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Updates in Surgery Dec 2023Indocyanine green (ICG) is a useful tracer for lymph node mapping and retrieval. However, during endoscopic surgery, it is challenging to administer ICG into the thyroid...
Indocyanine green (ICG) is a useful tracer for lymph node mapping and retrieval. However, during endoscopic surgery, it is challenging to administer ICG into the thyroid without spillage. We developed a simple technique of delivering ICG, thereby preventing leakage. Patients who underwent the transoral endoscopic thyroidectomy were retrospectively reviewed. In 20 patients, who constituted the ICG group, 0.1 mL ICG was injected into the peri-tumoral space under ultrasound guidance, soon after the patients received general anesthesia. Patients with papillary thyroid carcinoma who did not receive the ICG injection comprised the control group (n = 43). The location, size, and number of harvested lymph nodes were recorded in conjunction with parathyroid-related parameters. No ICG spillage occurred in the ICG group, and 76 ICG-stained lymph nodes were detected in the pretracheal (57.9%), paratracheal (25.0%), and prelaryngeal regions (17.1%). The ICG group demonstrated a significantly higher number of total (5.3 vs 2.1) and metastatic (1.5 vs 0.6) lymph nodes, a larger metastatic deposit in the positive node (3.5 mm vs 1.6 mm), and a higher rate of pathologically node-positive disease (70.0% vs 27.9%) than did the control group. The postoperative calcium level (7.8 mg/dL vs 7.2 mg/dL) was also higher in the ICG group. Pre-incisional, trans-isthmic injection of ICG under ultrasound guidance is a simple technique to prevent the leakage of ICG. Under fluorescence imaging, an adequate number of lymph nodes can be harvested for examination, which may assist in intraoperative decision-making.
Topics: Humans; Indocyanine Green; Thyroidectomy; Retrospective Studies; Lymph Nodes; Thyroid Neoplasms; Sentinel Lymph Node Biopsy
PubMed: 37421517
DOI: 10.1007/s13304-023-01580-x -
Hepato-gastroenterology 2014To determine the anatomic distribution of mesentery-like appearance around the thyroid and explore a potential mesothyroid excision for thyroid cancer patients....
BACKGROUND/AIMS
To determine the anatomic distribution of mesentery-like appearance around the thyroid and explore a potential mesothyroid excision for thyroid cancer patients. According to the concept of total mesorectal excision (TME) for rectal cancer, we perform a concept of complete mesothyroid excision for thyroid cancer. Most digestive organs have mesentery. In-depth understanding of mesentery has changed the conceptual framework of surgical treatment and improved management and better outcomes of digestive tumors.
METHODOLOGY
The anatomic distribution of the fascia and fascial spaces was studied by dissection of ten specimen fixed in 10% formalin. Thyroid cancer patients (n=5) were included to verify the fascia and fascial spaces during the operation.
RESULTS
The paratracheal fat tissue was found to connect to the pretracheal fat tissue with a structure embedded in two layers of fascia. The two layers of fascia combined with carotid sheath from the outside, while the inside component was connected to the thyroid and considered mesentery.
CONCLUSION
The thyroid has mesentery which is located in pretracheal and paratracheal area. An adequate treatment for the patients is the systematic en bloc removal of the tumor and lymph nodes while performing mesothyroid excision.
Topics: Fascia; Fasciotomy; Humans; Lymph Node Excision; Mesentery; Thyroid Gland; Thyroid Neoplasms
PubMed: 25699346
DOI: No ID Found -
Gan To Kagaku Ryoho. Cancer &... Dec 2020A case of successful local treatment for metachronous oligometastases to the lung and mediastinal lymph nodes in a postmenopausal woman with breast cancer is presented....
A case of successful local treatment for metachronous oligometastases to the lung and mediastinal lymph nodes in a postmenopausal woman with breast cancer is presented. A 44-year-old woman underwent partial mastectomy and left axillary lymph node dissection for right breast cancer. Thirteen years and 3 months after the operation, she was referred to our hospital for a right lung mass detected by mass screening and diagnosed with a metastatic lung tumor from left breast cancer following CT-guided biopsy. She was simultaneously diagnosed with right breast cancer, and pulmonary metastasectomy, right partial mastectomy, and sentinel lymph node biopsy were performed. Two years after the second operation, follow-up CT showed a swollen lymph node at the pre-tracheal space, and endobronchial ultrasound-guided transbronchial needle aspiration confirmed the diagnosis of metastatic breast cancer. The mediastinal lymph node metastasis showed no change in size for 2 years and 7 months with fulvestrant therapy, and no other metastases were found. Proton beam therapy of 60 GyE in 30 fractions was administered to the metastatic lymph node. Substantial tumor shrinkage with no severe toxicity was observed, and to date, the patient has remained disease-free. More cases need to be studied to investigate the appropriate strategy for local therapy in patients with oligometastatic breast cancer.
Topics: Adult; Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Mastectomy; Sentinel Lymph Node Biopsy
PubMed: 33468973
DOI: No ID Found