Gland surgery最新文献

{"title":"Comparison of endoscopic surgical approaches for total thyroidectomy: a systematic review and Bayesian network meta-analysis.","authors":"Tengjiang Long, Junlei Li, Yuquan Yuan, Zeyu Yang, Peng Xu, Bin Pan, Yiceng Sun, Supeng Yin, Chengzhi Zhao, Fan Zhang","doi":"10.21037/gs-24-424","DOIUrl":"10.21037/gs-24-424","url":null,"abstract":"<p><strong>Background: </strong>Different approaches to endoscopic total thyroidectomy are emerging for the treatment of differentiated thyroid cancer, raising clinical concerns about comprehensively evaluating the strengths and weaknesses of these approaches. In this study, we aimed to conduct a network meta-analysis to compare different endoscopic surgical approaches to total thyroidectomy, revealing their respective advantages and limitations.</p><p><strong>Methods: </strong>PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2024. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to determine the probability that each surgical approach for the best individual outcome.</p><p><strong>Results: </strong>Twenty-one studies comprising 4,361 patients were included. Based on the SUCRA value, the endoscopic transoral approach (EOA) retrieved the highest number of lymph nodes (LNs) (SUCRA =0.59) among all endoscopic surgical approaches. The minimally invasive video-assisted approach (MIVAA) significantly shortened the operative time (SUCRA =0.77) compared to other endoscopic surgical approaches. MIVAA ranked as the most effective surgical approach for reducing the rate of permanent hypoparathyroidism (SUCRA =0.81) and controlling intraoperative bleeding (SUCRA =0.77). The endoscopic gasless transaxillary approach (EGAA) effectively shortened the hospital stay (SUCRA =0.95) and reduced the rate of transient hypoparathyroidism (SUCRA =0.74). The endoscopic bilateral areola (EBAA) approach ranked as the most effective surgical approach for preventing recurrent laryngeal nerve (RLN) palsy (SUCRA =0.92).</p><p><strong>Conclusions: </strong>The surgical outcomes of endoscopic total thyroidectomy are comparable to those of open thyroidectomy. MIVAA was superior to other endoscopic surgical approaches in terms of operative time, intraoperative bleeding volume, and permanent hypoparathyroidism rate. EOA demonstrated a significant advantage in LNs retrieval. EBAA was superior in protecting the RLN.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"1-12"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution and clinical impact of single-port transaxillary robotic thyroidectomy: a comprehensive review.","authors":"Kwangsoon Kim","doi":"10.21037/gs-24-409","DOIUrl":"10.21037/gs-24-409","url":null,"abstract":"<p><p>Single-port (SP) transaxillary robotic thyroidectomy represents a significant innovation in the field of endocrine surgery, offering a minimally invasive approach that combines oncological efficacy with enhanced cosmetic outcomes. The introduction of the SP robotic system has enabled surgeons to perform thyroidectomy and lateral neck dissection through a single axillary incision, resulting in a scarless neck and reduced postoperative morbidity. This review explores the current practices and surgical techniques associated with SP transaxillary robotic thyroidectomy, emphasizing the benefits of the SP robotic system over traditional multi-port and open approaches. The system's enhanced precision, due to its articulated instruments and high-definition three-dimensional visualization, allows for meticulous dissection, minimizing the risk of complications such as recurrent laryngeal nerve injury and hypocalcemia. The SP design simplifies the surgical process, reducing trauma to surrounding tissues and leading to faster recovery times and improved patient satisfaction. Clinical outcomes of the SP approach are promising, with studies indicating comparable oncological safety to conventional methods and superior cosmetic results. Patient satisfaction is notably high, particularly regarding the absence of visible neck scarring. However, the technique's adoption is limited by its steep learning curve and the high cost of the SP robotic system. This review also highlights the need for further long-term studies to fully assess the sustainability of the SP robotic system's benefits, especially in terms of oncological outcomes and cost-effectiveness. The potential of the SP transaxillary approach to become a standard option in thyroid surgery is discussed, alongside the importance of continued research and surgeon training to optimize its use. In conclusion, SP transaxillary robotic thyroidectomy offers a compelling alternative to traditional approaches, with the potential to significantly enhance patient outcomes and satisfaction in thyroid surgery.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"74-81"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Tension-free thyroidectomy (medial thyroidectomy)-a prospective study: surgical technique and results of 259 operations.","authors":"","doi":"10.21037/gs-2024b-5","DOIUrl":"10.21037/gs-2024b-5","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/gs-23-147.].</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"116-117"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography for predicting pathological complete response to neoadjuvant chemotherapeutic in breast cancer patients.","authors":"Chengchun Ge, Lukai Shi, Zhonghua Tan","doi":"10.21037/gs-2024-568","DOIUrl":"10.21037/gs-2024-568","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accurately predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) in breast cancer remains a clinical challenge. Current imaging-based models are limited in their ability to integrate key metabolic parameters to enhance prediction accuracy. This study aimed to develop and validate a nomogram using &lt;sup&gt;18&lt;/sup&gt;F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters, including maximum standardized uptake value (SUV&lt;sub&gt;max&lt;/sub&gt;), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), to improve pCR prediction. These parameters, representing both tumor metabolic burden and activity, were hypothesized to collectively provide a robust means of predicting pCR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study enrolled 95 breast cancer (BC) patients who underwent &lt;sup&gt;18&lt;/sup&gt;F-FDG PET/CT before and after NACT. Patients were categorized into pCR (n=46) and non-pCR (n=49) groups based on postoperative pathological outcomes. Clinical and pathological characteristics, as well as changes in SUV&lt;sub&gt;max&lt;/sub&gt;, MTV, and TLG, were compared between the two cohorts. Logistic regression identified independent predictors of non-pCR. The dataset was then randomly divided into training (n=66) and validation (n=29) cohorts for nomogram construction and validation. The model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Relative to the non-pCR cohort, the pCR group exhibited smaller tumor diameters, lower Ki-67 expression, fewer lymph node metastases, and higher proportions of HER2+ molecular subtype (P&lt;0.05). Pretreatment SUV&lt;sub&gt;max&lt;/sub&gt;, MTV, and TLG levels in the pCR group were significantly lower than those in the non-pCR group, and showed a marked decrease after treatment (P&lt;0.05), whereas no significant changes were observed in the non-pCR group (P&gt;0.05). SUV&lt;sub&gt;max&lt;/sub&gt;, MTV, TLG, and molecular subtype were identified as independent predictors of non-pCR through logistic regression analysis. A nomogram constructed using these predictors achieved area under the ROC curve (AUC) of 0.9003 and 0.9363 in the training and validation cohorts, respectively. The model demonstrated good calibration (Hosmer-Lemeshow test, χ&lt;sup&gt;2&lt;/sup&gt;=6.412, P=0.60) and clinical utility through decision curve analysis, effectively stratifying patients at high risk of non-pCR based on a cutoff value of 0.8230.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;&lt;sup&gt;18&lt;/sup&gt;F-FDG PET/CT demonstrates significant clinical value in predicting pCR to NACT in BC patients. By integrating metabolic parameters such as SUV&lt;sub&gt;max&lt;/sub&gt;, MTV, and TLG into a nomogram, this approach enables accurate prediction of treatment efficacy, aiding in the early identification of patients unlikely to benefit from NACT. This facilitates timely adjustments to persona","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"48-59"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary thyroid mucosa-associated lymphoid tissue marginal zone lymphoma in a 46-year-old female: a case report.","authors":"Jing Yang, Li Jiao, Guoli Du, Sheng Jiang","doi":"10.21037/gs-24-353","DOIUrl":"10.21037/gs-24-353","url":null,"abstract":"<p><strong>Background: </strong>Primary thyroid lymphoma (PTL) is an extremely rare form of thyroid malignancy, merely accounting for 2-5% of all cases. Owing to its low incidence and the absence of concrete clinical manifestations, PTL is frequently misdiagnosed as thyroiditis or thyroid cancer, thereby presenting a significant hurdle to accurate diagnosis.</p><p><strong>Case description: </strong>This case study centered around a 46-year-old female patient. We meticulously detailed the diagnosis and treatment process of her primary thyroid mucosa-associated lymphoid tissue (MALT) marginal zone lymphoma. Although ultrasonography can preliminarily flag suspected cases, a histopathologic biopsy remains indispensable for a conclusive diagnosis. In terms of treatment, surgery is only recommended under specific circumstances. Radiotherapy and chemotherapy are common approaches and play a pivotal role in managing the conditions of particular PTL patients. In this instance, the patient sought medical attention due to a rapidly enlarging neck mass. Ultrasonography revealed diffuse thyroid lesions with reticular nodules, and further biopsy verified MALT lymphoma. Subsequently, an individualized radiotherapy plan was devised.</p><p><strong>Conclusions: </strong>If PTL can be diagnosed at an early stage and treatment commenced promptly, the prognosis is generally favorable. Hence, a profound understanding of the clinical and imaging characteristics of PTL and the attainment of early diagnosis are of crucial importance for effective treatment and prognosis evaluation. This can not only enhance the survival rate of patients but also furnish valuable experience for the diagnosis and treatment of subsequent similar cases, facilitating the advancement of medicine.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"90-100"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on fat transfer prior to alloplastic breast reconstruction based on recent published data.","authors":"Ammara Ghumman, Mitchell H Brown","doi":"10.21037/gs-24-408","DOIUrl":"10.21037/gs-24-408","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"101-104"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary results from randomized control trial point toward the utility of neurotization in innervated breast reconstruction.","authors":"Maxwell Godek, Jacquelyn Roth, Keisha E Montalmant, Bernice Z Yu, Peter W Henderson","doi":"10.21037/gs-24-458","DOIUrl":"10.21037/gs-24-458","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"105-107"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of preoperative systemic inflammatory markers and carcinoembryonic antigen in medullary thyroid carcinoma and the risk factors affecting its prognosis.","authors":"Zhujuan Wu, Yuhan Jiang, Hao Gong, Tianyuchen Jiang, Anping Su, Liangying Yi","doi":"10.21037/gs-24-397","DOIUrl":"10.21037/gs-24-397","url":null,"abstract":"<p><strong>Background: </strong>Medullary thyroid carcinoma (MTC) is a rare malignancy originating from aggressive parafollicular C cells that causes 8-13% of thyroid cancer-related deaths despite its low incidence. Calcitonin and carcinoembryonic antigen (CEA) are considered to be important indicators for the diagnosis of MTC, while serum inflammatory markers have been shown to be valuable in the diagnosis and evaluation of a variety of malignant tumors, but the amount of research literature on MTC is still limited. This article aims to assess the value of serum inflammatory markers, CEA and calcitonin in the differential diagnosis of MTC from papillary thyroid carcinoma (PTC), and to explore the risk factors affecting lateral zone lymph node metastasis of MTC and the clinical features that can be predictive of disease-free survival (DFS).</p><p><strong>Methods: </strong>We retrospectively analyzed 883 patients with PTC and 128 patients with MTC who received care at West China Hospital Sichuan University. The data of clinical characteristics and follow-up results were collected.</p><p><strong>Results: </strong>In our cohort, after performing propensity score matching (PSM), there were 117 patients in the MTC group and 436 in the PTC group. Compared with PTC, MTC patients had higher neutrophil-lymphocyte ratio (NLR) (P=0.008), neutrophil-monocyte-platelet-to-lymphocyte ratio (NMPLR) (P=0.03), and CEA values (P<0.001), and no significant differences were found between the remaining baseline characteristics, with CEA having the largest area under the curve (AUC) in the differential diagnosis of PTC and MTC at 0.898 [95% confidence interval (CI): 0.862-0.934, P<0.001]. Univariate and multivariate logistic regression analyses showed that the occurrence of extrathyroidal extension (ETE) [P=0.002, odds ratio (OR): 4.159, 95% CI: 2.734-5.584], calcitonin level >1,000 pg/mL (P=0.002, OR: 4.785, 95% CI: 3.220-6.350) and CEA level (P=0.04, OR: 1.005, 95% CI: 1.000-1.010) were significantly correlated with lateral zone lymph node metastasis in MTC, while platelet-to-lymphocyte ratio (PLR) was a predictor of DFS.</p><p><strong>Conclusions: </strong>Preoperative blood inflammatory indexes, CEA, and calcitonin level may be able to initially identify MTC and PTC. Meanwhile, ETE, CEA, and calcitonin levels are independent risk factors for lymph node metastasis in the lateral zone of the MTC; therefore, surgeons should consider more carefully planning surgery in conjunction with imaging in patients who have these risk factors at the initial visit.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"13-27"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant use of CDK4/6 inhibitors, ovarian function and fertility in premenopausal women: insights from the PENELOPE-B trial.","authors":"Yael Berner-Wygoda, Eitan Amir","doi":"10.21037/gs-24-418","DOIUrl":"10.21037/gs-24-418","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"112-115"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced magnetic resonance imaging features and management principles of low-grade myofibroblastic sarcoma of the breast: a case report.","authors":"Meng Zhu, Wei Cheng, Xuejuan Liu, Lin Ma, Yujuan Chen","doi":"10.21037/gs-24-347","DOIUrl":"10.21037/gs-24-347","url":null,"abstract":"<p><strong>Background: </strong>Low-grade myofibroblastic sarcoma (LGMS) originating from breast is rare. Existing literature comprises clinical and pathological reports, with limited information on imaging characteristics. This study reports a case of LGMS of the breast and presents its imaging characteristics, with an emphasis on those observed using contrast-enhanced magnetic resonance imaging (MRI).</p><p><strong>Case description: </strong>A 50-year-old patient presented with a left breast mass for 1 year. One year before the presentation, the patient had palpated a mass of approximately 1.5 cm in size in the upper part of the left breast without any obvious cause. The mass was perceived to be growing slowly. There was no relevant family history of breast conditions. Physical examination revealed a hard, ill-defined, irregularly shaped, non-tender mass of approximately 3.5 cm × 3 cm in size, with poor mobility and a close connection to the deep skin. The mammography showed a high-density mass without microcalcifications and boundary wrapping. Ultrasonography showed an oval, ill-defined hypoechoic mass. The combination of mammography and ultrasound examination results ruled out the possibility of ductal carcinoma and benign fibroepithelial tumor. On contrast-enhanced MRI, the mass exhibited heterogeneous enhancement, high signal intensity on T2-weighted imaging (T2WI), high signal intensity on diffusion-weighted imaging (DWI), and a type I time-intensity curve (TIC). A core needle biopsy (CNB) suggested a spindle cell tumor. To confirm the diagnosis, the patient underwent surgical excision, and postoperative pathology confirmed LGMS of the breast. The patient subsequently received adjuvant radiotherapy. Seven months postoperatively, bone scintigraphy suggested possible metastases.</p><p><strong>Conclusions: </strong>LGMS of the breast exhibited a degree of malignancy on ultrasonography, mammography, and MRI, with the contrast-enhanced MRI showing a persistent enhancement pattern (type I TIC). A preoperative biopsy indicated a spindle cell tumor. Surgical excision remains the best diagnostic method. A thorough understanding of the imaging characteristics and biopsy results of this tumor type provides comprehensive information for formulating corresponding treatment plans.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 1","pages":"82-89"},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}