Humans ; Liposarcoma/surgery* ; Retroperitoneal Neoplasms/surgery* ; Neoplasm Recurrence, Local/surgery*

Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; Neoplasm Recurrence, Local ; surgery

Local recurrent rectal cancer (LRRC) is located in the pelvis with or without distant metastasis. It is life-threatening for patients with rectal cancer. Despite the addition of imaging technology, preoperative neoadjuvant therapy and total mesorectal excision, loco-regional relapse still occurs with an incidence as high as 10% in recent reports. Non-operative approaches to management such as radiotherapy and chemotherapy can only prolong survival time by 1 year. Improvements in surgical techniques, reconstruction methods and management of preoperative complications have helped increase the cure rate of patients with recurrent rectal cancer. Multimodality therapy based on surgery is the key of treating LRRC. This review article highlights the progress in surgical managements for local recurrent rectal cancer.
Humans ; Neoplasm Recurrence, Local ; surgery ; Rectal Neoplasms ; surgery

OBJECTIVETo compare the differences in recurrence rates and surgical complications between thyroidectomy alone and thyroidectomy combined with central neck dissection as initial treatments to differentiated thyroid cancer and evaluate the clinic significance of central neck dissection for these patients.

METHODSThe literatures published in 1998-2013 were searched in Wanfang database, Chongqing VIP database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Pubmed, Medline and Beijing Kangjian foreign medical journal full text service. According to the inclusion and deletion criteria, 30 articles were included. Of them 26 articles involved in complications, hypocalcemia and recurrent laryngeal nerve palsy as two major complications were involved in 26 articles and 24 articles respectively, and 26 articles involved in recurrence rate. RevMan5.0 software package was used to perform meta-analysis.

RESULTSTotal complication rate in experimental group (plus central neck dissection) was 13.08% higher than that in control group (thyroidectomy only), the odds ratio (OR) [95% confidence interval (95%CI)] was 2.32[2.02, 2.67], Z value was 11.80, P < 0.01. Hypocalcemia in the experimental group was 11.80% higher than that in control group, OR value [95%CI] was 2.58[2.21, 3.02], Z was 11.98, P < 0.01. The rates of recurrent laryngeal nerve paralysis were low in both experimental group (5.26%) and control group(3.95%), and OR value [95%CI] was 1.22 [0.94, 1.58], Z was 1.48, P = 0.14. Recurrence rate in experimental group was 2.23% lower than that in control group, OR value [95%CI] was 0.78 [0.63,0.97], Z was 2.35, P = 0.03.

CONCLUSIONCentral compartment dissection as initial treatment to differentiated thyroid cancer may reduce the risk of recurrence, but increases the incidence of total complications and hypocalcemia, and has no significant effect on the rate of the recurrent laryngeal nerve paralysis.

Humans ; Neck Dissection ; Neoplasm Recurrence, Local ; Thyroid Neoplasms ; pathology ; surgery

Gastrointestinal Neoplasms ; pathology ; Humans ; Neoplasm Recurrence, Local ; surgery ; Postoperative Period

Presacral cysts are cystic or cyst-solid lesions between the sacrum and rectum. They are closely connected with adjacent pelvic floor structures such as sacrococcygeal fascia, rectum and anal sphincter. They are usually benign and are believed to be caused by aberrant embryogenesis. Clinically they are rare and its true incidence rate is unknown. Surgical resection remains the major treatment of presacral cysts. Unless the cysts are completely resected, the recurrence are unavoidable. The recurrent cysts even generate hard-to-heal sinus in the sacrococcyx, and cause the patients extreme pain. However, the current knowledge of presacral cysts is vague, even confused with other diseases such as ovarian cysts and perianal abscesses. Moreover, lack of the correct surgical concept or skills leads to palliative treatment of complex presacral cysts and serious complications such as fecal incontinence and massive haemorrhage which were attributed to impairing the function of anal sphincter or important blood vessels and nerves. The consensus summarizes the opinions and experiences of multidisciplinary experts in presacral cysts, and aims to provide clinicians with more detailed concept of the treatment, standardize the surgical approach and improve the resected efficacy of presacral cysts.
China ; Consensus ; Cysts ; Female ; Humans ; Neoplasm Recurrence, Local ; Rectum/surgery*

OBJECTIVETo study the micrometastasis distribution in liver tissue surrounding hepatocellular carcinoma (HCC), and provide reference for appropriate surgical safety margin.

METHODSThirty-six patients with HCC but without clinical metastasis underwent hepatectomy. Their specimens showing ample surgical margin were made into giant sections. Tumor micrometastasis in liver tissue around the primary tumor were examined microscopically. In each specimen, the surrounding tissue was divided into proximal(p) and distal(d) areas. In either area, three lines of demarcation 0.5 cm, 1.0 cm, and 2.0 cm away from the margin of the primary tumor were designated as L(0.5), L(1.0) and L(2.0). Therefore, the surrounding tissue was divided into six zones - Z(p0.5), Z(p1.0), Z(p2.0) and Z(d0.5), Z(d1.0), Z(d2.0). The maximum micrometastasis spread distance (MMSD) and density (D(p0.5), D(p1.0), D(p2.0) and D(d0.5), D(d1.0), D(d2.0)) in each zone were analyzed after search for micrometastasis in the giant sections.

RESULTS72.5% (111/153) micrometastases were found in form of microscopic tumor emboli. Their spread distance could be up to 6.1 cm. In 66.7% (24/36) specimens, micrometastases were found in the surrounding tissue. In 91.7% (22/24) of them, the distal MMSD was less than 3 cm. The proximal MMSD was less than 1.5 cm in 92.3% (12/13). The comparison of micrometastasis density in the different zones were D(d0.5) > D(d1.0) > D(d 2.0); D(p0.5) > D(p1.0) > D(p2.0); D(d1.0) > D(p1.0); D(d2.0) > D(p2.0) with significant differences.

CONCLUSION(1) Micrometastases of HCC exist mainly in form of microscopic tumor emboli, (2) The longer the distance from the primary focus, the lower the micrometastasis incidence, (3) In zones more than 0.5 cm away from the primary focus, tumor micrometastasis incidence is significantly lower in the proximal zones than that in the distal zones and (4) For HCC patients without clinical metastasis, a surgical margin of 3 cm wide in the distal area and 1.5 cm wide in the proximal area may reduce the rate of postoperative recurrence.

Carcinoma, Hepatocellular ; secondary ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; pathology ; surgery ; Neoplasm Metastasis ; Neoplasm Recurrence, Local

Carcinoma, Hepatocellular ; surgery ; Hepatectomy ; Humans ; Liver Neoplasms ; surgery ; Neoplasm Recurrence, Local ; surgery ; Reoperation

Carcinoma, Squamous Cell ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Neoplasm Recurrence, Local ; prevention & control ; surgery ; Prognosis

OBJECTIVETo study on thyroid bilateral gland lobe disease with endoscopic monolateral anterior chest approach.

METHODSTwenty patients experienced thyroid bilateral gland lobe surgery with endoscopic monolateral anterior chest approach; 24 experienced conventional surgery simultaneously and were enrolled in control group. Two groups were compared at surgical style, complications, surgical time, length of stay in hospital, incision cosmetic result and incision pain etc. Criteria of patients selected for thyroid bilateral gland lobe surgery with endoscopic monolateralanterior chest approach:with no surgical history of thyroid or other neck-related diseases and no chemotherapy; diagnosed with benign tumor according to presurgery CT result and thyroid functional examination. Diameter of tumor on both sides should be smaller than 4 cm, one side smaller than 2 cm, located at lower middle part of gland lobe and near to gland surface.

RESULTSPatients in both groups matched in age and sex; scorings on surgical style, hospital stay, postoperative drainage, and postoperative pain were not significantly distinctive. Endoscopic group had less bleeding volumn than conventional group during surgery, better cosmetic results, but longer surgical duration and higher cost of hospitalization. Both groups occurred no permanent glottic paralysis and hypocalcemia, no recurrence. Endoscopic group had one case ecchymoma; one case temporary glottic paralysis; both recovered in one month. Complication incidence in both groups was not significantly distinctive (chi(2) = 2.514, P = 0.201).

CONCLUSIONSGasless endoscopic monolateral anterior chest approach can well treat selected thyroid bilateral gland lobe disease and with a better cosmetic result than conventional surgery.

Humans ; Neoplasm Recurrence, Local ; surgery ; Thyroid Diseases ; surgery ; Thyroid Neoplasms ; surgery ; Thyroidectomy