S. Nikolic

Surgical treatment of colorectal liver metastasis after neoadjuvant chemotherapy.

688 Background: Liver is typical place for metastasis for patients with colorectal carcinoma. During the period of disease, 50% of patients with colorectal carcinoma will get liver metastases, 20% of the will have synchronous and 30% metachronous. Surgical resection is modality of choice in treatment for liver metastases in colorectal carcinoma. Applying neoadjuvant chemotherapy in patients with colorectal cancer liver metastases, which are primarily nonresectable or potentially resectable, it is possible to transform in resectable state. The goal of treatment is R0 liver resection and putting the patient in the NED stage of disease. METHODS All patients received protocol for potentially resectable metastase- FOLFOX-bevacizumab. The assessment was conducted on the basis of angioCT and NMR. With all patients liver resection procedures and RFA were applied. RESULTS During the period from June 2007 to December 2009 in 40 patients with nonresectable or potentially resectable metastases the neoadjuvant HT FOLFOX-bevacizumab was applied on average for three months. The patients were operated 6 weeks after the last application of bevacizumab, because of the possibility of intraoperative bleeding. The number of metastases ranged from 1 to 6. With 17 patients lobar resection was performed, and with 10 patients segmental resection was performed. With another 11 patients metastasectomy was performed, while RFA was performed with 2 patients. 3 years survival is 57.5%. CONCLUSIONS By applying neoadjuvant HT and bevacizumab with patients suffering from colorectal cancer liver metastases as the only existing metastases, it is possible to significantly reduce metastases, and thereby resection as well. With this approach time without disease and survival are increased.

539. Recurrent Laryngeal Nerve Reconstruction After Resection During the Operation of Locally Advanced Thyroid Cancer

S 887 MNGs,31 adenomas and 9 cysts.Out of 165 cancer cases 109 were papillary,20 follicular,46 mixed type and 5 medullary.18 had intrathorasic extensions.Using single ipsilateral incision 40 hemithyroidectomies,70 total thyroidectomies of benign and 55 early cancers were done.Central compartment clearance done in cancers. Bilateral approach used in 110 cases of carcinomas requiring bilateral node dissection and for 8 cases of bilateral intrathorasic extensions. Parathyroids were dissected pulvurised and injected into Sternocleidomastoid muscle before dissection. Results: Blood loss was 10-15 ml and hospital stay 24 hrs.There were no nerve injuries.Parathyroid deficiency was reported in 10/283. 165 thyroidectomies (115 total) were performed with single lateral incision. Within 6 months scar disappeared, sensory stimuli returned to normal giving excellent cosmesis and quality of life. Conclusions: ’Minimally invasive open Thyroidectomy’*’Thomas technique’, is a novel method applicable for all thyroid neoplasms . Avoidance of ’handling’ of the gland upfront,better accessibility and direct vision of nerves, ligation of vascular pedicles upfront, makes this approach unique and ’bloodless’.New technique facilitate better lymph adenectomy than anterior approach, is safest for intrathorasic extensions and even forTotal thyroidectomy with single lateral incision. Complications described in the literature are minimised with superior cosmetic results compared to Kocher~ Os technique. 539. Recurrent Laryngeal Nerve Reconstruction After Resection During the Operation of Locally Advanced Thyroid Cancer I. Markovic, R. Dzodic, I. Djurisic, M. Buta, M. Oruci, S. Nikolic, S. Petrovic, M. Mitrovic, M. Jevric, G. Pupic 1 Institute of Radiology and Oncology, Surgery, Belgrade, Serbia Background: Recurrent laryngeal nerve (RLN) palsy is a major obstacle in thyroid and parathyroid surgery. Permanent RLN paralysis was reported in 0.5 to 10% of cases. RLN injuries are more frequent during the operation and reoperations of cancer and recurrent goiter. In locally advanced thyroid cancer RLN could be infiltrated by tumor or lymph node metastases in paratracheal region. Primary objective is to achieve complete resection of tumor and lymph nodes. Resection of RLN in length of infiltration is sometimes necessary. Secondary goal during the operations is to improve phonation. A method of RLN reconstruction depends on type of injury. If end-to-end suture is not possible, anastomosis of proximal end of RLN with ansa cervicalis (ARA) using Miyauchi technique could be performed. Patient and Methods: A female patient in middle forties who was admitted to our Institute due to locally advanced multifocal papillary thyroid cancer with bulk lymph node metastases in both central and lateral neck compartments. Total thyroidectomy, central and bilateral modified radical neck dissections were performed using classic neck and modified McFee incisions. Right RLN was infiltrated about 3 cm in length up to its entrance into the larynx. Block resection of right lobe and paratracheal LNM was performed. Immediate ARA reconstruction with 6-0 resorbable sutures followed the operation. Results: The rate of RLN recovery was verified by postoperative direct laryngoscopy. It is important to underline that if the nerves were reconstructed by sutures vocal cords don‘t regain normal movement and are usually fixed in the median position. The patient‘s voice improves because reinervated cords recover from atrophy and restore tension during phonation which is shown on audio recording. Conclusion: Nerve reconstruction is strongly suggested in cases of planed or accidental resection. The ultimate method to evaluate quantitatively the voice recovery is the maximum phonation time. 541. Incidental Parathyroidectomy During Total Thyroidectomy G. Katsouli, O. Ignatova, G. Chinari, N. Perrakis, G. Tassopoulos, N. Petridis, P. Sarof, J. Nomikos, P. Arapantoni, K. Ntatsis Metaxa Cancer Hospital, Surgery, Piraeus, Greece Metaxa Cancer Hospital, Pathology, Piraeus, Greece Metaxa Cancer Hospital, Head and Neck Surgery, Piraeus, Greece Objectives: A retrospective study of the Second Department of Surgery and ENT Department of METAXA Cancer Hospital, in order to identify the degree of correlation of the presence parathyroid tissue in the thyroid specimens after elective total thyroidectomy. Patients-Methods: 183 cases of total thyroidectomy have been evaluated between 10/2009 and 10/2011.Preoperative calcium, phosphorus, PTH, FT3, FT4, TSH levels, Ultrasound, CT, R* Chest and FNA were reviewed in this patients. 36 of the 183 were males between 22 to 85 years old and 147 were females between 20 to 82 years old. This study evaluated the histopathological findings of total thyroidectomy. The presence or absence of parathyroid gland in the surgical thyroid specimen is reviewed. Results: 78 cases out of 183 patients confirmed thyroid malignancy. Among these 78 cases of thyroid malignancy, parathyroid tissue was found in 25 thyroid specimens. Among the 105 patients with benign disease, 14 with parathyroid tissue have been detected. Statistical evaluation with the X test proves a statistically significant relationship between malignancy and inadverted parathyroidectomy in total thyroid resection (0,001<P<0,01). Conclusion: The inadverted parathyroidectomy is noted frequently after total thyroidectomy with underlying malignancy. The suspicion of malignancy probably influences the surgeon to more radical resection.In literature is confirmed the findings of this study. There are also opposite results. 543. Evaluation of Effective Clinicopathologic Factors on Patients Outcome with Well Differentiated Thyroid Carcinoma A. Fanipakdel, H. Saidisaedi, S. Shahidsales, S.S. Roodbari 1 Omid Hospital, Radiotherapy-Oncology, Mashad, Iran 2 Razi Hospital, Radiotherapy-Oncology, Rasht, Iran Kowsar Hospital, Surgery, Astaneh Ashrafieh, Iran Introduction: Thyroid cancer is the most common cancer of endocrine system. Clinical, pathological and therapeutic factors affect patients’ outcome with differentiated thyroid carcinoma. The aim of this study was evaluation of the effective clinicopathologic factors on patients’ outcome with well differentiated thyroid carcinoma. Materials and Methods: In this retrospective analytic-descriptive study, patients’ files with thyroid carcinoma who referred to radiology-oncology departments in Omid and Ghaem hospital of Mashhad,Iran, were assessed from 1996-2006. Cases with pathologic report of papillary and follicular carcinoma were considered and a specific questionnaire including age, sex,time of admission, pathologic subtype, tumor size and metastases, adjuvant treatment, recurrence time, patient’s condition in the last visit and death time were recorded. Results: The patients’ mean age was 50.14 and median age was 52 years. Sixty patients (85.7%) had papillary and 11 cases (14.3%) had follicular carcinoma. End condition in 43 cases (55.8%) was good and in 34 cases (44.2%) was bad. Mean survival time was 44.1 and median survival time was 36 months. There was a significant association between T stage with end condition (P1⁄40.037) but there was no significant association between N stage with end condition (P1⁄40.665). Metastases at the time of the first visit had a significant correlation with patients outcome. 41patients (59.4%) from 69 cases with M0 disease had a good end condition versus only one patient (16.7%) from 6 cases with M1 disease with a good outcome