The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Purpose: The vascular clipping system (VCS) is beneficial as it is simple and easy to apply for microvascular suturing. Arteriovenous fistula (AVF) creation is a very basic standard technique of microvascular surgery. In this study the VCS and the conventional suture methods were compared in a rabbit model using the carotid artery and vein to create an AVF. Methods: There were 28 rabbits assigned equally into 2 groups using the AVF creation method (conventional suturing or the VCS procedure). Histopathology was performed on fixed samples. The procedure time of the 2 methods and changes in histopathology of tissue samples after surgery were compared. Results: The VCS procedure showed a lower degree of fibrosis and hyperplasia histologically compared with the conventional suture method. The VCS was quicker to perform and no significant anastomosis stricture was observed. Conclusion In a rabbit model of AVF, the VCS has benefits over the conventional suture method. The VCS provides comparable patency rates, produces fewer side effects such as fibrosis and hyperplasia, and takes less operation time than suturing. The VCS is expected to be useful for cases where renal patients need periodic hemodialysis and thus repetitive access to a vessel.

Purpose: The vascular clipping system (VCS) is beneficial as it is simple and easy to apply for microvascular suturing. Arteriovenous fistula (AVF) creation is a very basic standard technique of microvascular surgery. In this study the VCS and the conventional suture methods were compared in a rabbit model using the carotid artery and vein to create an AVF. Methods: There were 28 rabbits assigned equally into 2 groups using the AVF creation method (conventional suturing or the VCS procedure). Histopathology was performed on fixed samples. The procedure time of the 2 methods and changes in histopathology of tissue samples after surgery were compared. Results: The VCS procedure showed a lower degree of fibrosis and hyperplasia histologically compared with the conventional suture method. The VCS was quicker to perform and no significant anastomosis stricture was observed. Conclusion In a rabbit model of AVF, the VCS has benefits over the conventional suture method. The VCS provides comparable patency rates, produces fewer side effects such as fibrosis and hyperplasia, and takes less operation time than suturing. The VCS is expected to be useful for cases where renal patients need periodic hemodialysis and thus repetitive access to a vessel.

Early diagnosis followed by primary repair is the best treatment for spontaneous esophageal perforation. However, the appropriate management of esophageal leakage after surgical repair is still controversial. Recently, the successful adaptation of vacuum-assisted closure therapy, which is well established for the treatment of chronic surface wounds, has been demonstrated for esophageal perforation or leakage. Conservative treatment methods require long-term fasting with total parenteral nutrition or enteral feeding through invasive procedures, such as percutaneous endoscopic gastrostomy or a feeding jejunostomy. We report 2 cases of esophageal leakage after primary repair treated by endoscopic vacuum therapy with continuous enteral feeding using a Sengstaken-Blakemore tube.

Early diagnosis followed by primary repair is the best treatment for spontaneous esophageal perforation. However, the appropriate management of esophageal leakage after surgical repair is still controversial. Recently, the successful adaptation of vacuum-assisted closure therapy, which is well established for the treatment of chronic surface wounds, has been demonstrated for esophageal perforation or leakage. Conservative treatment methods require long-term fasting with total parenteral nutrition or enteral feeding through invasive procedures, such as percutaneous endoscopic gastrostomy or a feeding jejunostomy. We report 2 cases of esophageal leakage after primary repair treated by endoscopic vacuum therapy with continuous enteral feeding using a Sengstaken-Blakemore tube.
Early Diagnosis ; Endoscopy ; Enteral Nutrition ; Esophageal Perforation ; Fasting ; Gastrostomy ; Jejunostomy ; Negative-Pressure Wound Therapy ; Parenteral Nutrition, Total ; Vacuum ; Wounds and Injuries

Unilateral absence of a pulmonary artery (UAPA) is a rare congenital anomaly that may present with various symptoms, depending on the nature and severity of other cardiovascular anomalies. Furthermore, contralateral lung surgery in patients with UAPA is extremely rare, and clinical experience is limited. This report describes a case of surgical treatment of contralateral primary lung cancer in a patient with isolated UAPA. A 56-year-old man was diagnosed with primary lung cancer accompanied by isolated UAPA on the contralateral side. He underwent meticulous cardiorespiratory function tests preoperatively. We performed a right lower lobectomy. Although in the immediate postoperative period, the patient suffered from a mild decline in his respiratory function, he recovered uneventfully. The present case shows that preoperative awareness of UAPA and meticulous perioperative management enable contralateral lung surgery to be performed safely.
Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Perioperative Care ; Postoperative Period ; Pulmonary Artery*

PURPOSE: The status of tumor regression in rectal cancer after neoadjuvant concurrent chemoradiotherapy (CCRT) has significant effect on tumor recurrence and patient survival. The aim of this study was to evaluate the long-term oncologic outcomes of rectal cancer patients presenting complete response or down-staging of rectal cancer compared to patients with non-response after neoadjuvant therapy in advanced mid-to-lower rectal cancer.METHODS: We retrospectively reviewed 79 patients with stage II/III mid-to-lower rectal cancer following neoadjuvant CCRT between March 2003 and April 2012. Patients were classified into three groups according to down-staging tumor response after neoadjuvant CCRT: complete response group (CRG), partial response group (PRG), and non-response group (NRG).RESULTS: Of the 79 patients in the study, eight (10.1%), 31 (39.2%), and 40 (50.7%) were classified as CRG, PRG, and NRG, respectively. Median follow-up period was 57 months. There was significant difference in local recurrence (P=0.012) between the three groups, yet there was no significant difference in overall survival (CRG, 100%; PRG, 82.5%; NRG, 74.0%; P=0.244). There was a significant difference in disease-free survival (CRG, 100%; PRG, 90.1%; NRG, 57.7%; P=0.006).CONCLUSION: Tumor response with complete response or down-staging provided better oncologic outcomes in terms of disease-free survival and local recurrence in locally advanced rectal cancer patients.
Chemoradiotherapy ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoadjuvant Therapy ; Rectal Neoplasms ; Recurrence ; Retrospective Studies

PURPOSE: The aim of this study was to evaluate whether a simple verbal instruction regarding the rescuer gazing point can improve the depth of chest compressions (CCs) in the hands-only cardiopulmonary resuscitation (CPR). METHODS: Participants who took part in basic life support training courses for lay-rescuers were eligible for inclusion in this prospective, single-blinded, cluster randomized controlled study. After the training courses, both the control and the intervention groups performed the hands-only CPR for two minutes on a manikin placed on the ground. Immediately prior to CCs, instructors provided the intervention group with brief verbal instructions to look in the opposite direction of the adducted arm after placing the heel of the hand on the mid-sternum. RESULTS: One hundred and twenty-two participants (61 for each group) were enrolled in this study. The intervention group showed significantly deeper CCs than the control group (47.9±8.2 mm vs. 43±8.4 mm, p<0.01); however, there were no significant differences between the two groups in the quality of chest recoil, CC rate, or duty cycle of CCs. However, the frequency of incorrect hand position was higher in the intervention group when compared with the control group (10.3 [2.3-35.7] vs. 5.7 [0-33.0], p=0.036) CONCLUSION: Instructions to look in the opposite direction of the adducted arm during CCs improved the mean depth of CCs without significant adverse effects on the quality of recoil, CC rate, or duty cycle of CCs. However, the frequency of incorrect hand position was higher in the intervention group than the control group.
Arm ; Cardiopulmonary Resuscitation* ; Education ; Hand ; Heart Massage ; Heel ; Manikins ; Prospective Studies ; Thorax*

BACKGROUND: Guidelines for esophagogastroduodenoscopy (EGD) in the West allow the continued use of warfarin under therapeutic international normalized ratio (INR) level. In Korea, no guidelines have been issued regarding warfarin treatment before EGD. The authors surveyed Korean cardiac surgeons about how Korean cardiac surgeons handle warfarin therapy before EGD using a questionnaire. Participants were requested to make decisions regarding the continuation of warfarin therapy in two hypothetical cases. METHODS: The questionnaire was administered to cardiac surgeons and consisted of eight questions, including two case scenarios. RESULTS: Thirty-six cardiac surgeons at 28 hospitals participated in the survey, and 52.7% of the participants chose to stop warfarin before EGD in aortic valve replacement patients without risk factors for thromboembolism. When the patient’s INR level was 2, 31% of the participants indicated that they would choose to continue warfarin therapy. For EGD with biopsy, 72.2% of the participants chose warfarin withdrawal, and 25% of the participants chose heparin replacement. In mitral valve replacement patients, 47.2% of the participants chose to discontinue warfarin, and 22.2% of the participants chose heparin replacement. For EGD with biopsy in patients with a mitral valve replacement, 58.3% of the participants chose to stop warfarin, and 41.7% of the participants chose heparin replacement. CONCLUSION: This study demonstrated that attitudes regarding warfarin treatment for EGD are very different among Korean surgeons. Guidelines specific to the Korean population are required.
Anticoagulants ; Aortic Valve ; Biopsy ; Endoscopy* ; Endoscopy, Digestive System ; Heart Valve Prosthesis ; Hemorrhage ; Heparin ; Humans ; International Normalized Ratio ; Korea ; Mitral Valve ; Risk Factors ; Surgeons ; Thromboembolism ; Warfarin*

We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach.
Adult ; Atrial Septum/pathology/surgery ; Cardiomegaly/*etiology/radiography ; *Cardiopulmonary Bypass ; Female ; Heart Atria/pathology ; Heart Neoplasms/pathology/*surgery ; Humans ; Magnetic Resonance Imaging, Cine ; Neurilemmoma/*pathology/surgery ; *Printing, Three-Dimensional ; Sternotomy ; Treatment Outcome ; Vena Cava, Superior/pathology