Circumferential Sleeve Resection Research Articles

Anastomosis in the absence of a suprahyoid release following circumferential sleeve resection is feasible in differentiated thyroid carcinoma patients with tracheal invasion

Invasion of the trachea is observed in ~6% of patients with differentiated thyroid carcinoma (DTC), and surgery is accepted as the treatment of choice. However, surgical procedures can be challenging and are associated with various risks. The authors of the present study performed a retrospective study of patients with DTC and tumor invasion of the trachea. Outcomes from patients that received circumferential sleeve resection (CSR) of the trachea followed by anastomosis in the absence of suprahyoid release (n=21; CSR group) and patients that underwent tangential resections [n=103; tangential ‘shave’ resection (TSR) group) were analyzed. In the CSR group, 4 to 8 tracheal rings were circumferentially resected. All patients underwent end-to-end anastomosis in the absence of suprahyoid release following CSR, and 7 patients developed cancer metastasis following surgery. With the exception of 2 patients that succumbed to disease, the remaining patients in the CSR group survived without cancer recurrence. In the TSR group, all of the patients experienced cancer recurrence within five years post-surgery. A total of 61 patients developed metastases in the three years following surgery, and 71 patients succumbed to cancer metastasis within five years. The survival rate of the CSR group was significantly increased compared with the TSR group. The results of the present study suggest that in DTC patients with defects involving up to 8 tracheal rings, it may be appropriate to perform anastomosis without suprahyoid tissue release as it is associated with a reduced incidence of perioperative morbidity.

Mo1678 30-Day Readmission After Laparoscopic Sleeve Gastrectomy - A Predictable Event?

Corrosive injuries to the upper gastrointestinal tract is one of the difficult problems to treat. It resultsin major morbidity and mortality. Corrosives are substances which corrode and destroy tissues through direct chemical reaction. The strictures can present with various severity in pharynx, oesophagus and stomach. Isolated gastric strictures are less observed. Although corrosive substances can reach rapidly from oesophagus onto the stomach, they get stagnant in the prepyloric region because of pyloric spasm. The stricture may involve antrum, body and the pyloroduodenal area or diffusely the entire stomach depending upon the rapidity of spread of the ingested corrosive substance. We have classified the gastric strictures so as to optimize the treatment options based on the subtype. We herewith formulate a newworking classification. Treatment options according to the classified subtypes are also suggested to optimize the outcome. Data: 48 patients of isolated gastric stricture were included in this study. We had 20 patients with Type I; 12 underwent arcade preserving antrectomy, 14 had Bilroth Type I and 6 had Bilroth Type II restoration. We had one Type IIA; managed by strictureplasty. Four Type IIB; managed with pylorus preserving antrectomy. We had three Type III; treated by circumferential sleeve resection and gastrogastrostomy. We had five Type IV; managed with total gastrectomy. We had one Type V; managed by limited oesophagogastrectomy. We had three Type VI; managed by gastrojejunostomy as these patients had first part duodenal involvement. We had eleven Type VII; called as gastrocele; managed with antrectomy and colon pullup in five, gastrojejunostomy and colon pullup in three and antrectomy and retrograde dilatation in two. One patient died due to massive aspiration prior to treatment. There were acceptable morbidiy and two mortality in this series. Our new working formulation will form the basis of care in patients with gastric corrosive strictures.

Segmental tracheal resection for invasive differentiated thyroid carcinoma. Our experience in eight cases

In differentiated thyroid carcinoma (DTC), complete resection of local disease provides the longest survival and the best palliation. In pursuit of this goal, segmental tracheal or laryngotracheal resection can be performed on patients with DTC invading the airway. The study summarizes the technical aspects of the intervention and analyzes its results in eight patients. The results of eight tracheal or laryngotracheal resections for DTC invading the airway were analyzed. Three patients presented with local recurrent disease, whereas five underwent airway resection at the time of thyroidectomy or shortly after. All received a circumferential sleeve resection of the trachea (2–4 tracheal rings) that in three cases extended to the cricoid, followed by end-to-end anastomosis. Pathologic evaluation identified seven papillary and one poorly differentiated carcinomas. No postoperative deaths occurred; one patient required surgical reexploration because of postoperative bleeding, and two air leaks resolved with conservative treatment. Functional results were excellent. During follow-up, one patient died of lung and bone metastases, while in two cases locally persistent/recurrent disease has been detected; two patients are currently free of disease, and in the last three cases only persistent thyroglobulin levels are indicative of residual disease. In our experience, segmental airway resection is safe, provides excellent functional results, and can warrant adequate control of local disease.

The management of thyroid carcinoma invading the larynx or trachea

To describe the controversies in the management of thyroid carcinoma invading the airway. Contemporary review of literature; level of evidence: 5. Invasion of the larynx or trachea by thyroid carcinoma is uncommon and often identified at the time of operation, when the surgeon must decide the extent of resection. Invasion of the airway is associated with loss of tumor differentiation and a reduction in long-term survival compared to tumors limited to the thyroid gland. Whether or not the invaded airway should be resected remains controversial. Tangential shave excision of tumor is commonly performed, despite a marked risk of local recurrence. Circumferential sleeve resection of the larynx and trachea is safe and lowers the risk of local recurrence. In recurrent disease, laryngotracheal resection provides effective palliation of airway obstruction and hemoptysis. Long-term (>10-20 years) prospective studies are required to compare the outcome after shave excision with segmental airway resection for thyroid carcinoma. Based on the current literature and on our experience, we advocate circumferential tracheal resection in the setting of airway involvement.

Surgical Techniques and Results for Partial or Circumferential Sleeve Resection of the Pulmonary Artery for Patients with Non-Small Cell Lung Cancer

Surgical Techniques and Results for Partial or Circumferential Sleeve Resection of the Pulmonary Artery for Patients with Non-Small Cell Lung Cancer

Surgical Techniques and Results for Partial or Circumferential Sleeve Resection of the Pulmonary Artery for Patients with Non-Small Cell Lung Cancer

We assessed our experience with partial or circumferential resection of the pulmonary artery during lobectomy. We retrospectively reviewed a prospective electronic database of patients who underwent pulmonary artery resection. The technique used was an R0 resection with end-to-end anastomosis only if needed, distal control of the pulmonary artery by clamping the vein (not the artery), and no postoperative anticoagulation. Between October 1998 and June 6, 2006, 42 (3.2%) of 1328 patients who underwent lobectomy performed by one surgeon required resection of the pulmonary artery (38 partial, 4 circumferential) to achieve a margin-negative resection and avoid pneumonectomy. Of these, 41 had non-small cell lung cancer, and 23 (55%) had neoadjuvant chemoradiotherapy (median dose of 60 Gy). Right upper lobectomy was performed in 2 patients and a left upper lobectomy in 40. A negative bronchial and vascular margin was achieved in all. Morbidity occurred in 11 patients (atrial fibrillation in 6) and left recurrent laryngeal neurapraxia in 2. Aspiration resulted in one operative death. Follow-up (median, 48 months) showed no local recurrence on the pulmonary artery and normal blood flow through it. Five-year survival was 60%. Pulmonary artery resection and reconstruction to avoid pneumonectomy can be performed safely, even in a highly irradiated field. Clamping of the remaining pulmonary vein for distal control is safe and affords more room. Circumferential resection with end-to-end anastomosis of the pulmonary artery is rarely required. Partial resection is safe, does not impede blood flow, and does not compromise local recurrence rates. Postoperative anticoagulation is not needed.

The management and prognosis of laryngotracheal invasion by well-differentiated thyroid carcinoma

To explore the treatment and prognosis on patients with laryngotracheal invasion by well-differentiated thyroid carcinoma (DTC). Eighty-six patients treated for DTC with laryngotracheal invasion between 1976 and 1996, from Beijing Chaoyang Hospital and Cancer Hospital, Chinese Academy of Medical Sciences, were retrospectively analyzed. The different kinds of surgical modalities were performed according to the extent of laryngotracheal invasion by DTC, including shave excision (39 cases), tracheal window resection (11 cases), circumferential sleeve resection (8 cases), total laryngectomy (2 cases) and incomplete tumor resection (26 cases). Some patients received postoperative radiotherapy. Survival was evaluated using the Kaplan-Meier method. (1) Thirty-nine patients with laryngotracheal invasion were treated with shave excision, the 5- and 10-year survival rates were 92.3% (36/39) and 75.9% (22/29), respectively. Nine patients received postoperative radiotherapy, 30 patients didn't received postoperative radiotherapy. After a shave excision, the differences of 5- and 10-year survival rates between the irradiated and nonirradiated patients were not statistically significant (P >0.05). (2) Twenty-one patients underwent radial excision for intraluminal involvement extending through the laryngotracheal cartilage, including circumferential sleeve resection, tracheal window resection and total laryngectomy, the survival rate was 85.7% (18/21) for five years and 53.9% (7/13) for ten years. Eleven patients received postoperative radiotherapy, 10 patients didn't received postoperative radiotherapy. After a radial excision, the differences of 5- and 10-year survival rates between underwent irradiated and nonirradiated patients were not statistically significant (P >0.05). (3) For the 26 patients receiving the incomplete resection, the 5- and 10-year survival rates were 50.0% (13/26) and 19.2% (5/26), respectively. For 9 patients receiving postoperative radiotherapy, the 5- and 10-year survival rates were 77.8% (7/9) and 55.6% (5/9), respectively. 17 patients did not received postoperative radiotherapy, the 5-year survival rate was 35.5% (6/17). No patient survived for ten years. Tumors with minimal invasion could be treated successfully by shaving tumor from the aerodigestive tract. Intraluminal involvement extending through the laryngotracheal cartilage should be resected completely to prevent complications, such as airway hemorrhage or suffocation, and markedly improve the survival for patients with invasive DTC.

Pharyngolaryngoesophagectomy for well-differentiated papillary thyroid carcinoma widely invading the upper aerodigestive tract

Surgery 2002;132:885-8.

Surgery for patients with thyroid carcinoma invading the trachea: Circumferential sleeve resection followed by end-to-end anastomosis

Curative surgery can be accomplished by tracheal resection in patients with thyroid carcinoma invading the trachea; however, there is controversy regarding the extent of the tracheal resection. In this study we investigated by means of histologic examination the mode of tracheal invasion by thyroid carcinoma. Twenty-one patients with thyroid carcinoma invading the trachea underwent circumferential sleeve resection of the involved trachea. The extent of invasion of the tracheal wall on the adventitial and mucosal sides was compared on histologic examination. Three to nine tracheal rings were resected. Assessment of longitudinal spread showed that one to six rings (mean; 3.1 rings) were invaded on the adventitial side but only zero to four rings (mean; 1.9 rings) on the mucosal side, with invasion on the mucosal side never exceeding invasion on the adventitial side. In contrast, examination of circumferential spread showed invasion on the mucosal side exceeding invasion on the adventitial side in five cases. Our results suggest that when the extent of invasion of the adventitia is considered, carcinoma tissue may be left behind on the mucosal side of the trachea when partial wedge resection is performed and that, whenever feasible, circumferential sleeve resection should be performed in patients with thyroid carcinoma invading the trachea.