Bilateral Node Dissection Research Articles

Scope of prophylactic lymph node dissection in the surgical treatment of differentiated thyroid cancer. Recommendations of the AFCE (Association francophone de chirurgie endocrinienne) with the SFE (Société française d’endocrinologie) and the SFMN (Société française de médecine nucléaire)

Prophylactic lymph node dissection is considered only for papillary cancers. It is not indicated for vesicular cancers or oncocytic cancers, nor should it entail a secondary surgical intervention in the event of an incidental discovery of papillary cancer on a thyroidectomy specimen. Prophylactic lymph node dissection means a cervical lymph node dissection in the absence of any pre- or intraoperative evidence (biological, cytological, histological, clinical or ultrasound) of lymph node metastases. There is currently no evidence in the literature that prophylactic central dissection improves overall survival, which is similar for N0 and NX patients. Yet although prophylactic lymph node dissection is not justified by overall survival, it does seem to reduce the risk of locoregional recurrence in the case of micro-N1, and it allows occult metastases to be detected and a tumour to be reclassified. This enables patients at risk of recurrence to be more surely identified and therapeutic strategy and follow-up adapted accordingly. Prophylactic homolateral central lymph node dissection is warranted for papillary cancers with largest ultrasound diameter 4cm and above and/or with intraoperative macroscopic evidence of perithyroid tissue invasion. The benefits and risks of lymph node dissection must be assessed and discussed on a case-by-case basis. Only a central lymph node dissection homolateral to the tumour is recommended, except for bilateral or isthmic cancers, for which a prophylactic bilateral central lymph node dissection may be considered. This bilateral lymph node dissection incurs an increased risk of complications (parathyroids, recurrent laryngeal nerve). Prophylactic lateral lymph node dissection is not recommended.

Occult lymph node metastasis in cN0 tongue squamous cell carcinoma: A prospective observational study.

e18066 Background: Tongue squamous cell carcinoma (TSCC) is prone to occult lymph node metastasis, and preoperative evaluation of cervical nodes is critical for determining treatment strategies. There is scarce report of detecting occult lymph node metastasis in TSCC by using multi-parameter magnetic resonance imaging (mpMRI), spectral computed tomography (spectral CT) or other diagnostic functional imaging. In this study, we aimed to analyze the incidence and risk factors of occult lymph node metastasis in cN0 TSCC by comparing preoperative imaging with postoperative pathology results. Methods: This study prospectively enrolled newly-diagnosed cN0 TSCC patients admitted to the Hunan Cancer Hospital between May, 2022 and December, 2022. All patients underwent primary resection and selective dissection of cervical lymph nodes. MpMRI and spectral CT scan of oral cavity and neck were performed prior to surgery. Preoperative evaluation of lymph node metastasis was conducted by two senior radiologist independently. The location of cervical lymph nodes was assigned based on the 2013 consensus guidelines. Results: A total of 26 cN0 TSCC patients (6 cT1 stage, 13 cT2 stage, and 7 cT3 stage) were enrolled. The median age was 53 (range, 36-64), and there were 25 males. Among all patients, 13 patients underwent unilateral cervical lymph node dissection, while 13 patients underwent bilateral cervical lymph node dissection. A total of 208 lymphatic drainage areas were resected, and 1003 lymph nodes were removed. There were 7 of pT1, 12 of pT2, 7 of pT3 based on postoperative pathological stages. Besides, there are 21 cases staged pN0, 2 cases staged pN1, 2 cases staged pN2, and 1 case staged pN3. Among the 26 patients, 5 (19.23%) cases had occult lymph node metastasis. A total of 8 metastatic lymph nodes (4 in ipsilateral Ib level, 1 in contralateral Ib level, 3 in IIa level ipsilateral side) were detected in the whole group. No lymph node metastasis was detected in level IIb, III and IV. The median maximum diameter of metastatic lymph nodes was 12 mm (range 5 to 15 mm), and 1 extra-nodal extension was observed. Moreover, all occult lymph node metastases occurred in patients with a primary invasion depth of ≥ 5 mm (29.41%, 5/17). Conclusions: The incidence of occult lymph node metastasis in cN0 TSCC remains high under functional imaging diagnostic technology. Preventive neck dissection is necessary for patients with cN0 disease, especially those with primary tumor invasion depth exceeding 5 mm.

Cutaneous Radiation-Associated Angiosarcoma After Treatment of Carcinoma Penis: First Report from Tertiary Cancer Centre of North India.

Cutaneous radiation-associated angiosarcoma (cRAA) is a rare and aggressive secondary cutaneous angiosarcoma (cAS) with poor survival. cRAA has been mostly reported in breast carcinoma patients. Owing to its rarity, there is scanty literature available and no treatment guidelines. To the best of our knowledge, this is the first report of cRAA after multimodality treatment of carcinoma penis. A sixty-eight-year-old gentleman, a known case of carcinoma penis, underwent total penectomy with perineal urethrostomy and bilateral radical inguinopelvic lymph node dissection 6 years ago. He received adjuvant radiotherapy to the pelvis and bilateral groin. He presented with a bleeding plaque-like lesion with ulceration over the left lower abdomen (within previous radiation field) which rapidly progressed in size over the past 2 months. On examination, the lesion bled profusely on touch. Contrast MRI was suggestive of lobulated exophytic enhancing cutaneous lesion free from underlying muscle. Wedge biopsy was suggestive of cutaneous angiosarcoma. He underwent wide local excision with local perforator flap reconstruction from the right lower abdomen. Histopathology was suggestive of cutaneous angiosarcoma which showed immunoexpression of CD31, ERG1, cMYC suggestive of cRAA. cRAA is a very aggressive disease with 5-year survival of15-34%. To the best of our knowledge, this is the first ever reported case of cRAA of lower abdomen after multimodality management of carcinoma penis. It masquerades with other benign and less aggressive radiation-induced skin lesions. cMYC immunoexpression is specific for secondary cAS. Wide local resection with negative margin provides the best outcome.

Surgical treatment of patients with a combined forms of pulmonary tuberculosis and lung cancer

Objective — to improve surgical treatment of patients with combined forms of pulmonary tuberculosis and non small cell lung cancer due to minimally invasive diagnostics and with the use of sterno-mediastinal surgical dissection of tissue and complete systematic bilateral lymph node dissection (CSBLND). Materials and methods. Our studies involved retrospective analysis of 101 cases of treatment of patients with stage I—II—IIIА non-small cell lung cancer (NSCLC) and pulmonary tuberculosis. A review of diagnostics and operations over the past decade were conducted. All patients underwent surgical treatment. The main group included 48 patients who underwent 16 lobectomy and 32 pneumonectomy from the sternomediastinal access. A comparative analysis of the effectiveness of the CSBLND was carried out. The comparison group included 53 patients who underwent 17 lobectomy and 36 pneumonectomy, a surgical operation for lateral thoracotomy and selective dissection of the mediastinal lymph nodes was performed. Results and discussion. The analysis of the morphological features of combined forms of pulmonary tuberculosis and NSCLC has been made in comparison groups, that were explored retrospectively. There was a trend improved survival patients combined forms of pulmonary tuberculosis and NSCLC stage I—II—IIIA, who underwent of CSBLND (p = 0.05). A statistically significant of survival of patients who underwent pneumonectomy in the mail group (n = 32) with CSBLND (p = 0.01). In a comparative analysis of the frequency and nature of complications during surgery, we found out that in general in the main group they met in 2.1 times less often than in the comparison group (p < 0.05). Complications during operation in patients of the main group occurred in (11.4 ± 2.6) %, while in the comparison group — in (22.6 ± 4.2) % of cases. The analysis of data showed that patients with adenocarcinoma of lung cancer have been improvements in the performance of sterno-mediastinal surgical techniques (CSBLND) (p = 0.12). Therefore, patients with combined forms of pulmonary tuberculosis and NSCLC for suspected «jumping metastases» we recommended to carry out operations with sternotomy surgical access with full system bilateral lymph nodes dissection and radical rezection of pathologically altered lung. All this requires further development of high-tech surgical techniques in our country. Conclusions. The leading effect of pulmonary tuberculosis on the surgical treatment of patients with combined forms of tuberculosis and lung cancer has been shown in groups of comparison. The increase of 3 years survival in patients of basic groups is set, demonstrating the advantage of active diagnostical surgical tactics of stage I—II—IIIА NSCLC with used sterno-mediastinal access and the appliance of more radical CSBLND. Thus, the clinical effect of operative patients of the main groups in the immediate postoperative period was reached 95.7 % patients, in the groups comparison clinical effect be noted in 80.5 %.

Impact of bilateral mediastinal lymph node dissection on pulmonary function during the early postoperative period after curative-intent lung surgery for cancer: a randomized study.

Bilateral lymph node dissection is not a standard surgical treatment for non-small cell lung carcinoma. However, data from anatomical studies showing lymph flow to the contralateral mediastinal lymph nodes have prompted attempts to extend lymph node dissection to the contralateral mediastinum. Little is known about the functional effects of extended lymphadenectomy. This study aimed to determine whether bilateral mediastinal lymphadenectomy (BML) performed as part of lung cancer surgery leads to more severe impairment of respiratory function than standard systematic lymph node dissection (SLND). Respiratory function data were derived from a randomized clinical study (BML-1), which included patients with non-small cell lung cancer (NSCLC) who underwent curative-intent lung resection with standard SLND or BML. Lung function tests were performed preoperatively and on postoperative days 1, 3-5, 7-9, and 30-32. Data from 89 patients were available for the final analysis of the BML-1 study: 40 and 49 underwent BML and SLND, respectively. Complete respiratory function test data were available for 35 patients. The age, sex, Thoracoscore, revised cardiac risk index, dyspnea score, lobar location of the tumor, histology, preoperative pulmonary function test results, and type of lung resection were comparable for both groups. The vital capacities (VCs) were not different on postoperative days 1, 3-5, 7-9, and 30-32 (P=0.49, 0.66, 0.18, and 0.16, respectively). The forced expiratory volumes in 1st second (FEV1) obtained at the same time points were not different (P=0.40, 0.72, 0.81, and 0.32, respectively). BML was not associated with a more severe deterioration of respiratory function than standard (unilateral) lymph node dissection.

Sexual function and fertility preservation in testicular cancer survivors

Testicular cancer is a common cancer among reproductive age men, with the necessary treatment options having varying impacts on fertility and sexual function. Treatment begins with orchiectomy and is often followed by a combination of chemotherapy, radiation, and/or retroperitoneal lymph node dissection, which have different effects on spermatogenesis, gonadotropin levels, and ejaculation. Alkylating agents such as cisplatin are commonly used for testicular cancer and are amongst the most spermatotoxic chemotherapeutic agents. Radiation poses gonadotoxic effects despite gonadal shielding due to a scatter effect. Suprahilar and bilateral retroperitoneal lymph node dissections can cause ejaculatory dysfunction. Options to preserve fertility vary by pubertal status. While the standard recommendation for post pubertal patients is cryopreservation, prepubertal patients rely on experimental protocols for cryopreservation of germ cells with stem cell capabilities, with the hope that these cells will one day be stimulated to produce sperm. These topics are reviewed to give insight into current literature around fertility in testicular cancer survivorship and determine best possible practices in fertility preservation among patients.

Nasopharyngeal Relapse of Conjunctival Melanoma Four (04) Years after Complete Resection: About One (01) Case

Context: Malignant melanoma of the mucous membranes of the nasopharynx is extremely rare. Despite improved diagnostic capabilities, these lesions are often diagnosed at an advanced stage and the prognosis is poor, in part related to the high rate of recurrence and metastasis. Case Presentation: We report one (01) case of relapse of a malignant mucous melanoma of the nasopharynx, four (04) years after complete conjunctival resection in a fifty (50) year old woman. Before the signs of call for epistaxis, an X-ray workup performed showed a nasopharyngeal tumor, followed by surgical resection with bilateral cervical lymph node dissection. Histology reveals a malignant melanoma without lymph node involvement. Adjuvant radiotherapy was delivered. The control by emission of positron (PET) at six (06) months after the end of adjuvant treatment did not find any lesions. Conclusion: To our knowledge, this is the first case report of a diagnosis of nasopharyngeal melanoma after four (04) years of complete remission. In view of the aggressive high rate of recurrence and metastasis, close monitoring and radiological workup at the slightest sign of calling should be required. Thus, the diagnosis will be made at an early stage which could improve the prognosis.

Clinicopathological characteristics of carcinoma penis over 10years in a tertiary-level oncology center in Nepal: a retrospective study of 380 cases.

This study was done to find out the clinicopathological characteristics of carcinoma penis in Nepali population and to evaluate various risk factors that predict its inguinal lymph node metastasis. A retrospective cross-sectional study was carried out at the Urology Unit, Department of Surgical Oncology at BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Case notes of biopsy-proven penile cancer, from January 2012 to December 2021, who underwent some form of surgical intervention were included. A total of 380 patients were included in the study. The mean age of the patients was 55.92 ± 13.81years. At presentation, 78.5% had clinically node-positive disease. The most common treatment for the primary tumor was partial amputation of the penis (74.2%). Bilateral inguinal lymph node dissections were done in 370 cases. The most common histology was the usual SCC in 94.2% of cases and 69% were well differentiated. T3 was the most common staging in 49.4% cases. Pathologically nodal negative status was found in 58% cases. In univariate analysis, factors like duration of symptoms (≥ 6months), high-risk histopathology (basaloid/sarcomatoid variant), increased T-stage, poorly differentiated tumor, and the presence of PNI or LVI were significantly associated with lymph node metastasis. Penile cancer is a common cancer in developing countries such as Nepal. The majority of the patients present late. Early recognition and prompt treatment are required to improve the overall outcome.

How to do an open midline extraperitoneal bilateral retroperitoneal lymph node dissection for non-seminomatous germ cell tumour.

Retroperitoneal lymph node dissection, remains a crucial step in the management of patients with non-seminomatous germ cell tumours who have undergone chemotherapy. It is a technically challenging operation with a number of techniques that have been advocated. We outline the midline, extraperitoneal approach to perform a bilateral template lymph node dissection.

RF07 | PSAT233 The First Case Report of a de-novo Purely Prostatic Large Cell Neuroendocrine Carcinoma with Thyroid and Adrenal Metastases

Abstract Background Large Cell Neuroendocrine Carcinoma (LCNEC) is the rarest neuroendocrine prostatic malignancy. It usually arises after androgen-deprivation therapy (ADT), while de novo cases are even more infrequent with only 6 cases described to date. Case presentation A 78-year-old man with no history of ADT presented with cervical lymphadenopathy. Diagnostic approach included PET/CT, MRI, and CT scans, U/S, biopsies, cytological and immunohistochemical evaluations. CT revealed a non-enriching region on the right lobe of the thyroid gland. An 18F-FDG PET-CT found increased uptake in the thyroid gland and both adrenal glands. Neck ultrasound identified a right thyroid lobe nodule. A fine needle aspiration of the nodule was performed and cytology was consistent with poorly differentiated carcinoma. A total thyroidectomy with central and bilateral lymph node dissection was performed and the pathology report diagnosed a LCNEC metastatic to the thyroid gland. Additional metastases were identified in both adrenal glands. Despite appropriate treatment, the patient succumbed to his disease. Summary We report the first patient with a de novo purely prostatic LCNEC, metastasizing to the thyroid and the adrenal glands. Conclusions De novo LCNECs of the prostate are very rare, highly aggressive tumors with poor prognosis. They are resistant to most therapeutic agents, have high metastatic potential and are usually diagnosed at an advanced stage. Further studies are needed to characterize these tumors. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:24 p.m. - 1:29 p.m.

Mucoepidermoid carcinoma of the palate: a rare case report

<p class="abstract">The salivary glands home of several tumoral pathologies, diversified by their locations and their histological types. Described as a rare malignant tumor of the accessory salivary glands, more so in the palatine bone; the diagnosis of Mucoepidermoid carcinoma (CME) remains difficult to evoke due to the uncommonness of the clinical signs and the insidious evolution. The purpose of this case report is to discuss the clinical manifestation, diagnosis, treatment and the follow-up plan of this case. A 39-year-old patient, with no prior pathological history, presents with a painless swelling on the palate evolving for 4 years causing swallowing difficulties without any other signs, several clinical, radiographic and histopathological investigations were carried out for excision of the lesion. Biopsy of the lesion confirmed the diagnosis as mucoepidermoid carcinoma of the palate, following which wide surgical excision with adjacent free margins was performed, the additional surgical treatment consisted of bilateral functional lymph node dissection of groups I, II and III. The follow-up of the patient shows a good improvement in the local condition in the 18 months, after 36 radiotherapy sessions and without signs of recurrence. On the control CT scan with placement of an obturator palatal prosthesis to improve the quality of life awaiting a palatal flap. This case report highlights the need for diagnosis and of an appropriate treatment plan in cases of malignant tumors, as this can lead to morbidity and mortality.</p>

Cutaneous metastasis of carcinomatous component of ovarian carcinosarcoma: A case report and review of the literature

Skin metastasis of ovarian cancer is extremely rare. We report an unusual case of ovarian carcinosarcoma with cutaneous metastasis of carcinomatous component that displayed distinct clinical manifestation. A 48-year-old woman presented to the dermatologist complaining of a new onset of erythematous, plaque-like skin rash with multiple small nodules on the left inner thigh, the area measuring 8 × 5cm. While the patient had no history of dermatologic conditions, she underwent a total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection 16 months ago with a pathology confirmed stage IIIC ovarian carcinosarcoma. Of note, the carcinomatous component, mainly adenocarcinoma with hybrid features of seromucinous, endometrioid and minor high-grade serous carcinoma, involved bilateral fallopian tubes, omentum, and parametrium with extensive lymph node metastases. A skin biopsy specimen revealed an adenocarcinoma involving epidermis, dermis, and subcutaneous tissue with nodular contours, consistent with metastatic carcinomatous component of carcinosarcoma. Both carcinomatous component of primary ovarian carcinosarcoma and metastatic adenocarcinoma in the skin demonstrated Pax8, WT-1, and ER positivity and a mutation pattern of p53. The patient passed away 15 months after identification of skin metastasis. This case represents a unique example of cutaneous metastasis of ovarian carcinosarcoma with distinct clinical manifestation and detailed histopathological description. Alertness to the possibility of cutaneous metastasis, in combination with clinical history, morphological and immunohistochemical findings, is critical for a definitive classification.

S2233 Anorectal Melanoma

Introduction: Mucosal melanoma is rare and accounts for approximately 1% of all melanomas. Mucosal melanomas occur primarily in the head and neck (55%), anorectal, and vulvovaginal regions (18%). Anorectal mucosal melanoma accounts for 0.05% of all colorectal malignancies and 1% of all anal canal cancers. Case Description/Methods: A 61 year-old-male patient with no significant past medical history presented to the hospital with anal pain for one month with subsequent rectal bleeding. On examination, his heart rate and blood pressure were within normal limits. His digital rectal exam was remarkable for a palpable anorectal mass. His blood tests showed no anemia. Colonoscopy revealed a large non-obstructing cauliflower mass occupying the anorectum with overlying friable mucosa that easily bleeds on touch (Figure A, B). Histopathology showed undifferentiated spindle and round cell malignancy consistent with nodular type of malignant melanoma. Immunohistochemical staining revealed strong positivity for S100, Melan A, and HMB45 markers confirming the diagnosis of malignant melanoma. Magnetic resonance imaging (MRI) of the abdomen and pelvis redemonstrated a large anorectal endoluminal mass lesion with multiple enlarged presacral and bilateral internal iliac lymph nodes. Positron emission tomography-computed tomography scan (PET-CT) showed a fluorodeoxyglucose (FDG)-avid anorectal wall thickening and internal iliac lymph nodes. After a multidisciplinary team discussion, the patient underwent abdominoperineal resection with bilateral iliac lymph nodes dissection (Figure C). Discussion: Malignant melanoma of the anorectum is a rare mucosal neoplasm that typically presents in the fifth or sixth decade. Mucosal melanoma occurs in the anorectum due to abundance of the melanocytes in the mucosa of the anal canal. It usually presents with nonspecific complaints such as anal pain or rectal bleeding that can be misdiagnosed as hemorrhoids or rectal polyps and lead to delayed diagnosis. Surgical resection is the mainstay of treatment, while the benefit of radiotherapy and chemotherapy remains uncertain. This tumor is an aggressive tumor that carries a poor prognosis; and even with surgical intervention, the reported 5-year overall survival rate is 6%–15%.Figure 1.: Endoscopic image of the anorectal mass lesion on retroflection (A) and with the i-Scan (B). (C) Abdominoperineal resection with bilateral iliac lymph nodes dissection.

VE56 - Bilateral robotic assisted nerve sparing retroperitoneal lymph node dissection in a patient with non-seminomatous germ cell tumour residual after first-line chemotherapy: A video case report

VE56 - Bilateral robotic assisted nerve sparing retroperitoneal lymph node dissection in a patient with non-seminomatous germ cell tumour residual after first-line chemotherapy: A video case report

634. PERIOPERATIVE MORBIDITY AND MORTALITY AFTER STANDARD TWO-FIELD AND RADICAL THREE-FIELD ESOPHAGECTOMY – RESULTS FROM A RANDOMIZED TRIAL

Abstract The role of radical lymphadenectomy in esophageal cancer is controversial. While standard two-field lymph node dissection (2FLND) is considered the standard of care, the role of prophylactic radical three-field lymph note dissection (3FLND) is debatable. We conducted a large randomized trial comparing oncological outcomes between 2FLND and 3FLND for operable esophageal cancer. Here, we report the perioperative complications in the trial. Patients with operable esophageal squamous cell/adenocarcinoma between 18-75 years of age with no clinicoradiological supracarinal lymph node metastases were eligible. Patients were randomly allocated intraoperatively with allocation concealment (stratified by histology, T, N stage, level of growth, and neoadjuvant treatment) to 2FLND or 3FLND. Patients randomized to 2FLND underwent removal of all infracarinal mediastinal and D2 abdominal lymph nodes; patients randomized to 3FLND in addition had bilateral supracarinal mediastinal and lower cervical neck lymph node dissection. Intraoperative and postoperative details including perioperative complications were collected. Chi-square test was used for categorical and the Student t test for numeric variables. A total of 700 patients were recruited between Jan 2005 and Dec 2019 (359 2FLND, 341 3FLND). Demographic data are presented in the Table. More patients undergoing 3FLND required prolonged ventilation (4.2 vs 12%, p<0.001), had pulmonary complications (25.6 vs 38.1%, p<0.001) and anastomotic leaks (11.7% vs 17.6%, p=0.03). There were no differences in cardiac complications (0.8 vs 2.6%, p=0.08), chyle leaks (3.1 vs 3.5%, p=0.83), major morbidity (CD score >3a; 14.8% vs 19.4%, p=0.13) and mortality (4.5 vs 5.9%, p=0.4) in the two groups. Pulmonary complications and anastomotic leaks occur more frequently with 3FLND than 2FLND while major morbidity and mortality were similar. Oncological outcomes will dictate whether 3FLND is beneficial in patients with operable esophageal cancer.

Application of transverse cervical artery flap in laryngeal function preservation surgery of hypopharyngeal carcinoma

To explore the value and limitation of transverse cervical artery flap in laryngeal function preservation surgery of hypopharyngeal carcinoma. Between January 2013 and December 2019, 18 male patients with hypopharyngeal carcinoma were admitted. The patients' age ranged from 48 to 77 years, with a median age of 65 years. The disease duration ranged from 3 to 8 months (mean, 5 months). All patients were diagnosed as squamous cell carcinoma by biopsy before operation. According to the American Joint Committee on Cancer (AJCC) guidelines (2017, 8th ed), TNM staging was T2N0M0 in 9 cases, T2N1M0 in 2 cases, and T3N0M0 in 7 cases, and cTNM staging was stage Ⅱ in 9 cases and stage Ⅲ in 9 cases. The lesions of 15 cases were located in the piriform fossa of hypopharynx on one side, among which the esophageal entrance was involved in 4 cases. The lesions of 3 cases were located in the posterior wall of the hypopharynx with esophageal entrance involvement. After partial pharyngo- laryngectomy and bilateral neck lymph node dissection, the hypopharyngeal and laryngeal defects were repaired with transverse cervical artery flaps, the size of the flap ranged from 4 cm×3 cm to 6 cm×4 cm. The accompanying vein of transverse cervical artery (7 cases), external jugular vein (6 cases), and combination of both (5 cases) served as venous reflux. Retrograde external jugular venous reflux exercise was performed in 2 flaps with venous reflux obstruction during operation. The incisions at donor sites were directly sutured or via relaxed incision sutured. Radiotherapy and chemotherapy were supplemented within 3 months after operation. Tracheal cannula with air bag was used to prevent patients from aspiration in the early postoperative stage. The operation time was 4-6 hours, with an average of 4.5 hours. All patients were followed up 1-5 years (mean, 2 years and 6 months). Postoperative pathological examination showed that 7 cases had cervical lymph node metastases on the affected side, and there was no lymph node metastasis in cervical region Ⅴ; the remaining 11 cases had no lymph node metastasis. After operation, 16 flaps survived successfully, and 2 flaps with external jugular vein reflux were covered with white pseudomembrane, no flap necrosis was found after the pseudomembrane fell off. Four cases had no obvious accidental aspiration after operation; 14 cases had obvious accidental aspiration, of which 13 cases were significantly reduced at 3 months after operation, and 1 case still had obvious accidental aspiration at 6 months after operation, and the accidental aspiration decreased significantly after pulling out the gastric tube. All patients had no aspiration pneumonia. One case developed upper mediastinal lymph node metastasis at 1 year and 2 months after operation, and died of recurrence and pulmonary infection at 1 year and 3 months after operation. No recurrence or metastasis was found in the remaining 17 cases during follow-up. Tracheal cannula was successfully removed in 7 cases at 2-5 months after operation. Different degrees of accidental aspiration in 11 patients were confirmed by esophagography, so the tracheal cannula was retained. All patients had pronunciation function after operation. All incisions at the donor sites healed by first intention, and the shoulder joint function was normal. Using transverse cervical artery flap to repair the hypopharyngeal and laryngeal defects during hypopharyngeal carcinoma surgery in patients without lymph node metastasis in cervical region Ⅴ, can achieve good results of laryngeal function preservation. In cases with suspected lymph node metastasis in cervical region Ⅴ or venous dysplasia of accompanying vein of transverse cervical artery, there is a risk of tumor recurrence or flap necrosis, and the repair method needs to be cautiously employed.

Vulvar malignant melanoma: A case report and review of its management.

Vulvar malignant melanoma (VMM) is uncommon and poses a significant management challenge. Here, we presented a case of VMM managed by surgery, chemoradiation, and planned for targeted therapy. A 70- year-old woman with underlying diabetes mellitus and hypertension presented with a black-colored exophytic growth around her left vulva for two months. Initial biopsy confirmed malignant melanoma with positive staining for S100, HMB 45, and Melan A. An imaging study showed that the disease was localized to the vulva. She underwent bilateral radical vulvectomy and bilateral inguinofemoral lymph node dissection followed by radiotherapy. She had a locoregional disease recurrence, which was subsequently managed by palliative perineal radiotherapy, chemotherapy, and planned for immunotherapy. Vulvar malignant melanoma is a rare and aggressive tumor, with a poor overall prognosis, and high recurrence rate. Adjuvant chemotherapy, radiotherapy, and immunotherapy may be beneficial for local recurrence and distant metastasis cases. Molecular Analysis has a potential role in targeted therapy to improve the survival and outcome of the patient.

26P Uterine sarcoma: A retrospective Tunisian study of 103 cases

26P Uterine sarcoma: A retrospective Tunisian study of 103 cases

Clinical Efficacy of Modified Small Incision Thyroidectomy and Analysis of Influencing Factors of Postoperative Hypocalcemia.

ObjectiveAnalyze the clinical effect of modified small incision thyroidectomy and evaluate the influencing factors of hypocalcemia (EH) in patients after operation.MethodsA total of 220 patients with thyroid cancer in our hospital from October 2019 to October 2021 were selected. The patients were randomly divided into a control group and an observation group, with 110 patients in each group. The control group were treated with traditional thyroidectomy, while the observation group were treated with modified small incision surgery. The perioperative indicators of the two groups were compared. The thyroid hormone indexes of the two groups were meansured before operation and 7 days after operation, and the incidence of complications was compared between the two groups. Serum calcium was detected 7 days after operation in both groups. According to the level of blood calcium, patients were divided into EH group and normal group. The data of two groups were compared, and the related factors affecting the occurrence of EH after operation were analyzed.ResultsThe operation time, incision length and intraoperative bleeding volume of patients in the observation group were significantly lower than those of patients in the control group (p < 0.05). There was no significant difference in drainage time and postoperative drainage volume between the two groups (p > 0.05). The postoperative PTH level of patients in the observation group was significantly higher than that in the control group (p < 0.05), but there was no significant difference in FT3, FT4 and TSH levels (p > 0.05). The incidence of postoperative complications in the observation group (11.82%) was significantly lower than that in the control group (34.55%). Logistic regression analysis showed that bilateral lymph node dissection, parathyroidectomy and decreased PTH were the independent risk factors for EH in our patient after operation (p < 0.05).ConclusionThe modified small incision operation can effectively reduce the occurrence of surgical trauma and related complications. Bilateral lymph node dissection, parathyroidectomy and PTH decrease are the risk factors for postoperative EH in patients with thyroid cancer. Taking corresponding measures to improve the metabolic function of patients during perioperative period will help to reduce the incidence of postoperative EH in patients with thyroid cancer.

Locally advanced rectal cancer receiving total neoadjuvant therapy combined with nivolumab: a case report and literature review

BackgroundThe standard treatment for locally advanced rectal cancer (LARC) is preoperative chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy. However, it has been suggested that intensification of neoadjuvant treatment with polychemotherapy in addition to CRT instead of as an adjuvant chemotherapy is better tolerated and associated with a higher pathological complete response (pCR) rate. This concept is known as total neoadjuvant therapy (TNT).Recently, the addition of immunotherapy to preoperative CRT has been reported to be useful in LARC patients with mismatch-repair-deficiency and high levels of microsatellite instability (MSI-H), but there are no reports showing the therapeutic effect of nivolumab in combination with TNT.Case presentationA 23-year-old man had frequent diarrhea. Preoperative examination revealed two adenocarcinomas in the rectum. His maternal grandmother had a rectal cancer patient who developed the disease at age 70s. The larger tumor was located at the peritoneal reflection, and its anterior border close to the prostate (<1 mm); there were eight enlarged pararectal lymph nodes. Considering the size and depth of the tumor, it was judged that radical resection with sufficient margins would be difficult. Therefore, it was decided that TNT would be performed. At first, CAPOX (capecitabine and L-OHP) was administered, followed by preoperative CRT (RT:50.4 Gy and capecitabine). During this period, genetic testing diagnosed this patient as MSI-H, so additional nivolumab was administered after CRT. Colonoscopy revealed that the larger tumor was no longer detectable, so robot-assisted intersphincteric resection and bilateral lateral lymph node dissection was performed. The diagnosis of pCR was made for the larger tumor and partial response was achieved for the smaller tumor, and no lymph node metastasis was found. Major complications were not observed and the patient was discharged on the 14th day after surgery. He was followed up without adjuvant chemotherapy and is alive and recurrence-free after 9 months.ConclusionA case of LARC with MSI-H was treated with TNT with nivolumab, resulting in pCR and complete radical resection. This result suggests that nivolumab in addition to TNT can be an option as a preoperative strategy for LARC with MSI-H.