As remote-access thyroidectomy (RAT) becomes more widely used, evidence on patient- reported outcomes, particularly health-related quality of life (HRQoL), remains scarce and inconsistent. This meta-analysis compared postoperative HRQoL between thyroid cancer (TC) patients undergoing RAT and open thyroidectomy (OT) and assessed changes over time. A comprehensive search of five major databases was conducted from inception to August 2025. Studies reporting HRQoL after RAT or OT were included. Outcomes were grouped by postoperative timepoints. Outcomes were stratified across distinct postoperative timepoints to calculate pooled standardized mean difference (SMD) or mean difference (MD). Heterogeneity was explored through rigorous subgroup analyses encompassing surgical modalities, countries, and assessment instruments. Forty-one studies met the inclusion criteria, and 29 records were included in the quantitative synthesis. RAT demonstrated early advantages in comprehensive quality of life at 1 month and 3 months, and these advantages dissipated long term. Pain trajectories exhibited a biphasic pattern: RAT was associated with lower pain scores on postoperative day 1 but paradoxically higher scores during the 1–2 week period, with subsequent convergence. Cosmetic satisfaction and swallowing function consistently favored RAT from 1–2 weeks through 6 months, while voice outcomes showed no discernible differences. RAT appears to confer selected short- to medium-term patient-reported advantages over OT, particularly in cosmetic satisfaction and swallowing function. But these benefits are heterogeneous and not consistently maintained across all domains or timepoints. Future studies should standardize cross-culturally validated PRO instruments and adopt harmonized follow-up intervals and reporting guidelines to clarify the patient-centered value of RAT.

The BRAF V600E mutation induces sustained activation of the MEK-ERK signaling pathway, driving accelerated cell proliferation, enhanced migration, invasion, and resistance to apoptosis, which is recognized as a critical pathogenetic mechanism in refractory thyroid cancer. Small interfering RNA (siRNA) holds significant promise in cancer therapy due to its high specificity and silencing efficiency, ease of synthesis, and cost-effectiveness. However, its clinical application is limited by poor permeability and stability. DNA-assembled nanostructures, especially the tetrahedral DNA nanostructures (TDNs), are promising nanocarriers with preeminent biosafety, low biotoxicity, and high transport efficiency. In this study, we therefore synthesized a TDN-based BRAF V600EsiRNA delivery system (TDN-siBraf), which not only prolonged the half-life of siRNA, but also exhibited efficient siRNA delivery, excellent biocompatibility, and gene silencing efficiency. By establishing two distinct cell line models, a murine model and a notable in vitro patient-derived tumor organoids (PDTOs) model of refractory thyroid cancer, we demonstrated that TDN-siBraf could enhance targeted siBraf delivery and improve antitumor efficacy both in vivo and in vitro by inhibiting cancer cell proliferation and invasion while promoting apoptosis, with favorable biosafety and biocompatibility. Furthermore, treatment with the TDN-siBraf effectively inhibited the activation of the MEK-ERK signaling pathway, leading to mitochondrial dysfunction and elevated DNA damage, which ultimately culminated in cellular impairment. This study introduces a high-efficiency TDN-siBraf delivery system with prolonged siRNA half-life and enhanced antitumor activity in refractory thyroid cancer, offering a promising strategy with significant clinical translation potential.

Objective:To explore the feasibility and preliminary efficacy of domestic single-port robotic surgical system in the surgical treatment of thyroid cancer. Methods:Thyroid cancer patients who underwent domestic single-port robotic surgery in the Department of Head and Neck Surgery of Sichuan Cancer Hospital from June 2024 to January 2025 were prospectively included. Clinical data, oncological characteristics, and perioperative indicators were systematically collected. Results:A total of 7 patients were included, including 3 males and 4 females, with an age of （34.57±10.26） years. All procedures were successfully completed without conversion to open surgery. Operative time was（180.00±30.41） minutes. Blood loss was（5.00[15.00 ]）mL. Postoperative drainage volume was （167.86±130.95） mL. The postoperative pathological results were all thyroid papillary carcinoma. There were no system failures, no device-related complications and adverse events were observed during the operation and perioperative period. No tumor recurrence or metastasis was observed during the follow-up period. Conclusion:Preliminary data indicate that the domestic single-port robotic surgical system is safe and feasible for the surgical treatment of thyroid cancer, providing a practical basis for subsequent multi-disease, multi-center, and large-sample studies.

(编者按:随着现代科学技术的飞速发展临床诊疗技术和方法不断发展和完善.本专栏的开辟旨在创建一个学术交流平台针对本学科临床工作中的热点和难点邀请在相关领域做出大量工作并颇有建树的专家和教授介绍他们的见解和经验以飨读者.圆桌论坛为个人意见不具共识性.)

Objective To evaluate facial nerve reconstruction's impact on quality of life (QoL) and clinical outcomes in radical parotid malignancy surgery. Methods Patients were stratified into the Preservation Group, Reconstruction Group, and Disconnection Group, retrospectively analyzed objective measures (from medical records and operative reports) and subjective measures (using the Sunnybrook Facial Grading System [SFGS] and Facial Clinimetric Evaluation [FaCE] scale) across the three patient groups. Results No significant differences in recurrence or mortality were observed between Reconstruction and Disconnection groups (p > 0.05). Facial nerve reconstruction significantly improves outcomes in patients with high-risk parotid malignancies (p < 0.05), despite higher-risk profiles in the reconstruction cohort. This improvement remained stable over time, showing no significant decline (p > 0.05). Venous nerve conduit trap yielded superior facial nerve function and QoL versus end-to-end repair (p < 0.05). Conclusion Facial nerve reconstruction effectively improves outcomes in parotid malignancy surgery. Venous nerve conduit trap application is better than end-to-end repair.

Background: With the growing demand for cosmetically appealing, scar-free thyroidectomy procedures driving rapid advances in endoscopic and robotic technology, protecting the parathyroid glands (PGs) during remote-access thyroid surgery is essential to minimize complications and ensure favorable outcomes. However, current methods rely primarily on the surgeon's experience and are limited in complex environments. In this study, we developed a comprehensive artificial intelligence (AI) model for precise PG identification and segmentation during multi-approach remote-access thyroid surgery. Methods: A total of 210 surgical videos from Sichuan Cancer Hospital, encompassing multiple remote-access approaches, were used to develop AI models. We trained and evaluated five AI models and selected the best-performing YOLOv11 model for further development of our intelligent system, SmartThyroid. The differences in performance between SmartThyroid and surgeons in terms of PG recognition rates, time, and duration were analyzed. Results: SmartThyroid demonstrated excellent performance, achieving a mean Dice of 0.873, a mean IoU of 0.804, and an AP50 of 0.974. In the test group, SmartThyroid outperformed all surgeons in initial recognition time. It showed higher PG recognition rates and longer duration compared to junior surgeons, while performing similarly to senior surgeons. Furthermore, SmartThyroid significantly reduced initial recognition time and improved duration for all surgeons. Junior surgeons also showed enhanced PG recognition rates. Conclusions: SmartThyroid is an innovative AI model for precise PG identification and segmentation during multi-approach remote-access thyroid surgeries. It enhances the accuracy and efficiency of PGs identification in testing.

Introduction Chylous fistula (CF) is a serious complication after lateral (ND) in patients with head and neck malignancies. Due to the low incidence of this complication, its risk factors and clinical courses remain unclear. The aim of this study is to provide dependable results regarding these aspects through the largest sample size and comprehensive indicators. Methods A retrospective study was conducted at our hospital from 2014 to 2024. Univariate and multivariate regression analyses were used to identify the risk factors for CF. Results A total of 3819 consecutive neck dissections in 3733 patients were analyzed. The overall incidence of CF was 7.5 %. Logistic regression analysis revealed that alcohol use, poorly differentiated carcinoma, recurrence in lateral neck, retrieval of additional lateral lymph nodes (LNs), clinical extranodal extension (ENE) level IV and intraoperative identification of CF were independent risk factors. In subgroup analysis, alcohol use, recurrence in lateral neck, clinical ENE level IV and intraoperative identification of CF were independent risk factors for CF in papillary thyroid carcinoma, whereas retrieval of additional LNs of the lateral neck and surgical measures in the venous angle were more statistically significant in squamous cell carcinoma (SCC). The clinical courses of CF in the left neck and SCC were more severe. There were no independent risk factor for high-volume CF. Conclusion The incidence of CF after ND in head and neck malignancies was higher than expected. The risk factors for CF included variations in the lymphatic system, patient-specific clinicopathological characteristics and surgical factors.

Submandibular gland (SMG) excision via axillary is a brand new technique and we presented its own unique advantages compared with retroauricular and transoral approaches. The single-port (SP) robotic system offers improved visualization of the view and enhanced flexibility of instruments, ensuring optimal stability and dissection in this surgery. We reported the first case of transaxillary SMG excision using single-port robotic system made in China. A 26-year-old female patient presented with complaint of a painless mass in submandibular region. Ultrasound and computed tomography showed a lesion in submandibular gland. We performed single-port transaxillary robotic SMG excision without any complications. The present case suggests that SMG excision via transaxillary approach is technically feasible and safe with the SP robotic system; however, further exploration and research are needed.

During endoscopic or robotic-assisted thyroid surgery, the field of view may be restricted by tissue swelling or bleeding. These Limitations make delicate surgical manipulation in the confined space more challenging. This study proposes an artificial intelligence model designed to identify the recurrent laryngeal nerve. During thyroid surgery and thereby reduce the risk of accidental injury. This study retrospectively collected imaging data from three tertiary care hospitals, comprising 7482 images from 103 patients. The model relied on this dataset to optimize training. A variety of improvement strategies were integrated into the CMC-UNet model to enhance the accuracy and robustness of recurrent laryngeal nerve recognition. The Dice coefficient, Intersection over Union (IoU), and other metrics were used to evaluate the performance of the model in identifying the RLN. The Dice coefficient reached 0.8575, while the IoU achieved 0.7506. Compared with alternative models, the proposed model demonstrates a clear advantage in accuracy. Results from the controlled experiment indicate that anatomical variations in the course of the recurrent laryngeal nerve did not reduce the robustness of the model. Independent expert evaluations and inter-group experiments further confirmed the reliability and clinical applicability of the model, although variations may still occur across different surgical contexts. The CMC-UNet model achieved high accuracy in identifying the recurrent laryngeal nerve (RLN), with performance comparable to that of senior medical experts. The results of assisted identification may support clinical decision-making by providing auxiliary guidance and potentially reducing the risk of accidental injury.

IntroductionWe previously made a detailed expansion to the gasless transaxillary endoscopic thyroidectomy(GTET) procedure described in the previous literatures. In this study, we optimized the procedure focused on the limitation of the approach in terms of trauma and lymph node dissection and made a comparison with the early procedure.Materials and methodsThis paper gave a detailed description of the updated procedure and prospectively collected data about patients with papillary thyroid carcinoma(PTC) performed by the two procedures from December 2020 to April 2023. The differences in surgical outcome, surgical trauma and parathyroid gland(PG) function protection were analyzed.ResultsOf the 302 patients, 184 underwent with early procedure(EP), and 118 underwent with updated procedure(UP). The surgical outcomes of operative time, time of thyroidectomy and central neck dissection, blood loss, drainage and postoperative hospital stay were shorter in UP than that of the EP. The mean number of lymph nodes retrieved and weight of dissection lymphatic tissue in the UP were significantly more than that in EP without increasing the mean number of metastatic lymph nodes. Postoperative complications did not differ between the two procedures. The UP had more advantages in the identification and preservation of the superior parathyroid gland, however, it did not improve the preservation in situ of the inferior parathyroid gland. The visual analog scale score for pain and the changes among inflammation factors was lower in the UP.ConclusionThe UP of GTET could perform safely and efficiently while reducing surgical trauma in selected patients.

Background The diagnosis of follicular thyroid carcinoma (FTC) prior to surgery remains a major challenge in the clinic. Methods This multicentre diagnostic study involved 41 and 150 age- and sex-matched patients in the training cohort and validation cohort, respectively. The diagnostic properties of circulating small extracellular vesicle (sEV)-associated and cell-free RNAs were compared by RNA sequencing in the training cohort. Subsequently, using a quantitative real-time polymerase chain reaction (qRT‒PCR) assay, high-quality candidates were identified to construct an RNA classifier for FTC and verified in the validation cohort. The parallel expression, stability and influence of the RNA classifier on surgical strategy were also investigated. Results The diagnostic properties of sEV long RNAs, cell-free long RNAs and sEV microRNAs (miRNAs) were comparable and superior to those of cell-free miRNAs in RNA sequencing. Given the clinical application, the circulating sEV miRNA (CirsEV-miR) classifier was developed from five miRNAs based on qRT‒PCR data, which could well identify FTC patients (area under curve [AUC] of 0.924 in the training cohort and 0.844 in the multicentre validation cohort). Further tests revealed that the CirsEV-miR score was significantly correlated with the tumour burden, and the levels of sEV miRNAs were also higher in sEVs from the FTC cell line, organoid and tissue. Additionally, circulating sEV miRNAs remained constant after different treatments, and the addition of the CirsEV-miR classifier as a biomarker improves the current surgical strategy. Conclusions The CirsEV-miR classifier could serve as a noninvasive, convenient, specific and stable auxiliary test to help diagnose FTC following ultrasonography.

γδ T cells are evolutionarily conserved T lymphocytes that manifest unique antitumor efficacy independent of tumor mutation burden (TMB) and conventional human leukocyte antigen (HLA) recognition. However, the dynamic changes in their T cell receptor (TCR) repertoire during cancer progression and treatment courses remain unclear. Here, a comprehensive characterization of γδTCR repertoires are performed in thyroid cancers with divergent differentiation states through cross-sectional studies. The findings revealed a significant correlation between the differentiation states and TCR repertoire diversity. Notably, highly expanded clones are prominently enriched in γδ T cell compartment of dedifferentiated patients. Moreover, by longitudinal investigations of the γδ T cell response to various antitumor therapies, it is found that the emergence and expansion of the Vδ2neg subset may be potentially associated with favorable clinical outcomes after post-radiotherapeutic immunotherapy. These findings are further validated at single-cell resolution in both advanced thyroid cancer patients and a murine model, underlining the importance of further investigations into the role of γδTCR in cancer immunity and therapeutic strategies.

Precise direct cosmic-ray (CR) measurements provide an important probe to study the energetic particle sources in our Galaxy, and the interstellar environment through which these particles propagate. Uncertainties on hadronic models, ion-nucleon cross sections in particular, are currently the limiting factor towards obtaining more accurate CR ion flux measurements with calorimetric space-based experiments. We present an energy-dependent measurement of the inelastic cross section of protons and helium-4 nuclei (alpha particles) on a Bi_4Ge_3O_12 target, using 88 months of data collected by the DAMPE space mission. The kinetic energy range per nucleon of the measurement points ranges from 18 GeV to 9 TeV for protons, and from 5 GeV/n to 3 TeV/n for helium-4 nuclei. Our results lead to a significant improvement of the CR flux normalisation. In the case of helium-4, these results correspond to the first cross section measurements on a heavy target material at energies above 10 GeV/n.

颈部遗留明显瘢痕是传统颈部开放入路下颌下腺切除术的痛点，内镜下颌下腺切除手术可有效避免此问题，达芬奇机器人更是凭借其三维立体高分辨率、具有7个方向自由度EndoWrist功能的机械臂及直觉同步操控技术等优势让内镜技术进一步发展。四川省肿瘤医院在完成了腋窝入路内镜下颌下腺及肿瘤切除术后，于2023年2月3日利用达芬奇机器人的加长机械臂完成了机器人辅助下经腋乳入路下颌下腺切除术。术后患者恢复快，切口甲级愈合，围手术期未见明显并发症。随访3个月患者无舌尖麻木、口底运动感觉异常等并发症，美观满意度高，疗效满意。

腮腺良性肿瘤切除术需要保留面神经等重要结构，尤其在功能性外科，对于功能美观的要求更是逐步提高，这同手术操作精细化、颜面部美观切口密不可分。达芬奇机器人系统具备自由活动的机械臂、3D立体的可视化成像、精准可控的操作，与兼具美观的耳后发际线入路相结合，可探索出新形势下腮腺良性肿瘤达芬奇机器人切除新方式，2023年7月7日四川省肿瘤医院甲状腺口腔颌面外科完成1例达芬奇机器人辅助下耳后发际线切口入路腮腺良性肿瘤切除（科技查新报告编号：2023422），患者术后无面瘫等表现，出院后随访2周切口愈合良好，无涎瘘等并发症。

目的:探讨达芬奇机器人手术系统在头颈肿瘤外科应用中的安全性、可行性及手术技巧.方法:回顾性分析 2022 年 6 月至 2023 年 7 月在四川省肿瘤医院接受达芬奇机器人(Da Vinci Xi系统)手术的 54 例头颈部肿瘤患者的基本资料,包括肿瘤部位、病理类型、手术入路、手术时间、术中出血量、术后并发症、术后住院时间等.其中甲状腺手术 41 例,口咽部手术 8 例,腮腺手术 3 例,颌下腺手术 2 例.入路选择包括口腔入路、双侧腋窝和乳晕入路、单侧腋窝和乳晕入路(unilateral axilla-areola,UAA)及耳后入路.结果:54 例患者均顺利完成机器人辅助手术,无中转开放手术.1 例UAA甲状腺癌患者术后乳晕隧道出血再次内镜下止血,1 例腋乳入路甲状腺癌腺叶切除患者术后发生术区感染.所有甲状腺手术患者术后无永久性甲状旁腺功能减退和永久性喉返神经麻痹发生.腮腺和颌下腺患者术后无面瘫、舌尖麻木、口底运动感觉异常等并发症发生,美观满意度高,疗效满意.结论:与传统开放手术入路相比,达芬奇机器人手术系统应用在头颈肿瘤外科手术中安全、可行,创伤小、并发症少,功能保护更具优势,美容效果显著,在目前开展成熟的甲状腺、口咽手术基础上,可向颌下腺、腮腺等部位拓展,具有良好的临床应用前景.

Radical cure and functional preservation of tumors are the fundamental goals of surgical treatment of head and neck tumors, and the preservation of good aesthetics is a higher pursuit on this basis. Fully hiding the surgical incision and reducing the visibility of scars are important goals of cosmetic surgery. Using complete endoscopy for the head and neck is an effective method. CO2-free transaxillary total endoscopic surgery is a method with many advantages, which has been widely used in the resection of thyroid tumors, but for other parts and types of tumors in the head and neck, this surgical method is rarely used. The research team expanded its application scope and applied it to submandibular gland tumor resection and other head and neck surgeries for the first time. Through this exploration, it improved traction devices such as retractors, strictly limited the surgical indications, analyzed and summarized the key points, steps and methods of surgery, and built a treatment system for head and neck tumor surgery under complete endoscopy using the non-inflatable transaxillary approach. In this article, we introduce the system and select typical cases to share.

甲状腺内胸腺癌(intrathyroid thymic carcinoma,ITTC)是一种十分罕见的甲状腺内肿瘤,既往称为甲状腺内显示胸腺样分化的癌,2017 年第 4 版《内分泌器官肿瘤 WHO 分类》将此类肿瘤正式更名.本文报道 1 例肺腺癌合并甲状腺内胸腺癌病例,其在诊断过程中历经 2 次修正,最终经过规范化诊治,疗效满意.本文通过总结该病例诊治经过并复习相关文献,旨在介绍ITTC的临床病理特征及治疗方法,提升该类型罕见肿瘤的临床诊治水平.

Abstract Background:The dysfunction of the tongue caused after total tongue resection is a major challenge for surgeons.The purpose of this study was to explore the functional recovery and survival of patients after radical resection of advanced tongue cancer and one-stage total tongue reconstruction with laryngeal preservation. Methods:Twelve cases of tongue reconstruction with pectoralis major myocutaneous (PMMF) flap or anterolateral thigh (ALT) flap from 2012 to 2020 were analyzed. The speech function, tongue flexibility, deglutition, and patient satisfaction with the donor appearance were evaluated at 3 and 6 months after operation.The survival status was recorded at 1,3, and 5 years after surgery. Results:There were 7 males and 5 females, with an average of 48.75 years. 5 cases with (PMMF) flap , and 7 cases with (ALT) flap ,the overall flap survival rate was 100% (12 / 12). Postoperative tracheal tube removal rate was 100%(12 / 12).9 cases had a history of secondary or even multiple surgeries or chemoradiotherapy,8 cases concomitanted adjuvant chemoradiotherapy after surgery.Pathological types included:10 cases of squamous cell carcinoma , 1 case of sarcomatoid carcinoma(SC) and 1 case of adenoid cystic carcinoma（ACC）. At 6 months after surgery, 3 (27.2%) of 11 patients (1 dead at 4 months) had normal language, 4 (36.4%) had near-normal language, and 4 (36.4%) had vague speech. In addition, 3 (27.2%) patients had a normal diet, 1 (9.1%) patient had a soft diet, 6 (54.5%) patients had a liquid diet, and 1 (9.1%) patient still required tube feeding. Six months after the operation, the tongue was basically in a fixed state, and the range of motion of the tongue did not improve significantly(P=0.217). The patients' satisfaction with the recovery of the donor site was (10/11) 90.9%.Compared with three months after surgery,the articulation of speech（P=0.024）, swallowing, chewing and eating （P=0.033）were significantly improved at six months after surgery . The 1-year, 3-year and 5-year survival rates were 66.66%, 33.33% and 25.0%, respectively. Conclusion:Total glossectomy is most often used as salvage therapy in patients with stage IV primary cancer or in recurrent cases.Reconstruction after total glossectomy using larger tissue flaps such as ALT or PMMF flaps has acceptable risk of complications and affords most patients the potential for intelligible speech and tube-feed-free nutrition with improved quality of life and reasonable long-term survival.

Circular RNA nucleoporin 214 (circ-NUP214) is a novel-identified circRNA, and has been demonstrated to promote cell tumorigenesis in papillary thyroid carcinoma (PTC). However, the detailed roles and molecular mechanism underlying circ-NUP214 in PTC remain unclear. The expression levels of circ-NUP214, microRNA (miR)-15a-5p, and hexokinase 2 (HK2) were detected by quantitative real-time polymerase chain reaction, western blot or immunohistochemical (IHC) assay. Cell proliferation, apoptosis, migration and invasion were analyzed using cell counting kit-8 assay, 5-Ethynyl-2 '-Deoxyuridine (EdU), flow cytometry, and transwell assay, respectively. Glucose metabolism was assessed by analyzing glucose consumption, lactate production, and adenosine triphosphate (ATP)/adenosine diphosphate (ADP) ratios. Murine xenograft models were established for in vivo experiments. The interaction between miR-15a-5p and circ-NUP214 or HK2 was analyzed by the dual-luciferase reporter assay. A significant increase of circ-NUP214 expression in PTC tissues and cells was found. Circ-NUP214 knockdown inhibited cell proliferation, migration, invasion and glycolysis but induced apoptosis in PTC in vitro and reduced tumor growth in vivo. MiR-15a-5p was a target of circ-NUP214, and silencing of miR-15a-5p reversed the inhibitory effects of circ-NUP214 knockdown on PTC cell malignant phenotypes and glycolysis. MiR-15a-5p directly targeted HK2, miR-15a-5p-mediated inhibition of cell proliferation, migration, invasion and glycolysis and the promotion of cell apoptosis in PTC were abolished by HK2 overexpression. Besides that, circ-NUP214 indirectly regulated HK2 expression via miR-15a-5p. Circ-NUP214 promoted PTC tumorigenesis by regulating miR-15a-5p/HK2 axis, suggesting a potential therapeutic target for PTC treatment.