Δευτέρα 10 Ιουνίου 2019

Head and Neck

ORIGINAL ARTICLE
Endoscopic transoral parathyroidectomy: Initial experience
Luis‐Mauricio Hurtado‐López MD, PhD  Sandra‐Haydee Gutiérrez‐Román MD, MSc  Erich Basurto‐Kuba MD  Kuauhyama Luna‐Ortiz MD
First published: 03 June 2019 https://doi.org/10.1002/hed.25828
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Abstract
Background
We evaluate our initial experience of transoral vestibular approach parathyroidectomy (TOEPVA) for the treatment of primary hyperparathyroidism.

Methods
We conducted a prospective study of patients with single parathyroid adenoma, using TOEPVA to perform the parathyroidectomy. The variables we analyzed were size, volume, and location of the adenoma, bleeding, identification, and preservation of the recurrent laryngeal nerve, injury to the mental nerve, and the effective cure rate, using measures of central tendency.

Results
Our study included 21 women, with an average age of 43 years. The recurrent laryngeal nerve and mental nerve suffered no permanent damage, the average size of the adenoma was 26.6 mm, and a volume of 3.95 mL. We were able to identify the adenoma and cure the hyperparathyroidism in 20 of the patients (95.2%).

Conclusions
TOEPVA is viable and safe in who wish to avoid the cervical scar resulting for the patient with primary hyperparathyroidism.

ORIGINAL ARTICLE
Association between blood pressure and postoperative hematomas in the patients undergoing head and neck cancer reconstruction
Kuan‐Ying Wang MD  Kuo‐Chung Yang MD  Fang‐Yi Su MD  Yu‐Ching Chen MD  Yu‐Hsuan Hsieh MD Shiao‐Lin Huang MD  Wen‐Chung Liu MD, PhD
First published: 07 June 2019 https://doi.org/10.1002/hed.25831
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Abstract
Background
Postoperative hematoma is one of the most common complications of free flap reconstruction and compromises the perfusion of pedicles and perforators. Therefore, we reviewed our patients to analyze the associated risk factors.

Method
This study involved a retrospective chart review from 2014 to 2016. We identified the patients undergoing free flap reconstructions for head and neck cancer. Patients with postoperative hematoma requiring surgical intervention were included.

Result
We enlisted 289 patients undergoing head and neck reconstructions. Eighteen patients (6.2%) had postoperative hematomas of which 12 hematomas occurred within the first 3 days and 9 in the first 24 hours. Elevated systolic blood pressure increased the risk of hematoma formation, but hematoma was not associated with higher failure rate. Tachycardia was observed in the patients with hematoma.

Conclusions
Transient elevated blood pressure increased the risk of hematoma. We suggest controlling systolic blood pressure below 150 mm Hg for prevention of hematoma.

BOOK REVIEW
Infections of the ear, nose, throat, and sinuses.  By Durand, Marlene L., Deschler, Daniel G.. Springer, New York City, NY. 2018. $199.00 US. 404 pp
Jonathan S. Choi MD  Benjamin D. Lovin MD
First published: 07 June 2019 https://doi.org/10.1002/hed.25835

ORIGINAL ARTICLE
Efficacy of posttreatment radioiodine scanning in patients with differentiated thyroid cancer
Shorook Na'ara MD, PhD  Kamel Mahameed MD  Moran Amit MD, PhD  Jacob T. Cohen MD  Michal Weiler‐Sagie MD, PhD  Igor Albitskiy MD  Ziv Gil MD, PhD  Salem Billan MD
First published: 04 June 2019 https://doi.org/10.1002/hed.25833
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Abstract
Background
Differentiated thyroid cancers often require radioiodine treatment followed by posttreatment scan. We aimed in this study to assess the utility of the posttreatment radioiodine scan in this population.

Methods
An analysis of patients who received radioiodine treatment at Rambam Campus, during 2006‐2013. Scans showing remnant normal thyroid tissue were considered as normal. Positive uptake was defined as uptake in the lateral neck or distant sites.

Results
A total of 455 patients were analyzed, 68% had T1‐T2 and 28% had positive lymph nodes. Positive uptake in the lateral neck was recorded in 52 (11.4%) and in distant sites in 41 (9%) patients. Tracheal invasion, esophageal invasion, nerve invasion, and N1b classification were associated with a positive scan (P < .05). A positive radioactive iodine scan was not related to poor prognosis.

Conclusions
Posttreatment scans are positive in only 20% of patients. Locally invasive tumor and positive nodes are associated with positive scans.

CLINICAL REVIEW
Efficacy and toxicity of sorafenib in the treatment of advanced medullary thyroid carcinoma: A systematic review and meta‐analysis
Huy Gia Vuong MD, PhD  An Thi Nhat Ho MD  Thao T. K. Tran MD  Jaume Capdevila MD, PhD  Mustafa Benekli MD, PhD  Tadao Nakazawa MD, PhD  Ryohei Katoh MD, PhD  Tetsuo Kondo MD, PhD
First published: 04 June 2019 https://doi.org/10.1002/hed.25832
Section Editor: Nabil Saba
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Abstract
Introduction
The aim of this study is to investigate and summarize the treatment efficacy and adverse effects (AEs) of sorafenib in the treatment of metastatic medullary thyroid carcinomas (MTCs).

Methods
We included studies reporting the treatment efficacy or drug toxicity of sorafenib as a single therapeutic agent in MTCs. Pooled incidence and its 95% confidence interval (CI) for complete response, partial response (PR), stable disease (SD), and sorafenib‐related AEs were calculated using random‐effect model.

Results
Eight trials with 101 metastatic MTCs were included for meta‐analyses. The overall PR and SD were 21% (95% CI = 9‐33) and 58% (95% CI = 41‐75), respectively. Hand‐foot syndrome, diarrhea, alopecia, mucositis, skin rash, fatigue, and hypertension were the most commonly observed AEs.

Conclusion
Our results show that sorafenib treatment has a modest effect and might be a candidate treatment in patients with metastatic MTCs who have failed other therapeutic regimens.

ORIGINAL ARTICLE
Combined analysis of miRNA‐181a with phase angle derived from bioelectrical impedance predicts radiotherapy‐induced changes in body composition and survival of male patients with head and neck cancer
Tomasz Powrózek PhD  Anna Brzozowska PhD  Marcin Mazurek MSc  Radosław Mlak PhD  Grzegorz Sobieszek PhD  Teresa Małecka‐Massalska
First published: 04 June 2019 https://doi.org/10.1002/hed.25830
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Abstract
Background
Nutritional deficits developing as an effect of applied radiotherapy (RTH) negatively affect patients' quality of life, survival, and therapy outcomes. We demonstrated novel approach to prediction of RTH‐induced changes in body composition of patients with head and neck cancer using phase angle (PA) derived from bioelectrical impedance in combination with miRNA‐181a expression.

Results
Patients with simultaneous presence of low PA and high miRNA expression were at a significantly higher risk of decreasing the fat‐free mass index (FFMI) <14.9 kg/m2 (odds ratio [OR] = 5.14; P = .02), FFM < 44.7 kg (OR = 6.20; P = .04), and lean mass (OR = 10.0; P = .04) during the therapy period. Receiver operating curve analysis allowed to predict changes in FFMI, lean mass, and FFM with area under the curve calculation over 0.700. The simultaneous presence of high miRNA and low PA negatively affected patients' survival (OR = 5.12; P = .02).

Conclusion
Evaluation of PA in combination with miRNA demonstrates higher diagnostic accuracy and predictive value for detecting RTH‐induced changes in body composition of patients with cancer.

ORIGINAL ARTICLE
Level of plasma catecholamine predicts surgical outcomes of carotid body tumors: Retrospective cohort study
Huanrui Hu PhD  Jichun Zhao PhD  Zhoupeng Wu PhD  Bin Huang PhD
First published: 03 June 2019 https://doi.org/10.1002/hed.25827
Funding information: West China Hospital post‐doctor fund, Grant/Award Number: 2018HXBH045
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Abstract
Backgrounds
Carotid body tumors (CBTs) are rare neoplasms and some of them produce catecholamine. Although operations for catecholamine‐producing CBTs are safe, the relationship between prognosis and endocrine function has not been analyzed before.

Methods
Patients diagnosed with CBTs in our department between 2009 and 2018 were analyzed. Plasma catecholamine was examined as a variable of surgical outcomes and prognosis by using statistical methods.

Results
Patients who suffered CBTs and underwent operations were divided into two groups according to their plasma catecholamine. Patients in the normal group had more or heavier surgical complications, such as neurological complications (P = .008) and blood loss (P = .03), than those in the high group. However, overall survival, local recurrence, and remote metastasis were not varied significantly in both groups.

Conclusions
A high level of plasma catecholamine was a predictor for the improved operative outcomes of CBTs. Hence, nonfunctional CBTs had further short‐term surgical complications.

EDITORIAL COMMENTARY
Transoral parathyroidectomy—Why make a simple operation complicated? A surgical fantasy
Ashok R. Shaha MD
First published: 03 June 2019 https://doi.org/10.1002/hed.25829
Synopsis for Table of Contents: Transoral vestibular approach to parathyroid surgery is a new innovative technique as a scarless surgical procedure. Several issues related to long‐term complications, recurrent hyperparathyroidism, and learning curve need to be addressed prior to routine application of this new technology.


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