trastuzumab and other HER2-targeted treatments, many patients still experience inadequate responses, highlighting the need for more accurate and accessible biomarkers to predict treatment outcomes. Serum HER2 (sHER2) levels, as a non-invasive biomarker, have shown promise in monitoring treatment response; however, the role of sHER2 dynamics during treatment remains underexplored. The aim of this study was to investigate the potential of sHER2 dynamics as a predictor of pathological complete response (pCR) in HER2-positive BC patients undergoing NAT.

Methods: This retrospective study analyzed 120 HER2-positive BC patients who underwent standard NAT followed by surgery at Fudan University Shanghai Cancer Center (FUSCC). sHER2 levels were measured at three time points: baseline, after the second cycle of therapy (C2), and at surgery. Logistic regression analysis was used to assess the association between changes in sHER2 levels and the achievement of pCR. The study also examined the influence of other clinicopathological factors such as estrogen receptor (ER) status, Ki67, and tissue HER2 (tHER2) levels on pCR.

Results: During NAT, sHER2 levels showed a significant decline, with a more pronounced reduction observed in patients achieving pCR. The greatest reduction in sHER2 levels after C2 was strongly associated with pCR. Both univariate and multivariate analyses identified significant reductions in sHER2 levels after C2 and ER-negative status as independent predictors of pCR. Notably, sHER2 changes from baseline to C2 demonstrated a stronger predictive value for pCR compared to changes observed later in treatment.

Conclusions: Our study confirms that reductions in sHER2 levels after C2 are a strong indicator of favorable treatment response in HER2-positive BC patients undergoing NAT. Monitoring sHER2 dynamics early in treatment can serve as a useful, non-invasive biomarker to predict pCR and may guide therapeutic decisions in clinical practice.