The researchers conclude that a sinus wash at the time of adenoidectomy for children with a high CT score led to an improved outcome compared with adenoidectomy alone, independent of oral or parenteral antibiotic management.
Explore This IssueMay 2008
Efficacy of Nodal Dissection for Recurrent Papillary Thyroid Cancer
Although papillary thyroid cancer (PTC) generally has an excellent prognosis with regard to mortality, eventual recurrence in the thyroid bed or neck has been reported in up to 30% of patients. These locoregional recurrences may be associated with significant morbidity as well as long-term mortality in higher-risk patients. For patients with locoregional recurrences, both adjuvant radioiodine therapy and lymph node dissection (LND) have been advocated; however, the relative safety and efficacy of these two treatment modalities are unclear. Recent American Thyroid Association guidelines recommend surgery for bulky disease or disease that is amenable to a surgical approach, but also report that radioiodine is often used in place of surgery. Furthermore, if surgery is chosen as the treatment modality, the optimal extent of surgical dissection remains undefined. Kathryn G. Schuff, MD, and associates report on a retrospective analysis of the safety and efficacy of surgical management of persistent/recurrent PTC in a group of patients who underwent selective central or lateral LND by one surgeon, who used a systematic approach to treatment planning.
The study population included all patients with persistent/recurrent PTC who underwent central compartment or cervical LND during a 26-month period. Seventy-five patients met the inclusion criteria; a total of 79 resections were performed on these 75 patients. All patients had previously undergone total thyroidectomy, and most had also received radioiodine ablation. Previous LND had been performed in 57 patients, although the extent of the dissections varied widely. Of the 79 dissections, all were included in the safety analysis, and 41 met the criteria for efficacy analysis.
Nodal involvement with PTC in the central or lateral compartments was found in 91% of the resections. There were 25 minor complications among the 79 resections, and seven major complications, including permanent hypoparathyroidism, significant abscess, and pulmonary embolism after deep venous thrombosis. Neither prior nodal dissection, extent of nodal dissection, nor extent of disease were predictive of surgical complications.
The authors used a systematic, individualized approach to LND based on initial tumor site, prior surgical therapy, known pathways of nodal spread, and higher efficacy of formal nodal dissection over berry picking. This approach led to a cure rate of 41% of classifiable resections, using the criterion of postoperative stimulated thyroglobulin (Tg) of 2 ng/dL or less. In addition, 72% of resections had either cure or postoperative reductions of more than 50% in Tg levels, the primary serum marker of well-differentiated thyroid cancer persistence/recurrence.