Background: Differentiated thyroid carcinoma exhibits favorable survival outcomes; however, postoperative functional morbidity remains a significant concern, requiring integrated evaluation of oncological safety and functional preservation. Objective: To evaluate functional and oncological outcomes following surgery for differentiated thyroid carcinoma, focusing on complication profiles, disease control, and associations between surgical extent and postoperative functional impairment. Methods: A prospective observational study was conducted at the Department of ENT, 250 Bed Mohammad Ali Hospital, Bogura, from June 2023 to December 2024. A total of 102 patients underwent thyroid surgery. Variables included demographic data, tumor characteristics, surgical extent, hypocalcemia, recurrent laryngeal nerve injury, voice outcomes, recurrence, and disease-free survival. Statistical comparisons were performed using parametric and categorical analyses. Results: Mean age was 41.8 ± 11.2 years; females constituted 72.5%. Papillary carcinoma represented 86.3%, and follicular carcinoma 13.7%. Total thyroidectomy was performed in 68.6%, lobectomy in 31.4%. Transient hypocalcemia occurred in 21.6% (mean serum calcium 7.9 ± 0.6 mg/dL), permanent hypocalcemia in 4.9%, and recurrent laryngeal nerve palsy in 6.9% (permanent 1.0%). Mean Voice Handicap Index score increased from 8.4 ± 3.1 preoperatively to 14.6 ± 4.8 postoperatively (p = 0.003). Complication rates were higher following total thyroidectomy than lobectomy (32.9% vs 12.5%; p = 0.01). Locoregional recurrence occurred in 7.8%, with one-year disease-free survival of 92.2%. Conclusion: Surgical treatment of differentiated thyroid carcinoma achieves excellent oncological control; however, functional complications vary with surgical extent, underscoring the need for risk-adapted, function-preserving surgical strategies.

Background: Effective preoperative patient counseling is essential to shared decision-making. In thyroid surgery, patient communication can be complicated by the complex anatomy and variable surgical approaches, which may not be fully conveyed through conventional verbal explanations or schematic drawings. Virtual three-dimensional (3D) thyroid models may provide an intuitive tool to enhance patient comprehension. Methods: We conducted a randomized controlled trial at Peking Union Medical College Hospital with 94 newly-diagnosed thyroid cancer patients scheduled for thyroidectomy. Participants were assigned to either the control group (n = 47), which received preoperative drawing-based counseling, or the intervention group (n = 47), which utilized a virtual 3D model for communication. The Thyroid Navigator app, developed by Kuma Hospital, was used to provide dynamic 3D representation of the thyroid gland, surrounding structures, and potential surgical procedures. After standardized preoperative consultations, patients were surveyed to assess their understanding in pertinent anatomy and postoperative complications. Results: Patients in the 3D model group demonstrated similar correct response rates in lesion localization (p = 0.536) or parathyroid gland recognition (p = 0.071), but significantly higher accuracy in identifying the recurrent laryngeal nerve and the extent of lymph node dissection compared with the control group (p < 0.05). Moreover, comprehension of the causes of major postoperative complications—including hoarseness (recurrent laryngeal nerve injury, p = 0.004), hypocalcemia (parathyroid gland impairment, p = 0.015), and bleeding (inadequate hemostasis, p = 0.008)—was significantly improved in the 3D model group. Conclusions: Use of a virtual 3D thyroid model significantly improves patient comprehension of thyroid anatomy, surgical procedures, and potential complications, thereby enhancing clinician–patient communication. Virtual 3D models represent a practical and cost-effective supplement to conventional counseling in thyroid surgery, offering clear benefits in patient education and shared decision-making.

A man in his late 60s, with a history of psoriatic arthritis, presented with a 10-year history of hoarseness and exertional dyspnea. Flexible laryngostroboscopy demonstrated bilateral true vocal cord immobility resting in paramedian positions with glottic airway space reduction at ~5 to 10 mm on respiration. A contrast-enhanced computed tomography scan of the neck was performed to assess for a lesion along the course of the recurrent laryngeal nerves (RLNs), and it confirmed the findings of vocal cord immobility, evidenced by enlarged pyriform sinus and laryngeal ventricle, medialization and thickening of the aryepiglottic folds, and anteromedial deviation of the arytenoid cartilage, but no lesions along the RLNs. In the absence of structural, neurologic, or malignant causes, the findings were suggestive of cricoarytenoid joint fixation secondary to psoriatic arthritis. While cricoarytenoid arthritis is associated with other rheumatologic conditions, its association with psoriatic arthritis is exceedingly rare, with only 1 previously documented case. Our case highlights the importance of considering psoriatic arthritis in the workup of bilateral vocal cord immobility, particularly in patients with no other identifiable cause.

BackgroundIntraoperative neuromonitoring—that is, recording of electromyographic signals—is used routinely during (para)thyroid surgery. Surgeons label selected signals to document nerve identity, body side, and time point of stimulation (before or after resection), with a mislabelling rate of 20%. For the purpose of an automated error alert of mislabelled electromyographic signals, the authors developed a multitask one-dimensional convolutional neural network.MethodsRaw intraoperative neuromonitoring data were corrected using MIONQA software. Labelled electromyographic signals were extracted and metadata (duration of surgery, timing, median electromyographic peak values of actual surgery) were added to each electromyographic wave. Between 150 and 280 extracted features were used to train, validate, and test various convolutional neural networks.ResultsAvailable raw data from a single centre including 1541 operations with continuous intraoperative nerve monitoring and 508 with intermittent intraoperative nerve monitoring between 2014 and 2024 were used. By repeated adjustments of the model architecture and the number of extracted features, an optimized one-dimensional convolutional neural network was designed. After multiple runs with randomized training (11 414 electromyograms) and test (4891) data, the final optimized convolutional neural network achieved a mean(standard deviation) accuracy of 95.72(0.76)% for correct identification of recurrent laryngeal, vagal, and superior laryngeal nerves; 97.68(0.72)% for correct prediction of the resected body side; and 97.61(0.89)% for correct identification of the stimulation time point (before versus after resection). The receiver operating characteristic curve for classification of the electromyographic peak signals had an excellent area under the curve of 0.993.ConclusionThe newly developed convolutional neural network enables accurate automated classification of electromyographic peak signals, facilitating the identification and correction of mislabelled intraoperative nerve monitoring data. Such optimized data quality is essential for artificial intelligence training, enabling neuromonitoring machines to alert the surgeon in the operating theatre of mislabelling. Future studies will aim to include a wider range of clinical scenarios and external data sets, in order to further optimize the existing labelling tool and allow clinical applications.

Gasless transaxillary endoscopic thyroidectomy (GTET) offers an extracervical approach with cosmetic benefits, yet spatial orientation around critical structures can be challenging for learners. We aimed to standardize and illustrate a stepwise GTET workflow with clearly annotated intraoperative landmarks. This single-center descriptive study presents a unified, stepwise technique for GTET. High-resolution intraoperative images were annotated in-figure (arrows and labels) to identify constant landmarks and "risk zones," including the recurrent laryngeal nerve (RLN; trunk/entry), inferior parathyroid and feeding vessels, Berry ligament, tracheal plane, external branch of the superior laryngeal nerve (EBSLN) corridor, upper-pole dissection plane, and central compartment boundaries. For each step, concise tips and pitfalls are provided to support reproducibility and teaching. An atlas-style, annotated workflow is presented that links exposure, landmark identification, and safe dissection planes. The figures and legends prioritize consistent orientation cues and highlight commonly hazardous areas (e.g., Berry ligament region, RLN entry, inferior parathyroid pedicle), aiming to reduce ambiguity for less-experienced surgeons. This annotated, stepwise description of GTET may facilitate surgical orientation, communication, and training. The framework is intended to be adaptable across learning environments; future prospective studies should evaluate learning curves and clinical outcomes using standardized endpoints.

Endoscopic thyroidectomy (ET) has been carried out for more than 20 years, but few studies on the anatomy of ET can be found in the literature. We performed this study to identify ET's surgical planes and anatomic landmarks by clinical anatomic research. The surgical planes and anatomic landmarks were observed through an endoscope in 83 consecutive cases during living ET by the anterior chest approach. The appropriate procedure spaces were between the superficial fascia and the pectoralis major fascia on the anterior chest, and between the platysma and the superficial layer of the deep fascia on the anterior neck, which formed two continuous layers. The ET dissecting triangle was the space between the strap muscles and the thyroid lobe, which formed the surgical plane for finding the inferior thyroid vessels (100.0%) and the middle thyroid vein (100.0%). The inferior parathyroid gland could be found beneath the inferior thyroid artery (92.5%), while the superior parathyroid gland was adjacent to the middle thyroid veins (90.0%). The recurrent laryngeal nerve could be found beneath the inferior parathyroid gland (85.7%). All exposed recurrent laryngeal nerves entered the larynx posterior and inferior to the thyroid cartilage, above which a vessel, perpendicular to the recurrent laryngeal nerve, and running from the thyroid lobe to the larynx (100.0%), served as a landmark. The surgical planes and anatomic landmarks identified could guide surgeons and aid the preservation of the recurrent laryngeal nerve and the parathyroid glands during ET.

Modified P1 zone is defined as the zone related to the recurrent laryngeal nerve(RLN) 1cm proximal to the nerve entry point to the larynx, where the vessels cross the nerve at a vertical plane. RLN injuries are common in this zone during thyroidectomy. This study aims to describe the vascular pattern at the modified P1 zone. This prospective analysis included 131 consecutive subjects who underwent thyroid surgery between October 2023 and June 2024. Various clinical, radiological, histopathological and intraoperative parameters were studied. The study included 212 nerves at risk(NAR). The mean age of the study population was 43 ± 12.6years. Immediate post-operative vocal cord palsy was noted in 3.3% of NAR. 100% of patients had at least one vessel in relation to RLN in the modified P1 zone. The mean number of vessels in this zone was 3 ± 1.2. Type 3 vascular pattern(presence of vessels anterior and posterior to the nerve) was the most common(68.9%). Multivariate analysis showed the presence of Pelizzo grade 2 tubercle of Zuckerkandl (OR 2.4; 95% CI: 1.07-5.37, p = 0.033) and the presence of stage 2 or 3 tumor stage(OR 2.2; 95% CI: 1.10- 4.55, p = 0.026) were independent predictors of the increased number of vessels(> 2 vessels). The study describes the consistent vascular pattern and its relationship with RLN in the modified P1 zone. Awareness of this may help surgeons to prevent RLN injury during thyroid surgery and effectively tackle the vessels in modified P1 zone.

This study aimed to develop a connector that adapts standard endoscopic instruments into functional nerve stimulator probes. The connector underwent engineering validation in a laboratory and preclinical testing using a porcine model. A handheld standard stimulator probe served as the control. The experimental group consisted of a long monopolar probe and two connector-adapted probes. Recurrent laryngeal nerve (RLN) and vagus nerves were stimulated to compare the efficacy and safety of the adapted probes with the standard probe. The connector, when coupled to endoscopic instruments, did not show a statistically significant difference in electromyographic (EMG) amplitude at 1 mA stimulation compared with the standard probe. Safety analysis showed no significant hemodynamic effects. This proof-of-concept study demonstrates that the developed connector, when paired with endoscopic instruments, enables reliable nerve identification and preservation during endoscopic thyroid surgery, with favorable efficacy and safety profiles.

ObjectiveElectrical stimulation of the baroreceptors pathways at the carotid sinus bulb – known as baroreflex activation therapy (BAT) – is intended to change autonomic tone and ultimately reduce blood pressure and heart rate. BAT is pre-market approved by the United States Food and Drug Administration (FDA) for the treatment of heart failure and received an FDA humanitarian device exemption for drug resistant hypertension. However, responder rates are limited by side-effects including numbness in the head and neck, altered speech, respiratory constriction, dry cough, vomiting, and altered sensory and motor function of the tongue. We hypothesized that these side-effects are driven by activation of other nearby nerve fibers of similar or lower threshold than the carotid sinus nerve. In this study, we sought to identify the neural sources responsible for off-target muscle activation contributing to these side-effects. These sources would inform strategies mitigating off-target activation in BAT therapy.MethodsDomestic swine were used in this work as the diameter and thickness of the swine carotid artery are closer to human than those of canine models. A monopolar disk electrode mimicking the clinical CVRx® Neo electrode was surgically placed proximal to the carotid bifurcation with the position optimized for stimulation dose responsive changes in blood pressure. Evoked responses were recorded during dose response testing from multiple neck muscles, and the corresponding off-target nerve pathways were identified by sequential transection of nearby nerves.ResultsThe following activated off-target muscle groups and their corresponding nerve pathways were verified which included 1) the cricoarytenoid via recurrent laryngeal nerve, 2) cricothyroid via superior laryngeal nerve, 3) sternocleidomastoid via accessory nerve, and 4) the tongue via hypoglossal nerve. The constrictor muscle group was also activated through a more complex neural pathway.ConclusionWe identified multiple sources of therapy-limiting side-effects of BAT in the swine model. These results will help guide the design of improved stimulation electrodes, surgical placement, and parameter programming to reduce BAT-associated side-effects while increasing on-target activation in patients.

PurposeMelkersson-Rosenthal Syndrome is a rare neuro-mucocutaneous disease characterised by recurrent orofacial swelling, facial palsy and lingua plicata. Patients often do not present with the complete triad of symptoms which can make this a diagnostic challenge. We present three cases of suspected MRS seen in our tertiary eye unit, highlighting the challenges in diagnosis and management of MRS.Case descriptionsCase 1 is a 54-year-old female with a background of neuro-sarcoidosis who presented with a several year history of bilateral upper lid swelling and recurrent facial nerve palsy. She experienced complete resolution of symptoms after a period of observation.Case 2 is a 49-year-old female who had a one-year history of recurrent facial nerve palsy associated with facial, neck and lip swelling. She was treated with oral steroids but did not experience complete remission.Case 3 is a 74-year-old female who presented with an 18-month history of bilateral peri-orbital swelling. Biopsy of skin and orbicularis showed granulomatous inflammation. She was treated with oral non-steroid anti-inflammatories as well as topical and oral steroids but without complete resolution.ConclusionMRS is a rare but important differential in patients with recurrent peri-orbital swelling. Given the recurrent nature of MRS and its associations with severe systemic diseases, early recognition and a multi-disciplinary approach is essential to diagnosis and management.

Laryngeal ultrasound-guided adhesive transcutaneous electrodes versus conventional endotracheal electrodes for intraoperative neuromonitoring during thyroid and neck surgery.

Radical esophagectomy is widely regarded as one of the most complex surgical procedures in Upper Gastrointestinal surgery due to the intricate anatomy of the mediastinum, and a deep understanding of its embryological development is essential for navigating the interrelated structures and fascial planes involved. In this study, we investigated the embryogenesis of the supracarinal area of the posterior superior mediastinum, focusing on key anatomical structures such as the alar fascia and the supracarinal mesoesophagus—the latter being the fascial structure between the esophagus and the subclavian arteries that incorporates the recurrent laryngeal nerves, and is critical for performing precise esophagectomy and supracarinal lymphadenectomy. Our primary objective was to trace the embryological origins of these supracarinal fasciae; however, due to the absence of clearly distinguishable fasciae in early embryonic development, we adopted a second approach—utilizing anatomical knowledge from adult surgical dissections to identify analogous structures in late-stage embryos. To achieve this, we studied the posterior mediastinum of five embryos, ranging from stage 15 (33 days) to stage 23 (57 days), and one fetus at twelve weeks. Our results reveal a progressive transformation of the vascular system from primitive pharyngeal arch arteries to a definitive aortic system by stage 19, with the vagus nerves appearing at stage 17 and the recurrent laryngeal nerves becoming recurrent by stage 19. While the mediastinum consists of homogeneous mesenchymal tissue in early development, the boundaries of the supracarinal mesoesophagus are more defined in initial stages but become indistinct in later ones. Through comparative analysis with adult anatomy, we were able to delineate the development and positioning of both the alar fascia and the supracarinal mesoesophagus in late-stage embryos. This embryological insight is particularly valuable for anatomists and upper GI surgeons, as it enhances the understanding of the development and spatial organization of critical mediastinal structures—such as the esophagus, trachea, vascular elements, vagus and recurrent laryngeal nerves—which can contribute to safer, more consistent surgical outcomes in esophagectomy.

Feasibility and prognostic utility of laryngeal adductor reflex monitoring in anterior cervical spine surgery.

Backgrounds: Graves' disease (GD) is the most common cause of hyperthyroidism, characterized by autoimmune stimulation of the thyroid gland. Long-term treatment options include antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy, but there is no universal agreement on which treatment approach is best. Each modality has different benefits and limitations, making comparative evaluation is important to help guide individual treatment decisions. Methods: This literature review summarizes evidence from clinical trials, meta-analyses, and observational studies evaluating the efficacy, recurrence rates, safety profiles, and long-term outcomes of antithyroid drugs (ATD), RAI, and thyroidectomy in the management of Graves’ disease. Databases such PubMed, SpringerLink, ScienceDirect, and references inside the extracted studies were used. Results: ATDs remain the preferred first-line therapy in many regions due to their non-invasive approach and potential for remission, although 30–70% of patients relapse after discontinuation. Long-term low-dose therapy can reduce recurrence but requires monitoring for hepatotoxicity. RAI demonstrates high cure rates (>90%) and is cost-effective, but frequently results in permanent hypothyroidism and may worsen orbitopathy. Thyroidectomy provides the most definitive treatment, with a relapse rate about zero and rapid achievement of euthyroidism, although it carries risks such as recurrent laryngeal nerve injury and hypoparathyroidism. Comparative studies consistently show superior remission with surgery, followed by RAI, while ATDs have the highest recurrence. Conclusions: Each treatment modality for GD offers distinct advantages and disadvantages. Thyroidectomy provides the most reliable cure, RAI offers effective and economical definitive therapy, and ATDs remain valuable first-line options. Optimal treatment selection should be individualized based on patient preference, comorbidities, and desired long-term outcomes.

Thyroid surgery requires a thorough knowledge of the neck anatomy and its anatomical variations. This is of utmost importance since it is well known that variations of the recurrent laryngeal nerve are prone to iatrogenic injuries. Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. Surgeons must comprehensively understand the anatomy of the recurrent laryngeal nerve during thyroid operation. To assess the anatomical variations of recurrent laryngeal nerves, with inferior approach using inferior thyroid artery as a consistent anatomical landmark, and outcomes in patients who had undergone thyroid surgery in Tibebe Ghion Specialised Hospital, Bahir Dar, Ethiopia. An institutional-based prospective observational study of 102 consecutive patients was conducted from June 2021 to August 2022 at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. Data were collected prospectively using a standardized intraoperative checklist and intraoperative photographs. The study included 102 patients (92 female, 10 male). Age distribution was 18–39 years: 53.9%; 40–60 years: 42.2%; 61–80 years: 3.9%. A total of 156 RLNs were dissected: 87 right and 69 left. Right-side branching was observed in 24.1% of nerves (single trunk 75.9%; bifurcation 18.4%; trifurcation 5.7%); left-side branching occurred in 10.2% (single trunk 89.8%; bifurcation 10.2%). In relation to the ITA, right RLNs were posterior in 68.9%, anterior in 27.7%, and interdigitating among arterial branches in 3.4%; left RLNs were posterior in 91.3%, anterior in 7.3%, and interdigitating in 1.4%. Using the operative landmark of the tracheoesophageal groove (TEG - defined here as the space between the trachea and esophagus at the level of dissection), 93.1% of right RLNs were identified within or adjacent to the TEG and 6.9% were lateral to the tracheal surface; 100% left RLNs were identified within or adjacent to the TEG. Early postoperative course was uneventful in 92.2%; transient hoarseness occurred in 2.0%. Anatomical consideration of the variations in the course, branching pattern, and relation of recurrent laryngeal nerve with inferior thyroid artery and tracheoesophageal groove is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy.

BackgroundThe treatment of esophageal cancer requires optimized surgical approaches to improve patient outcomes. Minimally invasive esophagectomy (MIE) has demonstrated advantages compared to open procedures, but the difference in efficacy of single-incision versus multi-incision techniques under various reconstruction routes remains unclear. This retrospective propensity-weighted study aimed to evaluate the perioperative outcomes and short-term functional recovery between single-incision laparo-thoracoscopic MIE with retrosternal reconstruction (SIMIE-RS) and multi-incision MIE with posterior mediastinal reconstruction (MIMIE-PM) in patients with esophageal cancer.MethodsThis retrospective study included 339 patients with esophageal cancer who underwent McKeown esophagectomy. The inverse probability of the treatment weighting (IPTW) approach was employed to assess outcome between SIMIE-RS and MIMIE-PM. The primary endpoints included postoperative complications, functional recovery parameters, and perioperative outcomes. Secondary endpoints included oncological adequacy, hospital length of stay, and quality of life indicators.ResultsPulmonary complications were markedly reduced in the SIMIE-RS group as compared to the MIMIE-PM group, with a lower incidence of pneumonia (0.9% vs. 5.5%; P=0.02). Postoperative pain control was substantially improved in the SIMIE-RS group, who exhibited lower visual analog scale scores at 24 hours (3.1±1.0 vs. 7.5±1.1; P<0.001) and 72 hours (1.6±1.1 vs. 3.3±1.2; P<0.001) as compared to the MIMIE-PM group. SIMIE-RS also provided greater functional recovery, with superior forced expiratory volume in 1 second (FEV1) preservation at 1 month (3.2±0.5 vs. 2.4±0.6; P<0.001) and reduced reflux symptoms (1.2±0.5 vs. 1.8±0.9; P<0.001). Hospital length of stay was significantly shorter in the SIMIE-RS group than in the MIMIE-PM group (7.0±1.6 vs. 9.7±1.5 days; P<0.001). The safety profiles of the SIMIE-RS group and MIMIE-PM group were comparable in terms of surgery-related complications, including anastomotic leakage (2.8% vs. 5.0%; P=0.55), recurrent laryngeal nerve paralysis (0.9% vs. 1.0%; P>0.99), and chylothorax (0.9% vs. 1.5%; P=0.66). Oncological adequacy was maintained, with similar total lymph node yields between the groups (33±11.1 vs. 32.1±12.2; P=0.53).ConclusionsSIMIE-RS provides superior perioperative outcomes as compared to MIMIE-PM, with significant reductions in pulmonary complications, enhanced functional recovery, improved pain control, and shortened hospital stays, as well as comparable surgical safety and oncological adequacy. Our findings indicate that SIMIE-RS is a viable innovation in esophageal cancer surgery that concentrates operative trauma while optimizing reconstruction pathways.

Reoperative Parathyroidectomy: Recognizing Unique Risk Profiles.

IntroductionThyroidectomy is the most common endocrine head and neck surgery. First-time hemithyroidectomies have been shown to have lower rates of complications such as recurrent laryngeal nerve palsy and hypocalcaemia, when compared to total and completion thyroidectomies, due to dissection occurring on one side in hemithyroidectomies. As a result, hemithyroidectomies (low risk) can be performed as day-case surgeries, while higher-risk total and completion thyroidectomies are more likely to have inpatient care postoperatively. This study aims to examine postoperative admission duration and outcomes following completion and total thyroidectomy in a single centre.MethodsThis retrospective, observational, descriptive review included 137 cases of total and completion thyroidectomies carried out at the Department of Otolaryngology, York District Hospital, UK, over four years. The outcome was defined as the presence or absence of complication(s) in the first 30-day postoperative period. Postoperative duration was classified into less than one day, one day to less than two days, two days to less than three days, and three days or more of inpatient care before discharge.ResultsA total of 137 patients met the study criteria. There were 77 total thyroidectomies and 60 completion thyroidectomies. Nineteen patients had a postoperative stay of less than one day, 70 patients had between one day and less than two days postoperative care, 22 patients had two days to less than three days admission, and 26 patients had a postoperative stay of three days or more. There were 104 females and 33 males. The mean age was 51.10 ± 15.42 years, with an age range of 17-90 years. Overall, the most common preoperative diagnosis was cancer (n = 52), all of which had a complete thyroidectomy. Thyrotoxicosis (n = 45) was the second-highest indication.Hypocalcaemia was the most common cause of delayed discharge postoperatively, accounting for 58.3% (n = 14) of all patients who stayed more than three days after surgery. Of all obese patients, 51% had a postoperative stay of two or more days. A total of 106 patients (80.3%) had a drain inserted, and the use of a drain was related to extended hospital stay postoperatively (Chi-square value = 8.989, p = 0.029). There was no statistically significant relationship between the use of drains and prevention of symptomatic seroma (Chi-square value: 0.011, p = 0.918, Fisher's p = 1.000). There were five (3.6%) cases of postoperative haematoma, and one of those five did not have a drain (Chi-square value = 0.000, p = 0.987, Fisher's p = 1.000). All five postoperative haematoma patients had total thyroidectomy (Chi-square value = 4.044, p = 0.044, Fisher's p = 0.068). Patients with higher BMI were more likely to have a longer postoperative stay in the hospital (Chi-square value: 24.967, p = 0.003). Of those who stayed two days to less than three days, 86.3% were either overweight or obese, and 84.6% of patients who stayed three or more days were also either overweight or obese.ConclusionThe use of drains, BMI of the patient, and development of hypocalcaemia are associated with extended in-hospital stay following total and completion thyroidectomy. Planning for early discharge requires careful patient selection, with close monitoring in the observation period before discharge, while ensuring adequate availability of support and proximity to hospital or emergency response systems after discharge, for patient safety.

BackgroundEsophageal squamous cell carcinoma (ESCC) is a common malignant tumor with high disease burden and poor prognosis. Lymph node (LN) metastasis (LNM) is a key prognostic factor for ESCC patients, particularly left gastric artery lymph nodes (No. 7) metastasis. No. 7 LNs dissection is essential for preventing residual tumor and recurrence. However, research on No. 7 LNM in ESCC remains limited. This study aimed to evaluate the independent prognostic role of No. 7 LNM in ESCC and characterize its LNM patterns by comparing isolated No. 7 LNM with No. 7 LNM combined with LNM at other sites.MethodsThis study retrospectively analyzed clinical data from 144 patients with thoracic ESCC who had undergone radical esophagectomy and dissection of No. 7, recurrent laryngeal nerve (RLN, No. 106rec), subcarinal (No. 107), and main bronchial (No. 109) LNs at the Cancer Hospital of the Chinese Academy of Medical Sciences from 2019 to 2021. Postoperative follow-up included routine examinations every 3 months for the first 2 years. Lost-to-follow-up cases underwent standard right-censoring, with these data included in the final analysis. Patients were stratified into the No. 7-positive group (No. 7 LN+) and the No. 7-negative group (No. 7 LN−) based on postoperative pathological detection of No. 7 LNM. Kaplan-Meier survival analysis was used to assess the overall survival (OS) and disease-free survival (DFS) in patients with ESCC, and the Cox proportional hazards regression model was applied to identify the independent risk factors associated with OS and DFS.ResultsAmong 144 patients with thoracic ESCC, 75 had lower thoracic tumors, 124 received neoadjuvant therapy, and 115 had pathological stage N0–N1 disease. This study analyzed the association between No. 7 LNM and prognosis in these patients. Kaplan-Meier curves showed significantly poorer OS (P=0.007) and DFS (P=0.009) in the No. 7 LN+ group than the No. 7 LN− group. Multivariate Cox regression identified No. 7 LNM as an independent factor influencing the OS (P=0.03) and DFS (P=0.04) of patients with ESCC. Subgroup analysis of patients with No. 7 LNM revealed no significant differences in OS (P=0.33) or DFS (P=0.37) between patients with ESCC with and without 106rec LNM. However, patients with concurrent 107 LNM or 109 LNM had significantly poorer OS (P=0.02) and DFS (P=0.03) compared with those without such metastases. Furthermore, lower-thoracic ESCC patients in the No. 7 LN+ group had significantly poorer OS (P=0.04) and DFS (P=0.04) than the No. 7 LN− group. Sensitivity analysis of patients who received neoadjuvant therapy confirmed the results were robust.ConclusionsOur study confirms that No. 7 LNM is an indicator of poor prognosis in patients with thoracic ESCC. Standardized dissection of No. 7 LNs is critical during radical esophagectomy for thoracic ESCC.

Esophageal cancer is a significant health burden in China, commonly treated by esophagectomy, a procedure with considerable risks. While higher hospital volume is associated with improved outcomes in Western countries, it remains unclear if this volume-outcome relationship persists in China, where many centers handle a relatively high caseload compared to Western standards. This study investigated the impact of hospital volume on perioperative morbidity and long-term survival outcomes following esophagectomy for esophageal cancer within the context of Chinese medical centers. This study analyzed data from a prospective multicenter database (April 2015-December 2018) including 6775 patients with clinical stage cT1b-3N0-1M0 esophageal cancer undergoing radical esophagectomy across 19 Chinese centers. Centers were categorized based on procedural volume over 3.5years: Group A (high-volume: ≥ 400 cases) and Group B (low-volume: < 400 cases). Perioperative complications and 5-year overall survival (OS) and disease-free survival (DFS) were compared. Propensity score matching (PSM) was employed to balance baseline characteristics between groups. Analysis included 6,125 patients (4,633 Group A, 1,492 Group B) for survival outcomes. Group B demonstrated significantly higher rates of total complications (23% vs 19%, P < 0.001), including anastomotic leakage (5.9% vs 4.5%, P = 0.014), cardiovascular events (2.0% vs 0.9%, P < 0.001), and recurrent laryngeal nerve paralysis (12.1% vs 10.0%, P = 0.033), alongside longer mean operation times (P < 0.001). After PSM (1,492 matched pairs), Group A maintained superior 5-year OS (49% vs 45%, P < 0.05, HR: 1.12, 95%CI, 1.01-1.23) and 5-year DFS (45% vs 42%, P < 0.05, HR: 1.14, 95%CI, 1.03-1.25) compared to Group B. Hospital volume significantly influenced esophagectomy outcomes in China, even among centers with relatively high caseloads. Treatment at high-volume centers was associated with lower postoperative morbidity and better long-term survival for patients with esophageal cancer.