L. Yakovleva, M. Kropotov, A. K. Allahverdiev, M. S. Tigrov, P. A. Gavryshchuk
Background. From 10 to 20% of highly differentiated papillary thyroid cancer show signs of local prevalence: invasion into the surrounding fatty tissue, organs and tissues adjacent to the gland — the anterior muscles of the neck, recurrent nerve, esophagus, laryngopharynx, larynx, trachea. A tumor that has a massive spread, often with life-threatening symptoms in the form of dysphagia, stenosis of the trachea or larynx, has no alternatives to surgical treatment.Aim. Evaluation of the results of extended and extended-combined interventions for locally advanced highly differentiated thyroid cancer (immediate surgical and long-term results of treatment).Materials and methods. During the period from 2010 to 2021, 82 patients with locally advanced thyroid cancer were operated on. This cohort included patients in whom the tumor process spread not only to the neck, but also to the mediastinum: either in the region of the upper thoracic inlet, or there was a lesion of deeper parts of the mediastinum. The average age is 56.8 years. The ratio of men and women: 34 (41.5%) and 48 (58.5%), respectively. According to the prevalence of the tumor process, T4 tumors were diagnosed in 54.8% (n= 45). 37 patients had T3 (45.2%) tumors. In 57.3% (n= 47), the primary tumor was combined with the presence of a metastatic lesion in the regional lymph nodes of the neck. 34.1% (n 28) had distant metastases. In all cases it was a lesion of the lungs. Papillary thyroid cancer was verified in 89.6%. 21 patients underwent operations with resection of the larynx and trachea: in 7 cases, laryngectomy with resection of 5 to 8 rings of the trachea, in 4 cases, circular resections, in 6 cases, “shaving”, in 2 cases, “terminal” resections of the trachea with plasty of the defect of the sternum-clavicle-mastoid muscle, in 2 patients the plates of the thyroid cartilage were resected while maintaining the integrity of the organ. In 24 patients, mediastinal lymph node dissection (sternotomy) was performed; in 2 cases, mediastinal lymph node dissection was performed thoracoscopically. In 2 cases, resection of bone structures was performed — the manubrium of the sternum and sternoclavicular joints. In 33 patients, removal of the primary tumor, paratracheal, paraesophageal metastases and metastatic conglomerates from the posterior mediastinum (4 cases) was performed through the cervical approach.Results. The postoperative period in this group of patients was complicated by the development of pneumonia in 52 (63.4%) patients. Purulent mediastinitis developed in 6 (7.8%) patients, arrosive bleeding in 6% (n= 5), osteomyelitis of the sternum in 2 (2.4%) cases, gastric bleeding in 1 patient (1.5%), lymphorrhea in 2 (2.4%), parathyroid insufficiency developed in 70.7% (n 58) of observations. Postoperative mortality was 6% (n= 5).OS and disease-free survival amounted to 66.7% and 53.4%, respectively. Death from the progression of the disease occurred in all cases due to the growth of distant met
{"title":"Locally advanced thyroid cancer. Issues of diagnosis and treatment","authors":"L. Yakovleva, M. Kropotov, A. K. Allahverdiev, M. S. Tigrov, P. A. Gavryshchuk","doi":"10.14341/serg12763","DOIUrl":"https://doi.org/10.14341/serg12763","url":null,"abstract":"Background. From 10 to 20% of highly differentiated papillary thyroid cancer show signs of local prevalence: invasion into the surrounding fatty tissue, organs and tissues adjacent to the gland — the anterior muscles of the neck, recurrent nerve, esophagus, laryngopharynx, larynx, trachea. A tumor that has a massive spread, often with life-threatening symptoms in the form of dysphagia, stenosis of the trachea or larynx, has no alternatives to surgical treatment.Aim. Evaluation of the results of extended and extended-combined interventions for locally advanced highly differentiated thyroid cancer (immediate surgical and long-term results of treatment).Materials and methods. During the period from 2010 to 2021, 82 patients with locally advanced thyroid cancer were operated on. This cohort included patients in whom the tumor process spread not only to the neck, but also to the mediastinum: either in the region of the upper thoracic inlet, or there was a lesion of deeper parts of the mediastinum. The average age is 56.8 years. The ratio of men and women: 34 (41.5%) and 48 (58.5%), respectively. According to the prevalence of the tumor process, T4 tumors were diagnosed in 54.8% (n= 45). 37 patients had T3 (45.2%) tumors. In 57.3% (n= 47), the primary tumor was combined with the presence of a metastatic lesion in the regional lymph nodes of the neck. 34.1% (n 28) had distant metastases. In all cases it was a lesion of the lungs. Papillary thyroid cancer was verified in 89.6%. 21 patients underwent operations with resection of the larynx and trachea: in 7 cases, laryngectomy with resection of 5 to 8 rings of the trachea, in 4 cases, circular resections, in 6 cases, “shaving”, in 2 cases, “terminal” resections of the trachea with plasty of the defect of the sternum-clavicle-mastoid muscle, in 2 patients the plates of the thyroid cartilage were resected while maintaining the integrity of the organ. In 24 patients, mediastinal lymph node dissection (sternotomy) was performed; in 2 cases, mediastinal lymph node dissection was performed thoracoscopically. In 2 cases, resection of bone structures was performed — the manubrium of the sternum and sternoclavicular joints. In 33 patients, removal of the primary tumor, paratracheal, paraesophageal metastases and metastatic conglomerates from the posterior mediastinum (4 cases) was performed through the cervical approach.Results. The postoperative period in this group of patients was complicated by the development of pneumonia in 52 (63.4%) patients. Purulent mediastinitis developed in 6 (7.8%) patients, arrosive bleeding in 6% (n= 5), osteomyelitis of the sternum in 2 (2.4%) cases, gastric bleeding in 1 patient (1.5%), lymphorrhea in 2 (2.4%), parathyroid insufficiency developed in 70.7% (n 58) of observations. Postoperative mortality was 6% (n= 5).OS and disease-free survival amounted to 66.7% and 53.4%, respectively. Death from the progression of the disease occurred in all cases due to the growth of distant met","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47987472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. M. Morozova, O. G. Tsygankova, E. Yurova, N. A. Torokhtiy, K. Stegniy, T. A. Kulakova, R. Goncharuk, M. Dmitriev
BACKGROUND. Currently, pheochromocytomas are classified as malignant tumors (WHO 2017), which means that special postoperative tactics are required for patients with different risks of pheochromocytoma aggressiveness.AIM. Assess the predictors of malignant potential of pheochromocytomas using the GAPP and PASS scales.MATERIALS AND METHODS. From 2016 to 2021, 24 patients diagnosed with pheochromocytoma, age from 18 to 81 years (median 50.4+-3.3), were hospitalized at the Primorsky Regional Center for Diabetes and Endocrine Diseases, 21 of them were women and 3 were men. Hormone producing adenoma in the right adrenal gland was found in 13 patients (54.2%), on the left in 8 (33.3%) cases, bilateral pheochromocytoma — in 3 (12.5%) cases. Clinical manifestation: a sharp increase in systolic blood pressure of more than 200 mmHg accompanied by crises, tachycardia was detected in 14 patients, the rest of the clinical symptoms were nonspecific: persistent arterial hypertension, as well as general weakness. The sizes of the revealed formations varied from — 1.1x1.6x1.6 cm to — 7.7x10.6x8.5 cm. (median 37+-1.2). The diagnosis was confirmed by standard examinations. All patients underwent unilateral adrenalectomy at the Surgery Center of the FEFU Medical Center, using two main methods: retroperitoneoscopy and laparoscopy. After the operation, histological and immunohistochemical studies were performed. The analysis of immunohistochemical studies was carried out. The expression of Ki67, Chromogranin A, Synaptophysin was determined. Since it is currently impossible to absolutely accurately determine the malignant potential of pheochromocytomas, the PASS and GAPP scores have been introduced into clinical practice. A retrospective analysis of the cytological material of patients operated on in 2020 and 2021 was carried out.RESULTS. According to the PASS scale, more than 4 points were detected in 7 out of 10 patients. GAPP scores ranged from 0 to 2 in 3 out of 10 people; 3-6 points for 5; more than 7 points in 2 patients. At the same time, the results of the calculation on both scales in 100% of cases correspond to each other, which makes it possible to identify patients with moderate and high malignant potential.CONCLUSION. The results obtained confirm the need to use additional tools in clinical practice to determine the prognosis in a particular patient, which means it will allow developing an algorithm for dispensary observation, the timing of the follow-up examination.
{"title":"Clinical and immunohistochemical characteristics of pheochromocytomas","authors":"A. M. Morozova, O. G. Tsygankova, E. Yurova, N. A. Torokhtiy, K. Stegniy, T. A. Kulakova, R. Goncharuk, M. Dmitriev","doi":"10.14341/serg12759","DOIUrl":"https://doi.org/10.14341/serg12759","url":null,"abstract":"BACKGROUND. Currently, pheochromocytomas are classified as malignant tumors (WHO 2017), which means that special postoperative tactics are required for patients with different risks of pheochromocytoma aggressiveness.AIM. Assess the predictors of malignant potential of pheochromocytomas using the GAPP and PASS scales.MATERIALS AND METHODS. From 2016 to 2021, 24 patients diagnosed with pheochromocytoma, age from 18 to 81 years (median 50.4+-3.3), were hospitalized at the Primorsky Regional Center for Diabetes and Endocrine Diseases, 21 of them were women and 3 were men. Hormone producing adenoma in the right adrenal gland was found in 13 patients (54.2%), on the left in 8 (33.3%) cases, bilateral pheochromocytoma — in 3 (12.5%) cases. Clinical manifestation: a sharp increase in systolic blood pressure of more than 200 mmHg accompanied by crises, tachycardia was detected in 14 patients, the rest of the clinical symptoms were nonspecific: persistent arterial hypertension, as well as general weakness. The sizes of the revealed formations varied from — 1.1x1.6x1.6 cm to — 7.7x10.6x8.5 cm. (median 37+-1.2). The diagnosis was confirmed by standard examinations. All patients underwent unilateral adrenalectomy at the Surgery Center of the FEFU Medical Center, using two main methods: retroperitoneoscopy and laparoscopy. After the operation, histological and immunohistochemical studies were performed. The analysis of immunohistochemical studies was carried out. The expression of Ki67, Chromogranin A, Synaptophysin was determined. Since it is currently impossible to absolutely accurately determine the malignant potential of pheochromocytomas, the PASS and GAPP scores have been introduced into clinical practice. A retrospective analysis of the cytological material of patients operated on in 2020 and 2021 was carried out.RESULTS. According to the PASS scale, more than 4 points were detected in 7 out of 10 patients. GAPP scores ranged from 0 to 2 in 3 out of 10 people; 3-6 points for 5; more than 7 points in 2 patients. At the same time, the results of the calculation on both scales in 100% of cases correspond to each other, which makes it possible to identify patients with moderate and high malignant potential.CONCLUSION. The results obtained confirm the need to use additional tools in clinical practice to determine the prognosis in a particular patient, which means it will allow developing an algorithm for dispensary observation, the timing of the follow-up examination.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42425777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. S. Tigrov, L. Yakovleva, M. Kropotov, P. A. Gavrishchuk, A. V. Khodos, А. S. Vyalov, G. R. Alizade
Background. The need to perform prophylactic central cervical lymph node dissection in localized forms of highly differentiated thyroid cancer remains open at the moment. Preoperative examination does not always allow to reliably determine the presence of regional metastasis in the lymph nodes of the VI group.Aim. Evaluation of the neck central lymphatic collector damage frequency in clinical N0-Nx based on the results of a morphological study after performing a preventive central cervical lymph node dissection.Materials and methods. The study involved 295 patients operated on in 2016-2022 for papillary thyroid cancer with the prevalence of the tumor process — cT1-T2, N0-Nx. The ratio of men and women is 11.5% (n=34) and 88.5% (n=261). Of these, 40.7% (n=120) were less than 55 years old, 59.3% were more than 55 years old (n=175). All patients underwent surgical treatment in the amount of thyroidectomy and hemithyroidectomy with central cervical lymph node dissection.Results. In a morphological study, in some patients there was a change in the clinical stage from T1-T2 to T3: pT1 was found in 80.3% (n=237); рТ2 — in 9.2% (n=27); рТ3 — in 10.5% (n=31). In 77 (26.1%) of 295 patients, metastases were found in the lymph nodes of the central tissue of the neck. Primary surgical treatment — thyroidectomy with central cervical lymph node dissection —was performed in 295 patients, of which tumors corresponding to the cT1 — 247 (83.7%), cT2 — 48 (16.3%). According to the results of pathomorphological examination of the tissue of the neck after prophylactic lymph node dissection, pN1a was detected in 57 (23.1%) and 20 (41.7%) patients, respectively.When assessing the frequency of damage to the regional lymph collector of group VI after performing a morphological study of the removed tissue, it was revealed that with pT1 the frequency of damage to the lymph nodes was 22.8% (n54); at рТ2 — 33.3% (n9); and at pT3 this figure increases to 45.2% (n14).Conclusion. According to the results of the study, it was revealed that there is a clear dependence of the defeat of regional lymph nodes of the central tissue of the neck on the size of the primary tumor from 22.8% with pT1 to 33.3% with pT2 and 45.2% with pT3. Thus, the implementation of prophylactic central cervical lymphadenectomy for papillary thyroid cancer is an important component of surgical treatment.
{"title":"Central cervical lymph node dissection in the treatment of papillary thyroid cancer","authors":"M. S. Tigrov, L. Yakovleva, M. Kropotov, P. A. Gavrishchuk, A. V. Khodos, А. S. Vyalov, G. R. Alizade","doi":"10.14341/serg12769","DOIUrl":"https://doi.org/10.14341/serg12769","url":null,"abstract":"Background. The need to perform prophylactic central cervical lymph node dissection in localized forms of highly differentiated thyroid cancer remains open at the moment. Preoperative examination does not always allow to reliably determine the presence of regional metastasis in the lymph nodes of the VI group.Aim. Evaluation of the neck central lymphatic collector damage frequency in clinical N0-Nx based on the results of a morphological study after performing a preventive central cervical lymph node dissection.Materials and methods. The study involved 295 patients operated on in 2016-2022 for papillary thyroid cancer with the prevalence of the tumor process — cT1-T2, N0-Nx. The ratio of men and women is 11.5% (n=34) and 88.5% (n=261). Of these, 40.7% (n=120) were less than 55 years old, 59.3% were more than 55 years old (n=175). All patients underwent surgical treatment in the amount of thyroidectomy and hemithyroidectomy with central cervical lymph node dissection.Results. In a morphological study, in some patients there was a change in the clinical stage from T1-T2 to T3: pT1 was found in 80.3% (n=237); рТ2 — in 9.2% (n=27); рТ3 — in 10.5% (n=31). In 77 (26.1%) of 295 patients, metastases were found in the lymph nodes of the central tissue of the neck. Primary surgical treatment — thyroidectomy with central cervical lymph node dissection —was performed in 295 patients, of which tumors corresponding to the cT1 — 247 (83.7%), cT2 — 48 (16.3%). According to the results of pathomorphological examination of the tissue of the neck after prophylactic lymph node dissection, pN1a was detected in 57 (23.1%) and 20 (41.7%) patients, respectively.When assessing the frequency of damage to the regional lymph collector of group VI after performing a morphological study of the removed tissue, it was revealed that with pT1 the frequency of damage to the lymph nodes was 22.8% (n54); at рТ2 — 33.3% (n9); and at pT3 this figure increases to 45.2% (n14).Conclusion. According to the results of the study, it was revealed that there is a clear dependence of the defeat of regional lymph nodes of the central tissue of the neck on the size of the primary tumor from 22.8% with pT1 to 33.3% with pT2 and 45.2% with pT3. Thus, the implementation of prophylactic central cervical lymphadenectomy for papillary thyroid cancer is an important component of surgical treatment.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45899248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Adrenocortical cancer (ACC) is a rare malignant endocrine tumor endowed with an aggressive biological potential and a poor prognosis. Surgical adrenalectomy remains the only radical treatment for local ACC. The overall 5-year survival rate of stages with local ACC varies from 56% to 96% and depends on the level of surgical training of a specialized center and the use of adjuvant therapy. Mitotan is the only approved chemotherapeutic agent for the adjuvant treatment of both the primary tumor and relapse and metastases.Aim. To evaluate the experience of mitotane successful use in a young patient with recurrent ACC using the experience of a large medical institution.Clinical observation. Patient R., 31 years old, is under dispensary observation for recurrent adrenocortical cancer of the left adrenal gland T1N0M0 stage 1, class 3. Progression from 2015, 2017, February 2019, April 2019, September 2020 (in the bed, MTS to the left kidney, MTS to the retroperitoneal tissue, MTS to the soft tissues of the lumbar region on the left, MTS to the lungs). Eradication of the tumor tissue was performed surgically, followed by morphological confirmation of the removed foci. For the first time, the diagnosis was established at the age of 23 during an examination for Itsenko-Cushing’s syndrome. Morphologically, the diagnosis of ACC was established after a histological examination of the tumor biopsy obtained by left-sided adrenalectomy (adrenocortical cancer, ki67 up to 20%).During a scheduled dispensary examination in September 2020, according to CT scan of the chest with contrast, two foci were identified in the right lung: in C1 — 10 * 15 mm, in C2 — 30 * 21 mm. By decision of the council (consisting of an oncologist-endocrinologist, a thoracic surgeon and a chemotherapist), a decision was made to prescribe mitotane with dose titration under the control of the level of mitotane in the blood until it reaches 14–20 ng/l, without morphological examination of the foci. Hypocorticism was corrected by the simultaneous use of hydrocortisone with mitotane at a dose of 20 mg per day under the control of ACTH levels. In X-ray evaluation by CT of the chest with a frequency of 3 months, the therapeutic effect in the form of a decrease in the size of the foci (RESIST1.1) occurred in the first 3 months. Mitotan was canceled in November 2021 after complete regression of tumor foci according to CT scan of the chest (pneumosclerosis areas 10*4 mm). Currently, the patient is receiving hormone replacement therapy with hydrocortisone 25 mg per day and is under dispensary observation.Conclusion. Clinical observation has demonstrated the successful use of mitotane in the treatment of metastatic adrenocortical cancer.
{"title":"Experience of mitotane successful in the treatment of metastatic adrenocortical cancer","authors":"D. P. Yashina, Z. Afanasieva","doi":"10.14341/serg12764","DOIUrl":"https://doi.org/10.14341/serg12764","url":null,"abstract":"Background. Adrenocortical cancer (ACC) is a rare malignant endocrine tumor endowed with an aggressive biological potential and a poor prognosis. Surgical adrenalectomy remains the only radical treatment for local ACC. The overall 5-year survival rate of stages with local ACC varies from 56% to 96% and depends on the level of surgical training of a specialized center and the use of adjuvant therapy. Mitotan is the only approved chemotherapeutic agent for the adjuvant treatment of both the primary tumor and relapse and metastases.Aim. To evaluate the experience of mitotane successful use in a young patient with recurrent ACC using the experience of a large medical institution.Clinical observation. Patient R., 31 years old, is under dispensary observation for recurrent adrenocortical cancer of the left adrenal gland T1N0M0 stage 1, class 3. Progression from 2015, 2017, February 2019, April 2019, September 2020 (in the bed, MTS to the left kidney, MTS to the retroperitoneal tissue, MTS to the soft tissues of the lumbar region on the left, MTS to the lungs). Eradication of the tumor tissue was performed surgically, followed by morphological confirmation of the removed foci. For the first time, the diagnosis was established at the age of 23 during an examination for Itsenko-Cushing’s syndrome. Morphologically, the diagnosis of ACC was established after a histological examination of the tumor biopsy obtained by left-sided adrenalectomy (adrenocortical cancer, ki67 up to 20%).During a scheduled dispensary examination in September 2020, according to CT scan of the chest with contrast, two foci were identified in the right lung: in C1 — 10 * 15 mm, in C2 — 30 * 21 mm. By decision of the council (consisting of an oncologist-endocrinologist, a thoracic surgeon and a chemotherapist), a decision was made to prescribe mitotane with dose titration under the control of the level of mitotane in the blood until it reaches 14–20 ng/l, without morphological examination of the foci. Hypocorticism was corrected by the simultaneous use of hydrocortisone with mitotane at a dose of 20 mg per day under the control of ACTH levels. In X-ray evaluation by CT of the chest with a frequency of 3 months, the therapeutic effect in the form of a decrease in the size of the foci (RESIST1.1) occurred in the first 3 months. Mitotan was canceled in November 2021 after complete regression of tumor foci according to CT scan of the chest (pneumosclerosis areas 10*4 mm). Currently, the patient is receiving hormone replacement therapy with hydrocortisone 25 mg per day and is under dispensary observation.Conclusion. Clinical observation has demonstrated the successful use of mitotane in the treatment of metastatic adrenocortical cancer.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43042977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Dolidze, S. Covantsev, I. N. Lebedinskiy, D. L. Rotin, N. V. Pichugina, D. Slepukhova, S. I. Gaibullaeva
Background. In recent decades, there has been an increase in the incidence of malignant neoplasms of the thyroid gland by 20%. In 2020, thyroid cancer was diagnosed in 586,202 people worldwide and caused 43,646 deaths. Diagnosis of thyroid carcinoma has stepped forward due to the introduction of fine needle aspiration biopsy into widespread practice, with the classification of cytological material according to the Bethesda system. However, one category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the formation as benign or malignant and requires surgical intervention. At the same time, in the vast majority of cases, the tumor is benign.Aim. To evaluate the possibilities of trephine biopsy for the differential diagnosis of benign and malignant neoplasms of the thyroid gland in the cytological category Bethesda IV.Materials and methods. The study included 8 patients (2 men and 6 women) with a nodular thyroid gland and a cytological picture of a follicular tumor (Bethesda IV). The age of the patients ranged from 21 to 67 years, mean age 52.12±16.12. The sizes of nodule at US in three projections were accordingly 11,66±1,52; 11.33±1.15; 10.66±1.52 mm. Before the intervention, patients canceled drugs that affect the blood coagulation system. All patients underwent a trephine biopsy under ultrasound guidance with a mandatory assessment of blood supply in the mode of color Doppler mapping and power Dopplerography. Manipulation was performed along the midline of the neck through the isthmus of the thyroid gland. The material was taken from at least two sites, one through the tumor tissue, the other along the edge of the tumor with the capture of the capsule with a 18G needle. Additional biopsies were performed if a tumor site suspicious of malignancy was identified.Results. The results of trephine biopsy coincided in 8 cases (100%) with the results of an urgent and planned histological examination. The obtained data were regarded as highly informative in 5 cases (62.5%) and medium informative in 3 cases (37.5%). The material reliably assessed the morphological type of the tumor, the degree of vascularization of the capsule, the presence or absence of invasion into the capsule or vessels. Histological studies made it possible to assess the size of the follicles, the presence of colloid, cell polymorphism, mitoses, and the contents of the cytoplasm; evaluate cell atypia.Conclusion. In the future, trephine biopsy may become an additional opportunity to identify tumor-like formations in patients with follicular thyroid tumors.
{"title":"Differential diagnosis of follicular thyroid tumors using core-needle biopsy","authors":"D. Dolidze, S. Covantsev, I. N. Lebedinskiy, D. L. Rotin, N. V. Pichugina, D. Slepukhova, S. I. Gaibullaeva","doi":"10.14341/serg12765","DOIUrl":"https://doi.org/10.14341/serg12765","url":null,"abstract":"Background. In recent decades, there has been an increase in the incidence of malignant neoplasms of the thyroid gland by 20%. In 2020, thyroid cancer was diagnosed in 586,202 people worldwide and caused 43,646 deaths. Diagnosis of thyroid carcinoma has stepped forward due to the introduction of fine needle aspiration biopsy into widespread practice, with the classification of cytological material according to the Bethesda system. However, one category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the formation as benign or malignant and requires surgical intervention. At the same time, in the vast majority of cases, the tumor is benign.Aim. To evaluate the possibilities of trephine biopsy for the differential diagnosis of benign and malignant neoplasms of the thyroid gland in the cytological category Bethesda IV.Materials and methods. The study included 8 patients (2 men and 6 women) with a nodular thyroid gland and a cytological picture of a follicular tumor (Bethesda IV). The age of the patients ranged from 21 to 67 years, mean age 52.12±16.12. The sizes of nodule at US in three projections were accordingly 11,66±1,52; 11.33±1.15; 10.66±1.52 mm. Before the intervention, patients canceled drugs that affect the blood coagulation system. All patients underwent a trephine biopsy under ultrasound guidance with a mandatory assessment of blood supply in the mode of color Doppler mapping and power Dopplerography. Manipulation was performed along the midline of the neck through the isthmus of the thyroid gland. The material was taken from at least two sites, one through the tumor tissue, the other along the edge of the tumor with the capture of the capsule with a 18G needle. Additional biopsies were performed if a tumor site suspicious of malignancy was identified.Results. The results of trephine biopsy coincided in 8 cases (100%) with the results of an urgent and planned histological examination. The obtained data were regarded as highly informative in 5 cases (62.5%) and medium informative in 3 cases (37.5%). The material reliably assessed the morphological type of the tumor, the degree of vascularization of the capsule, the presence or absence of invasion into the capsule or vessels. Histological studies made it possible to assess the size of the follicles, the presence of colloid, cell polymorphism, mitoses, and the contents of the cytoplasm; evaluate cell atypia.Conclusion. In the future, trephine biopsy may become an additional opportunity to identify tumor-like formations in patients with follicular thyroid tumors.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45017191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Yukina, E. Avsievich, A. Pushkareva, N. Nuralieva, E. Bondarenko, N. Platonova, D. G. Beltsevich, E. Troshina
Neurofibromatosis type 1 is a hereditary disease that has a multisystem character of organism damage, a wide variability of clinical manifestations, up to the almost complete absence of typical symptoms. Phenotypic manifestations, their expressiveness and heaviness can be varied even among members of the same family with identical mutations. One of the possible clinical manifestations of this pathology is pheochromocytoma, the development of which is associated with a high risk of developing life-threatening conditions. Timely diagnosis of the disease, the choice of treatment tactics for the patient, genetic testing of blood relatives can significantly improve the survival rate and prognosis of the disease. In this article, on the presented clinical examples of patients with a typical and atypical course of type 1 neurofibromatosis in combination with pheochromocytoma, the issues of managing patients with this pathology are outlined.
{"title":"Atypical and typical course of neurofibromatosis type 1 in combination with pheochromocytoma","authors":"M. Yukina, E. Avsievich, A. Pushkareva, N. Nuralieva, E. Bondarenko, N. Platonova, D. G. Beltsevich, E. Troshina","doi":"10.14341/serg12730","DOIUrl":"https://doi.org/10.14341/serg12730","url":null,"abstract":"Neurofibromatosis type 1 is a hereditary disease that has a multisystem character of organism damage, a wide variability of clinical manifestations, up to the almost complete absence of typical symptoms. Phenotypic manifestations, their expressiveness and heaviness can be varied even among members of the same family with identical mutations. One of the possible clinical manifestations of this pathology is pheochromocytoma, the development of which is associated with a high risk of developing life-threatening conditions. Timely diagnosis of the disease, the choice of treatment tactics for the patient, genetic testing of blood relatives can significantly improve the survival rate and prognosis of the disease. In this article, on the presented clinical examples of patients with a typical and atypical course of type 1 neurofibromatosis in combination with pheochromocytoma, the issues of managing patients with this pathology are outlined.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42217647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Bubnov, K. Slashchuk, E. Shirshin, V. Timoshenko
Nowadays, diabetes and diseases of thyroid gland take place on the first two stage in the rank of all endocrine diseases. There are 3 directions to treat thyroid glands pathologies such as: using special pills which substitute natural thyroid hormones, surgery and radioiodine therapy. It has proven that surgery of thyroid gland is the most effective method among considering upper. at The same time, it is associated with the greatest risks of complications. The most common injuries are damage to the recurrent laryngeal nerve and unintentional traumatization or removal of a healthy parathyroid gland. Parathyroid gland is a critical organ during thyroid surgery. It means that all negative reaction nearby the structure can lead to development different complications: hypoparathyroidism (transient or chronic) and hypocalcemia. In this article is considered actual methods of intraoperative optical visualization of parathyroid glans. The fundamental foundations of such methods, their advantages and disadvantages are also analyzed. It is shown that fluorescent methods in the red and near infrared regions of the spectrum using exogenous dyes have essential importance for endocrine surgery, as they allow to improve identification and reduce the risk of postoperative complications.
{"title":"Intraoperative identification of parathyroid glands during endocrine surgery","authors":"A. Bubnov, K. Slashchuk, E. Shirshin, V. Timoshenko","doi":"10.14341/serg12724","DOIUrl":"https://doi.org/10.14341/serg12724","url":null,"abstract":"Nowadays, diabetes and diseases of thyroid gland take place on the first two stage in the rank of all endocrine diseases. There are 3 directions to treat thyroid glands pathologies such as: using special pills which substitute natural thyroid hormones, surgery and radioiodine therapy. It has proven that surgery of thyroid gland is the most effective method among considering upper. at The same time, it is associated with the greatest risks of complications. The most common injuries are damage to the recurrent laryngeal nerve and unintentional traumatization or removal of a healthy parathyroid gland. Parathyroid gland is a critical organ during thyroid surgery. It means that all negative reaction nearby the structure can lead to development different complications: hypoparathyroidism (transient or chronic) and hypocalcemia. In this article is considered actual methods of intraoperative optical visualization of parathyroid glans. The fundamental foundations of such methods, their advantages and disadvantages are also analyzed. It is shown that fluorescent methods in the red and near infrared regions of the spectrum using exogenous dyes have essential importance for endocrine surgery, as they allow to improve identification and reduce the risk of postoperative complications.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47299852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Farafonova, P. A. Pankova, M. E. Boriskova, N. S. Feshenko, E. A. Totskiy
BACKGROUND: Despite the intensive development of safe thyroid surgery technologies, it has not yet been possible to achieve a significant reduction in the level of specific complications. One of the possible reasons is the method of the conventional surgical operation especially possible traction during thyroid tissue rotation on the way to n.reccurence. In 2022, group of authors led by I.V. Sleptsov proposed a new technique for Tention-Free Thyroidectomy (TFT), which demonstrated a significant reduction in the level of specific complications.AIM: To conduct a pilot study to assess the reproducibility, efficacy and safety of TFT in the work of the endocrine surgery department of Pavlov First St. Petersburg State Medical University.MATERIALS AND METHODS: The study was conducted at the Department of Endocrine Surgery in the period from January to April 2022. Patients with surgical thyroid disease underwent a new proposed TFT intervention. The method is fully consistent with the author’s description in patent No. 2772015, and the surgeons performing the new surgical technique underwent an internship with the authors of TFT before the initiation of the study. The study is prospective, non-randomized, uncontrolled. Persistent laryngeal dysfunction and persistent hypoparathyroidism were considered the primary endpoint. Secondary endpoints were transient vocal cord paresis, hypocalcemia and hypoparathyroidism.RESULTS: The study included 20 people. The indications for surgery were endocrinological and oncological. The number of performed hemithyroidectomies were 15, thyroidectomy (TE) — 5 (one with central lymph node dissection), the volume of the thyroid gland varied from 4 cm3 to 280 cm3 . None of the patients reached the primary endpoint. There were no permanent dysfunction of the larynx in our study. Only in one patient in the postoperative period, a violation of the mobility of the vocal fold was revealed, however, during follow up on the 30th day of the postoperative period the mobility of the vocal fold was restored (confirmed by direct laryngoscopy). Hypoparathyroidism and hypocalcemia were not detected. However, it is necessary to mention the number of TE was too small.CONCLUSION: Thus, the new proposed TFT method is fully reproducible in the work of a specialized department of endocrine surgery. The method has demonstrated high rates of efficiency and safety in real clinical practice. However, further studies with a higher evidence base are required.
{"title":"The efficacy and safety of tension-free thyroidectomy in the clinical work of the Endocrine Surgery Department Pavlov State Medical University, pilot study","authors":"U. Farafonova, P. A. Pankova, M. E. Boriskova, N. S. Feshenko, E. A. Totskiy","doi":"10.14341/serg12733","DOIUrl":"https://doi.org/10.14341/serg12733","url":null,"abstract":"BACKGROUND: Despite the intensive development of safe thyroid surgery technologies, it has not yet been possible to achieve a significant reduction in the level of specific complications. One of the possible reasons is the method of the conventional surgical operation especially possible traction during thyroid tissue rotation on the way to n.reccurence. In 2022, group of authors led by I.V. Sleptsov proposed a new technique for Tention-Free Thyroidectomy (TFT), which demonstrated a significant reduction in the level of specific complications.AIM: To conduct a pilot study to assess the reproducibility, efficacy and safety of TFT in the work of the endocrine surgery department of Pavlov First St. Petersburg State Medical University.MATERIALS AND METHODS: The study was conducted at the Department of Endocrine Surgery in the period from January to April 2022. Patients with surgical thyroid disease underwent a new proposed TFT intervention. The method is fully consistent with the author’s description in patent No. 2772015, and the surgeons performing the new surgical technique underwent an internship with the authors of TFT before the initiation of the study. The study is prospective, non-randomized, uncontrolled. Persistent laryngeal dysfunction and persistent hypoparathyroidism were considered the primary endpoint. Secondary endpoints were transient vocal cord paresis, hypocalcemia and hypoparathyroidism.RESULTS: The study included 20 people. The indications for surgery were endocrinological and oncological. The number of performed hemithyroidectomies were 15, thyroidectomy (TE) — 5 (one with central lymph node dissection), the volume of the thyroid gland varied from 4 cm3 to 280 cm3 . None of the patients reached the primary endpoint. There were no permanent dysfunction of the larynx in our study. Only in one patient in the postoperative period, a violation of the mobility of the vocal fold was revealed, however, during follow up on the 30th day of the postoperative period the mobility of the vocal fold was restored (confirmed by direct laryngoscopy). Hypoparathyroidism and hypocalcemia were not detected. However, it is necessary to mention the number of TE was too small.CONCLUSION: Thus, the new proposed TFT method is fully reproducible in the work of a specialized department of endocrine surgery. The method has demonstrated high rates of efficiency and safety in real clinical practice. However, further studies with a higher evidence base are required.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45838198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND. Current trends of «fast track surgery» give rise to development of new safe techniques of the thyroid and parathyroid surgery, the purpose of which is to minimize the level of postoperative complications, such as vocal cord palsy, hypoparathyroidism, bleeding. In this regard, it is important for the endocrine surgeon to save «dry operating field», which contributes to the clear visualization of such «thin» structures as the recurrent laryngeal nerve, the external branch of the superior laryngeal nerve and the parathyroid glands. Therefore, the key issue of this surgery is to understand the anatomical and topographic features of the blood supply to the internal neck organs (a complex of neck organs consisting of the thyroid and parathyroid glands, larynx, trachea, esophagus).AIM. To determine the main sources of arterial blood supply of the internal neck organs and their anatomical, topographic features.MATERIALS AND METHODS. The computed tomography protocols of cervical branches of brachiocephalic arteries were analysed in the study. The thickness of the reconstructed sections in the axial, frontal and sagittal planes was 0.35±0.05 mm. The fact of blood supply was confirmed by the anatomical close of the arterial structure to the internal organ and the presence of intramural arterial branches.RESULTS. The course of all cervical branches of the subclavian and common carotid artery was traced among 42 patients. It is noted, that only the inferior, superior thyroid arteries and thyroid ima artery supply internal neck organs with the blood. At the same time, the superior thyroid artery was visualized in all angiograms. However, the inferior thyroid artery was absent in 2.4% of cases. The thyroid ima artery was rarely detected (in 4.8% of patients). In 73.2% of cases, the inferior thyroid artery was detected high at the upper third level of the thyroid lobe and then had a descending course. In 23.2% of cases, the artery was formed at the middle third level of the thyroid lobe and was directed horizontally to the gland. Only in 3.6% of cases, the ascending course was determined in the vessel. The inferior thyroid artery was located on the posterior surface of the thyroid lobe, where it formed glandular branches. On the contrary, the branches of the superior thyroid artery were located mainly along the anterolateral surface of the thyroid gland. The average thickness of the inferior thyroid artery was 2.1±0.5 mm, and the superior thyroid artery was 1.6± 0.7 mm.CONCLUSION. According to the study, arterial blood supply to the internal neck organs is provided mainly by the inferior and superior thyroid arteries. At the same time, the trunk of the inferior thyroid artery is larger than the superior thyroid artery (p=0.032). The inferior thyroid artery forms branches along the posterior surface of the thyroid lobe and from a topographic point of view it is the main source of blood supply to the parathyroid glands. In most cases, the inferior thyr
{"title":"Arterial blood supply of the internal neck organs: anatomy, topography, clinical significance in endocrine surgery","authors":"A. Kuprin, V. Malyuga, E. Stepanova","doi":"10.14341/serg12720","DOIUrl":"https://doi.org/10.14341/serg12720","url":null,"abstract":"BACKGROUND. Current trends of «fast track surgery» give rise to development of new safe techniques of the thyroid and parathyroid surgery, the purpose of which is to minimize the level of postoperative complications, such as vocal cord palsy, hypoparathyroidism, bleeding. In this regard, it is important for the endocrine surgeon to save «dry operating field», which contributes to the clear visualization of such «thin» structures as the recurrent laryngeal nerve, the external branch of the superior laryngeal nerve and the parathyroid glands. Therefore, the key issue of this surgery is to understand the anatomical and topographic features of the blood supply to the internal neck organs (a complex of neck organs consisting of the thyroid and parathyroid glands, larynx, trachea, esophagus).AIM. To determine the main sources of arterial blood supply of the internal neck organs and their anatomical, topographic features.MATERIALS AND METHODS. The computed tomography protocols of cervical branches of brachiocephalic arteries were analysed in the study. The thickness of the reconstructed sections in the axial, frontal and sagittal planes was 0.35±0.05 mm. The fact of blood supply was confirmed by the anatomical close of the arterial structure to the internal organ and the presence of intramural arterial branches.RESULTS. The course of all cervical branches of the subclavian and common carotid artery was traced among 42 patients. It is noted, that only the inferior, superior thyroid arteries and thyroid ima artery supply internal neck organs with the blood. At the same time, the superior thyroid artery was visualized in all angiograms. However, the inferior thyroid artery was absent in 2.4% of cases. The thyroid ima artery was rarely detected (in 4.8% of patients). In 73.2% of cases, the inferior thyroid artery was detected high at the upper third level of the thyroid lobe and then had a descending course. In 23.2% of cases, the artery was formed at the middle third level of the thyroid lobe and was directed horizontally to the gland. Only in 3.6% of cases, the ascending course was determined in the vessel. The inferior thyroid artery was located on the posterior surface of the thyroid lobe, where it formed glandular branches. On the contrary, the branches of the superior thyroid artery were located mainly along the anterolateral surface of the thyroid gland. The average thickness of the inferior thyroid artery was 2.1±0.5 mm, and the superior thyroid artery was 1.6± 0.7 mm.CONCLUSION. According to the study, arterial blood supply to the internal neck organs is provided mainly by the inferior and superior thyroid arteries. At the same time, the trunk of the inferior thyroid artery is larger than the superior thyroid artery (p=0.032). The inferior thyroid artery forms branches along the posterior surface of the thyroid lobe and from a topographic point of view it is the main source of blood supply to the parathyroid glands. In most cases, the inferior thyr","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43048479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Y. Pikunov, A. A. Pechetov, O. Golounina, S. Buryakina, L. Y. Rozhinskaya, Z. Belaya
BACKGROUND: The Department of Thoracic Surgery of the National Medical Research Center of Surgery named after A. V. Vishnevsky has been dealing with the problem of surgical treatment of patients with neuroendocrine lung tumors for more than 20 years. This article presents the experience of treating patients with ectopic ACTH syndrome over the past 15 years.AIM: To study the features of preparation, surgical aspects of treatment and delayed results in patients with ACTH-producing tumors of bronchopulmonary localization.MATERIALS AND METHODS: The study included 55 patients who underwent surgical treatment of ACTH-producing neuroendocrine tumor of bronchopulmonary localization in the period from 2005 to 2020. In order to systematize the approach to surgical treatment and the choice of the type of operation, a point analysis of the patient’s severity has been developed. Demographic information about patients, anamnesis data, results of hormonal and instrumental studies at pre- and postoperative stages and long-term treatment results were analyzed. The control period of observation of patients after surgery ranged from 6 months to 5 years.RESULTS: The age of the patients ranged from 18 to 72 years (36±15). According to the MSCT results of the chest, neoplasms in the lungs ranging in size from 5 to 25 mm were detected. Patients who scored from 18 to 23 points had lung resection due to the severity of the condition. With a total score from 14 to 18, segmentectomy with lymph node dissection was performed. When the total score was less than 14, a lobectomy with lymph node dissection was performed. During the planned histological examination, lung neuroendocrine tumor of various differentiation degree was confirmed in all patients. The results of treatment were followed in the period from 6 to 60 months, with a median of 19 months [10;24]. Regression of clinical manifestations of hypercortisolism after 1 year of dynamic follow-up period was detected in 83% of patients. After 60 months of follow-up 10 patients (71.4%) had a persistent clinical effect after surgical treatment with complete regression of hypercortisolism symptoms.CONCLUSION: The analysis of the results of surgical treatment, according to the proposed methodological aspects, with dynamic control after 6, 12 and 36 months showed the effectiveness of such surgical intervention with results comparable to the world indicators of leading clinics.
{"title":"Features of preparation and surgical aspects of treatment of patients with ACTH-producing neuroendocrine lung tumors","authors":"M. Y. Pikunov, A. A. Pechetov, O. Golounina, S. Buryakina, L. Y. Rozhinskaya, Z. Belaya","doi":"10.14341/serg12721","DOIUrl":"https://doi.org/10.14341/serg12721","url":null,"abstract":"BACKGROUND: The Department of Thoracic Surgery of the National Medical Research Center of Surgery named after A. V. Vishnevsky has been dealing with the problem of surgical treatment of patients with neuroendocrine lung tumors for more than 20 years. This article presents the experience of treating patients with ectopic ACTH syndrome over the past 15 years.AIM: To study the features of preparation, surgical aspects of treatment and delayed results in patients with ACTH-producing tumors of bronchopulmonary localization.MATERIALS AND METHODS: The study included 55 patients who underwent surgical treatment of ACTH-producing neuroendocrine tumor of bronchopulmonary localization in the period from 2005 to 2020. In order to systematize the approach to surgical treatment and the choice of the type of operation, a point analysis of the patient’s severity has been developed. Demographic information about patients, anamnesis data, results of hormonal and instrumental studies at pre- and postoperative stages and long-term treatment results were analyzed. The control period of observation of patients after surgery ranged from 6 months to 5 years.RESULTS: The age of the patients ranged from 18 to 72 years (36±15). According to the MSCT results of the chest, neoplasms in the lungs ranging in size from 5 to 25 mm were detected. Patients who scored from 18 to 23 points had lung resection due to the severity of the condition. With a total score from 14 to 18, segmentectomy with lymph node dissection was performed. When the total score was less than 14, a lobectomy with lymph node dissection was performed. During the planned histological examination, lung neuroendocrine tumor of various differentiation degree was confirmed in all patients. The results of treatment were followed in the period from 6 to 60 months, with a median of 19 months [10;24]. Regression of clinical manifestations of hypercortisolism after 1 year of dynamic follow-up period was detected in 83% of patients. After 60 months of follow-up 10 patients (71.4%) had a persistent clinical effect after surgical treatment with complete regression of hypercortisolism symptoms.CONCLUSION: The analysis of the results of surgical treatment, according to the proposed methodological aspects, with dynamic control after 6, 12 and 36 months showed the effectiveness of such surgical intervention with results comparable to the world indicators of leading clinics.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43287528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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