B. Lallemant

The Use of Preoperative Routine Measurement of Basal Serum Thyrocalcitonin in Candidates for Thyroidectomy due to Nodular Thyroid Disorders: Results from 2733 Consecutive Patients

CONTEXTnThe preoperative routine measurement of basal serum thyrocalcitonin (CT) in candidates for thyroidectomy due to thyroid nodules is currently a subject of debate.nnnOBJECTIVEnThe objective of this study was to evaluate the role of systematic basal serum CT measurement in improving the diagnosis and surgical treatment of medullary thyroid carcinoma (MTC) in patients undergoing thyroidectomy for nodular thyroid disorders, regardless of preoperative CT levels.nnnDESIGNnWe determined basal serum CT levels in 2733 consecutive patients before thyroid surgery and performed a pentagastrin test in patients with hypercalcitoninemia. We correlated basal and stimulated CT levels with intraoperative and definitive histopathological findings, and we analyzed the impact of these results on surgical procedures.nnnRESULTSnTwelve MTCs were found among the 43 patients with basal serum CT level of 10 pg/ml or greater. Two MTCs were present among the 2690 patients with normal CT levels. MTC was always present in patients with a basal CT of 60 pg/ml or greater. For CT levels ranging from 10 to 59 pg/ml, MTC was diagnosed in 11% of patients. When preoperative hypercalcitoninemia was present, total thyroidectomy associated with comprehensive intraoperative histopathological analysis allowed the intraoperative diagnosis of five latent, subclinical MTCs. The pentagastrin test gave no additional diagnostic information for the management of patients with elevated preoperative basal serum CT level.nnnCONCLUSIONnRoutine measurement of CT in the preoperative work-up of nodular thyroid disorders is useful. This procedure improves intraoperative diagnosis of MTC and enables adapted initial surgery, the most determinant factor of treatment success.

Enhancement of temporal bone anatomy learning with computer 3D rendered imaging softwares

Aim: To determine whether the use of 3D anatomical models is helpful to students and enhances their anatomical knowledge. Methods: First year undergraduate students on the speech therapy or hearing aid practitioner courses attended either a lecture alone or a lecture followed by a 3D anatomy based tutorial, the latter which was also attended by ENT residents. Participants who received the tutorial were free to use the 3D model on the university computers or on their home computer and were then asked to answer a satisfaction questionnaire. At the end of the first year examinations, the grades of the undergraduate students were compared between the lecture alone group and lecture plus tutorial group. Results: Generally, all participants found this new tool interesting and user-friendly for the learning of temporal bone anatomy. However, most also considered the help of a teacher indispensable to guide them through the virtual dissection. First year undergraduate students who received the 3D anatomy tutorial performed significantly better during their end of year examination compared to those receiving a lecture alone, particularly concerning the more difficult questions. Conclusion: The 3D anatomical software, used in parallel with traditional teaching methods, such as lectures and cadaver dissection, appears to be a promising tool to improve student learning of temporal bone anatomy.

Transoral robotic surgery for the treatment of T1–T2 carcinoma of the larynx: Preliminary study

To determine the feasibility and the preliminary oncological results of transoral robotic surgery (TORS) for the treatment of early stage laryngeal tumors.

Morbidity and mortality revue of the French group of transoral robotic surgery: a multicentric study

AbstractTransoral robotic assisted surgery (TORS) represents an innovative endoscopic therapeutic alternative in the treatment of head and neck tumors. Many publications favor this surgery, especially in terms of functional results. The aim of this study was to investigate the TORS morbidity and mortality and to identify the risk factors for complications. It is a multicenter retrospective study. All head and neck tumor patients treated by TORS were included in the study over a period of 5xa0years (2009–2014). The studied parameters were the intraoperative and post-operative complications including hemorrhage, fistula, tracheotomy, aspiration pneumonia and death. The parameters were correlated with age, tumor location, tumor stage, endoscopic exposure and patient’s co-morbidities. 178 patients were included in the study. Malignant tumors classified as T1 were found in 169 cases (nxa0=xa051), T2 (nxa0=xa0100), T3 (nxa0=xa016) and T4 (nxa0=xa02). The tumor locations were distributed as follows: larynx (nxa0=xa084), oropharynx (nxa0=xa051), and hypopharynx (nxa0=xa043). Fifty-three patients followed post-radiation therapy. We observed 12 intraoperative complications including 6 hemorrhage, 3 pharyngeal fistulas and 3 external surgical conversions. Postoperatively, we detected 33 hemorrhage, 27 aspiration pneumonia, 9 tracheostomy, 2 pharyngostomes, 2 cervical spondylitis and 2 deaths. The risk factors identified were (i) anticoagulant and/or antiplatelet therapy for hemorrhage, (ii) tumoral stage and the laryngeal location for aspiration pneumonia and (iii) laryngeal location for tracheostomy. Higher age over 65xa0years has been identified as a risk factor for all post-operative complications. TORS is a safe technique for the treatment of head and neck tumors. We identified some risk factors for complications which should systematically be studied in order to reduce its morbidity.n

Management of the Neck in the Setting of Definitive Chemoradiation: Is There a Consensus? A GETTEC Study

BackgroundThe management of the neck remains controversial in the definitive chemoradiation setting of advanced N2–3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2–3 or selective ND for residual diseaseMethodsWe studied the patterns of care in the French-Belgian Groupe d’Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey.ResultsEighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND.ConclusionsOmission of ND based on computed tomographic scan and positron emission tomography–based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus–related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.

Robotic thyroid surgery: our experience with the infraclavicular approach.

Robot‐assisted endoscopic transaxillary thyroidectomy is an emerging surgical technique. Despite promising results it presents some limitations and remains controversial in terms of usefulness and validity. We developed an alternative robotic technique using a gasless infraclavicular approach.

Prédiction rapide de l’hypocalcémie par un dosage postopératoire immédiat de la parathormonémie (PTH) après thyroïdectomie

But de la presentation Etudier les valeurs diagnostiques du dosage de la parathormonemie (PTH) realisee au moment de la fermeture cutanee pour predire l’hypocalcemie postoperaoire apres thyroidectomie totale ou totalisation. Materiel et methodes Trois cent cinquante-cinq patients operes consecutivement ont beneficie d’un dosage de PTH precoce entre octobre 2011 et octobre 2013. Un dosage de la calcemie corrigee et une evaluation des symptomes lies a l’hypocalcemie (echelle EVA) etaient realises a j1 et j2. Resultats Soixante patients (17xa0%) ont presentes une hypocalcemie biologique ( xa04). En retenant une valeur seuil de PTH de 9xa0ng/L (technique Beckman), la sensibilite diagnostique du dosage precoce de la PTH etait la sensibilite du dosage etait de 95xa0% et sa valeur predictive negative de 99xa0%. En retenant une valeur seuil de PTH de 20xa0ng/L (technique Roche), la sensibilite diagnostique du dosage precoce de la PTH etait la sensibilite du dosage etait de 100xa0% et sa valeur predictive negative de 100xa0%. La maladie de Basedow et la realisation d’un curage ganglionnaire du niveau VI etaient les 2 facteurs de risque principaux d’hypocalcemie postoperatoire. Contrairement a certaines donnees de la litterature, la valeur preoperatoire du taux de vitamine D n’etait pas associee a un surrisque d’hypocalcemie. Conclusion Le dosage precoce de la PTH permet avec une grande fiabilite de predire la survenue d’une hypocalcemie postoperatoire mais depend du seuil et de la methode de dosage choisie. Cette information obtenue precocement permet d’optimiser la prise en charge des patients. Ce dosage permet la mise en œuvre rapide d’un traitement pour les patients a risque d’hypocalcemie et une sortie acceleree des patients juges a faible risque. Une etude de l’impact de dosage sur la prevention des symptomes de l’hypocalcemie par la mise en œuvre d’un traitement precoce par vitamine D est en cours.