To compare the clinical outcomes and learning curve characteristics of the traditional bilateral areolar approach (BAA) and the modified areolar approach (MAA) in endoscopic thyroidectomy and to assess the advantages and potential for clinical dissemination of the modified technique. We retrospectively reviewed 79 female patients who underwent endoscopic radical thyroidectomy for thyroid cancer. Patients were assigned to the BAA group or the MAA group according to the incision placement. Perioperative parameters were compared between groups, such as operative time, intraoperative blood loss, number of lymph nodes harvested, incidence of postoperative complications, and patient satisfaction. A cumulative sum analysis (CUSUM) was performed to construct learning curves and evaluate the progression of surgical proficiency. Compared with the BAA group, the MAA group demonstrated a significantly shorter operative time (P < 0.001), reduced intraoperative blood loss (P = 0.029), and a lower rate of short-term postoperative complications (P = 0.05). The CUSUM learning curve inflection point occurred earlier in the MAA group (20th case vs. 26th case), indicating more rapid acquisition of the technique. By optimizing incision placement and instrument alignment, the modified areolar approach shortens operative time, minimizes intraoperative trauma, and decreases complication rates. Its shorter learning curve and greater procedural stability facilitate faster mastery of endoscopic thyroidectomy, supporting its wider clinical adoption.

Objective To characterize the risk-adjusted learning curve of transareolar endoscopic thyroidectomy in patients with Hashimoto’s thyroiditis (HT) and differentiated thyroid carcinoma (DTC).To analyze their perioperative, pathological, and immunological features, thereby informing preoperative risk stratification and case selection. Methods This single-center retrospective study included 100 consecutive female patients who underwent endoscopic thyroidectomy performed by the same doctor, including 32 with HT and 68 without HT. We collected perioperative variables, complications, extent of lymph node dissection and nodal metastasis, aggressive pathological features, and TPOAb/TgAb indices. The primary endpoint was operative time. A risk-adjustment model was constructed, and the learning-curve breakpoint was estimated using risk-adjusted Cumulative Sum (CUSUM) and segmented regression. Spline fitting and multiple sensitivity analyses were performed to assess robustness. Perioperative and pathological outcomes were compared between groups, factors associated with central lymph node metastasis (CLNM) were analyzed using logistic regression. Associations of antibody status and titers with surgical and pathological parameters were also assessed. Results Operative time decreased markedly with accumulating experience and entered a relatively stable phase at approximately case 50. Compared with the non-HT group, the HT group had longer operative time and a higher lymph node yield. After risk adjustment, We find that HT did not alter the shape of the learning curve; this finding was consistently supported by multiple sensitivity analyses. Central lymph node metastasis was associated with capsular invasion and age, but not independently with HT. Antibody titers in the HT group also showed no consistent association with operative difficulty or aggressive pathological features. Conclusion HT does not materially alter the learning pattern of transareolar endoscopic thyroidectomy and should not be used as a basis for exclusion. With standardized technique and careful protection of critical structures, this procedure remains safe and feasible in patients with DTC and coexisting HT.

ObjectiveTo identify risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC) and to establish clinical prediction models.MethodsWe retrospectively collected clinical data from 249 patients with PTC and suspected LLNM, 222 patients met the inclusion criteria. Based on postoperative pathology of the lateral compartment, 145 patients without metastasis were classified as the non-metastasis group, 77 patients with metastasis were classified as the metastasis group. All included patients were randomly assigned to training set and validation set. Univariate and multivariate logistic regression analyses were performed to screen predictors of LLNM and construct nomogram models for preoperative and postoperative prediction. Model performance was evaluated using the Hosmer-Lemeshow goodness-of-fit test, calibration curves with bootstrap resampling, receiver operating characteristic (ROC) curves and the area under the curve (AUC), as well as decision curve analysis (DCA).ResultsIn preoperative analyses, age, maximum tumor diameter ≥1 cm on ultrasound, hyperechoic area in the lateral cervical lymph node, and lateral cervical lymph nodes perinodal vascularity were independent predictors of LLNM. In postoperative analyses, age, multifocality, pathological maximum tumor diameter ≥1 cm, and concomitant central lymph node metastasis were independent predictors. The AUCs for the preoperative model were 0.805 (training set) and 0.719 (validation set), and for the postoperative model were 0.885 (training set) and 0.762 (validation set). After 1,000 bootstrap resamples, the mean absolute errors (MAE) of the calibration curves were 0.047 and 0.066 for the preoperative model (training set and validation set), and 0.021 and 0.046 for the postoperative model.ConclusionDCA showed a higher net clinical benefit of both models than the treat-all or treat-none strategies, indicating good predictive accuracy and clinical utility.

Background:Horner's syndrome (HS) is a rare condition due to damage to the 3-neuron sympathetic pathway anywhere between the posterior-lateral nuclei of the hypothalamus and the oculosympathetic fiber, particularly as a post-thyroidectomy symptom. In this case report, we present a case of HS following endoscopic thyroid surgery (ETS) and briefly review the literature.Case report:During a routine physical examination, a 29-year-old female patient was incidentally found to have multiple nodules in the right thyroid. She was subsequently admitted to the Department of General Surgery for further examinations and treatment. A fine-needle aspiration biopsy confirmed malignancy in these nodules. As a result, the patient underwent radical resection of the right thyroid and ipsilateral central lymph node dissection using endoscopy. Pathological diagnosis revealed papillary thyroid carcinoma. Unexpectedly, on the third day after the operation, the patient was diagnosed with Horner's syndrome based on the presence of miosis and ptosis. After 1 week of follow-up, the symptoms related to HS significantly improved.Conclusion:Horner's syndrome is an uncommon complication of thyroidectomy in patients undergoing ETS. Therefore, it is crucial to perform careful operations and minimize iatrogenic surgical damage to reduce the incidence of HS. This case serves as a reminder that making rational judgments and implementing appropriate measures are essential for achieving a favorable prognosis and preserving facial esthetics.

Background: The purpose of this study was to observe the effectiveness of minimally invasive video-assisted thyroidectomy (MIVAT) in treating papillary thyroid microcarcinoma (PTMC). Methods: A total of 224 patients with PTMC who met the inclusion and exclusion criteria were selected from the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, between January 2017 and December 2019. They were randomized into the MIVAT group or traditional open operation group. For both groups, we observed the number of lymph node dissections, amount of intraoperative blood loss, duration of the operation, length of the incision, and number of injuries to the recurrent laryngeal nerve. Results: The average operation time (132.8±29.4 min) in the MIVAT group was significantly higher than that in the open surgery group (83.8±14.29 min) ( P =0.026). The length of incision (2.8±0.6 cm) in patients in the MIVAT group was significantly shorter than that in patients in the open group (7.4±1.1 cm) ( P =0.000). No significant differences were observed in the number of lymph node dissections ( P =0.712), the amount of intraoperative bleeding ( P =0.581), and the number of recurrent laryngeal nerve injuries ( P =0.634). The average follow-up was 5 years, and both groups had no recurrence. Conclusions: In the treatment of PTMC, MIVAT had similar outcomes as traditional open operations, although the operation time was longer. However, the length of the incision was significantly shorter and thus provided cosmetic advantages for patients.

Abstract Purpose To investigate the mechanisms of recurrent laryngeal nerve (RLN) injury during endoscopic thyroidectomy via breast approach (ET‐BA) in patients with papillary thyroid carcinoma (PTC). Methods The records of 416 PTC patients who underwent ET‐BA with intraoperative neural monitoring (IONM) from May 2015 to May 2021 in Beijing Friendship Hospital affiliated to Capital Medical University were retrospectively analyzed. Results All patients were women. Mean age was 37.80 (7.87) years. The ET‐BA was performed in 416 patients. Overall incidence of RLN injury was 4.3% (18 patients). Injury was transient in 13 patients (3.1%) and permanent in five (1.2%). Macroscopic physical changes were apparent in the injured nerve in five patients (27.8%) and postoperative hoarseness or cough after drinking water were present in 11 (61.1%). Two RLN injuries occurred during nerve identification at the RLN laryngeal entry point into the surgical field, 15 during early nerve dissection somewhere between the first 0.5 and 2 cm of the nerve's course through the surgical field, and one occurred distal to 2 cm. The percentage of patients with separation, transection, traction and thermal mechanisms of injury was 27.8%, 22.2%, 22.2%, and 16.7%, respectively. The mechanism of injury was unknown in 11.1%. Conclusions RLN injury may still occur during ET‐BA despite endoscopic magnification and early nerve identification even when IONM is used. Separation, transection, and traction injuries were the most frequent causes of injury.

Objective:To compare the effectiveness of areola approach endoscopic thyroidectomy (AET) and conventional open thyroidectomy (OT) in treating papillary thyroid carcinoma.Methods:Four hundred and twenty-eight female patients with papillary thyroid carcinoma who were treated at the Department of General Surgery, Beijing Friendship Hospital between January 2017 and January 2020 were included according to the inclusion and exclusion criteria, of whom 183 underwent AET (AET group) and 245 underwent OT (OT group). Direct comparison and subsequent propensity score matching methodology were utilized to compare the differences between the two operation methods in terms of surgical time, intraoperative parathyroid transplantation rate, intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. Data analysis was performed by using SPSS 25.0 software. The metric data of normal distribution was represented by mean ± standard deviation ( ± s), and the t-test was used for between-group comparison. The Chi-test was used for between-group comparison of count data. Results:The AET group had an age of (38.89±9.08) years, weight of (62.10±10.45) kg, and height of (161.97±5.31) cm; the OT group had an age of (45.88±12.47) years, weight of (65.11±12.72) kg, and height of (161.62±5.24) cm. The differences in age, weight, and body mass index between the two groups were statistically significant ( P<0.05). The surgical time in the AET group was (183.00±137.22) min, which was significantly longer than (87.94±28.25) min of the OT group ( t=16.67, P<0.001). The parathyroid transplantation rate in the OT group was significantly higher than that in the AET group (49.39% vs 34.97%, χ2=8.87, P=0.003). There were no statistically significant differences between the two groups in terms of intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. After propensity score matching based on differences in age, weight, body mass index, and soon, 183 cases of AET (AET-PS group) and OT (OT-PS group) were obtained for statistical analysis. The surgical time in the AET-PS group was (137.22±32.77) min, which was significantly longer than (90.26±29.35) min of the OT-PS group ( t=14.44, P<0.001). The parathyroid transplantation rate in the OT-PS group was significantly higher than that in the AET-PS group (53.01% vs. 34.97%, χ2=12.08, P=0.001). There were no statistically significant differences between the two groups in terms of intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. Conclusions:AET and OT are equally safe and effective in treating papillary thyroid carcinoma. AET surgery can be performed safely and feasibly under strict adherence to surgical principles.

BackgroundIn order to explore the surgical safety and the reliability of axillary staging of single-port endoscopic-sentinel lymph node biopsy, we combined it with indocyanine green that was excited by near-infrared fluorescence endoscopy and carbon nanoparticles as a tracer and compared this method to conventional open sentinel lymph node biopsy.MethodsThis is a retrospective and observational study, there were 20 patients in each group and the total sample size was 60: Group 1, single-port endoscopic-sentinel lymph node biopsy combined with indocyanine green and carbon nanoparticles; Group 2, single-port endoscopic-sentinel lymph node biopsy with carbon nanoparticles only; Group 3, conventional sentinel lymph node biopsy with indocyanine green and carbon nanoparticles. Sentinel lymph node detection and upper extremity function were determined to measure the safety and efficacy of the novel single-port endoscopic-sentinel lymph node biopsy (SPE-SLNB) technique to the standard conventional sentinel lymph node biopsy technique.ResultsThe detection rate of sentinel lymph nodes was 100% in Group 1, 100% in Group 2, and 95% in Group 3. There were no significant differences in upper arm function and pain scores between the three groups.ConclusionThe novel technique of combining indocyanine green and carbon nanoparticles with single-port endoscopic-sentinel lymph node biopsy achieved a similar detection rate and mean number of sentinel lymph nodes as conventional sentinel lymph node biopsy. Traditional open surgery requires two different incisions for breast surgery and SLNB. While the most important advantage of SPE-SLNB is that two procedures can be effectively performed through a single-port in the axilla Therefore, for patients who meet the indications, single-port endoscopic-sentinel lymph node biopsy is as safe and reliable as conventional sentinel lymph node biopsy but has the aesthetic advantage of only one incision.

Introduction This study compares the perioperative results, aesthetic outcome and oncologic safety of single-port insufflation endoscopic nipple-sparing subcutaneous mastectomy combined with immediate reconstruction using prosthesis implantation (SIE-NSM-IRPI) with those of conventional open-nipple and areola-sparing subcutaneous mastectomy combined with immediate reconstruction using prosthesis implantation (C-NSM-IRPI). Methods In this retrospective cohort study, 64 early-stage breast cancer patients were divided into SIE-NSM-IRPI (n = 38) and C-NSM-IRPI (n = 26) groups. Perioperative results (operation time, intraoperative blood loss, incision length, drainage duration, and recent complications) were then compared between the two groups. Differences in satisfaction with the breasts, psychosocial well-being, physical well-being (chest) and sexual well-being were analyzed according to the BREAST-Q scale, and survival outcomes were also compared. Results The median follow-up time was 51.5 months. The incision length of SIE-NSM-IRPI was shorter than that of C-NSM-IRPI ( P < 0.001). SIE-NSM-IRPI achieved the same detection rate and median number of sentinel lymph nodes as C-NSM-IRPI (3.00vs. 4.00, P = 0.780). The incidence of prosthesis removal due to infection or prosthesis exposure in the SIE-NSM-IRPI group was lower than that in the C-NSM-IRPI group ( P = 0.015). Satisfaction with breasts (82.00vs.59.00, P < 0.001), psychosocial well-being (93.00vs.77.00, P = 0.001) and physical well-being (chest) (89.00vs.82.00, P < 0.001) scores were higher in the SIE-NSM-IRPI group. There were no significant differences between the two groups in disease-free survival (hazard ratio = 0.829, 95% confidence interval = 0.182–3.779) and overall survival (hazard ratio = 1.919, 95% confidence interval = 0.169–21.842). Conclusion In this selected cohort of patients with early breast cancer, SIE-NSM-IRPI was comparable to C-NSM-IRPI, considering oncologic safety and detection of sentinel lymph nodes. It had a lower incidence of prosthesis removal, shorter incision length, and was associated with better patient satisfaction with the breasts. More random clinical trials of this novel approach in a larger cohort of Chinese patients with an extended follow-up period are needed in the future.

Objective:To explore the preventive value of "integrated prevention strategy" for nipple and areola ischemia after single-port endoscopic subcutaneous mastectomy.Methods:The clinical data of 72 patients with breast cancer who received single-port endoscopic subcutaneous mastectomy in Beijing Friendship Hospital, Capital Medical University from July 2019 to July 2021 were retrospectively analyzed, they were all female. The follow-up period was up to July 2022. According to the perioperative treatment methods, the patients were divided into observation group ( n=40) and control group ( n=32). The patients in the observation group who adopted the "integrated prevention strategy" scheme, and patients in the control group who adopted the conventional treatment scheme. The incidence of postoperative nipple and areola ischemic was compared between the two groups, and the postoperative cosmetic effect, quality of life and satisfaction of patients were evaluated. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; the Chi-square test was used to compare the data groups. Results:The postoperative drainage volume in the observation group was significantly lower than that in the control group [(632.40±226.37) mL vs (774.91±239.85) mL], and the difference was statistically significant ( P=0.013). Two weeks after operation, there was 1 case of nipple and areola ischemia in the observation group, and 7 cases in the control group, the difference was statistically significant between the two groups ( P=0.019). Twelve months after operation, the score of breast satisfaction (83.93±11.64 vs 67.28±11.52), chest satisfaction (89.63±8.06 vs 83.03±9.49) and psychosocial well-being (89.43±12.42 vs 78.88±10.40) in the observation group were better than those in the control group, the differences were statistically significant ( P<0.05). Conclusion:"Integrated prevention strategy" can effectively prevent the occurrence of nipple and areola ischemic after single-port endoscopic subcutaneous mastectomy and improve patient satisfaction, which has certain promotion value.

目的 探讨老年急腹症患者住院期间发生下肢深静脉血栓的危险因素.方法 收集2020年1月至2022年1月首都医科大学附属北京友谊医院接受治疗的165例老年急腹症患者的临床资料,根据住院期间是否发生下肢深静脉血栓将其分为血栓组29例和对照组136例.收集所有患者一般信息、入院时实验室检查情况、入院后的计算机断层扫描(CT)、彩色多普勒超声检查情况等,记录患者的手术相关信息,分析老年急腹症患者住院期间发生下肢深静脉血栓的危险因素.结果 血栓组患者的年龄、C反应蛋白水平、D-二聚体水平均明显高于对照组患者,差异均有统计学意义(P﹤0.05).78例患者接受了手术治疗,其中,血栓组患者手术率72.4％(21/29),明显高于对照组患者的41.9％(57/136),差异有统计学意义(P﹤0.01).多因素结果显示,年龄≥70岁、C反应蛋白水平升高(﹥5 mg/L)、D-二聚体水平升高(﹥0.5 mg/L)、手术均是老年急腹症患者住院期间发生下肢深静脉血栓的独立危险因素(P﹤0.05).结论 老年急腹症患者下肢深静脉血栓发生率较高,年龄≥70岁、C反应蛋白水平升高(﹥5 mg/L)、D-二聚体水平升高(﹥0.5 mg/L)、进行手术均是老年急腹症患者住院期间发生下肢深静脉血栓的独立危险因素,需对高危患者积极进行下肢深静脉血栓的相关预防.

PurposeTo describe the clinical imaging and pathological features of invasive micropapillary breast carcinoma (IMPC), including breast mammography, sonography, magnetic resonance imaging (MRI), and molecular imaging findings.Patients and methodsWe retrospectively reviewed our institution's surgical pathology database and identified 65 patients with pathologically proven IMBC; 63/65 patients had available imaging results. Two radiologists retrospectively reviewed all imaging evaluations according to the Breast Imaging Reporting / Data System (BI-RADS) Lexicon. Clinical and histopathologic features, receptor statuses, and clinical follow-up data were recorded.ResultsSixty-three patients were admitted with palpable abnormalities; one patient's mammogram revealed no abnormality (3.3%, 1/32), whereas 31 had abnormal mammograms (31/32, 96.8%) demonstrating 37 lesions. Twenty-four had irregular, spiculated masses, 12 had microcalcifications, and 19 had architectural distortion. Sonography detected 69 masses (54 patients), characterized by irregular shapes (61/69, 88.4%), hypoechoic structures (50/69, 72.4%), angular or spiculated margins (38/69, 55.1%; 30/69, 43.4%), echogenic halo (8/69, 11.5%), and abnormal vascularity (52/69, 75.3%). MRI detected 68 lesions (52 patients); 59/68 (86.8%) appeared as masses with angular or spiculated margins (32/68, 47.1%; 35/68, 51.4%), 58 exhibited irregular or lobulated shapes (58/68, 89.7%), 29 displayed heterogeneous internal enhancement (29/68, 42.5%), and 64 demonstrated type II or III washout kinetic curves (37/68, 55%; 27/68, 40%). Breast molecular imaging showed mild-to-moderate radiotracer uptake in 15 focal areas among 13 patients. Thirty-two, 38, and 43 patients had abnormal lymph nodes identified mammographically, by breast sonography, and by MRI, respectively. Immunohistochemistry revealed high estrogen receptor (90.5%), high progesterone receptor (71.6%), and low HER-2 (26.4%) positivity.ConclusionIMPC mammography, sonography, and MRI clinical imaging features highly suggest malignancy. Breast molecular imaging also contributed to the diagnosis. IMPC's invasiveness correlated well with regional lymph node metastasis. Radiologists and surgeons should be more attentive to these imaging findings and additional clinical and pathological IMPC features.

Purpose To evaluate the oncologic safety and surgical outcomes of endoscopic thyroidectomy (ET) performed via different surgical approaches for papillary thyroid carcinoma (PTC). Methods We reviewed the medical records of PTC patients who underwent ET between May 2015 and May 2021, at the Department of General Surgery, Beijing Friendship Hospital (affiliated with Capital Medical University). The patients were divided into three groups: the ET via breast approach (ETBA) group, the transoral ET vestibular approach (TOETVA) group, and the ET via transaxillary approach (ETTA) group. We evaluated the safety and surgical outcomes of each of these ET approaches. Results A total of 490 patients were included in the analysis: 416 in the ETBA group, 57 in the TOETVA group, and 17 in the ETTA group. There were no significant differences among the groups in clinicopathologic characteristics or surgical procedures, or in the incidences of complications such as hematoma, subcutaneous emphysema, infection, and chyle. The incidences of transient and permanent recurrent laryngeal nerve (RLN) injury were 1.4% and 4.3%, respectively, with no significant difference among the three groups. The incidences of transient and permanent postoperative hypoparathyroidism were 13.7% and 1.4%, respectively. The incidence of transient hypoparathyroidism in the TOETVA group was 1.7%, which was significantly lower than that in the ETBA group. The postoperative 1-, 3- and 5-year rates of disease-free survival were 99.5%, 96.8%, and 95.9%, respectively. Univariate and multivariate analyses showed that ET was not a significant risk factor for recurrence or metastasis (p = 0.83 and p = 0.49, respectively), regardless of the surgical approach. Conclusions TOETVA may be associated with a lower incidence of temporary hypoparathyroidism than ETBA. Apart from this difference, ETBA, ETTA and TOETVA showed comparable oncologic safety and surgical outcomes.

Objective:To explore the significance of exposing the circummammary ligament under endoscopy and the effect of membrane anatomy in breast reconstruction.Methods:The case data of 49 breast cancer patients who underwent endoscopic nipple-sparing mastectomy combined with one-stage breast reconstruction with prosthesis implantation in Beijing Friendship Hospital, Capital Medical University from February 2014 to December 2021 were retrospectively analyzed, there were 44 cases of posterior pectoralis prosthesis implantation, 5 cases of anterior pectoralis prosthesis implantation. The anatomical structure of the circummammary ligament was observed under endoscopy during operation, and the annular mammary ligament was used as an anatomical marker to complete subcutaneous glandectomy and prosthesis implantation for breast reconstruction, the BREAST-Q scales were used to evaluate the postoperative effect.Results:The medial sternal ligament, sub clavicular ligament, lateral confluence ligament and triangular ligament condensation could be clearly exposed in all 49 cases. Breast reconstruction module of BREAST-Q were used to evaluate the surgery effect after breast cancer surgery, the scores of postoperative breast satisfaction, chest wall status, psychosocial status and sexual health status were 81.43±12.57, 88.39±10.61, 88.04±13.70, 74.82±15.93.Conclusion:The endoscopic technique is beneficial to expose the circummammary ligament during operation, and surgical resection and reconstruction can better restore the appearance of the breast and improve postoperative satisfaction according to the principle of membrane anatomy.

Introduction Breast cancer is the most prevalent cancer and the leading cause of cancer-related death in women. Conventional open mastectomy (C-OM) is one of the most common procedures for breast cancer, which involves the removal of the nipple-areola complex and a large proportion of the breast skin, leading to poor cosmetic effect and restriction of upper extremity function. Single-port insufflation endoscopic nipple-sparing mastectomy (SIE-NSM) could conceal the incision along the wrinkles in the axilla, preserve all the breast skin and nipple-areola complex and provide a better cosmetic outcome and quality of life. This trial aims to investigate the oncological safety between SIE-NSM and C-OM in early breast cancer patients. Methods and analysis This is a single centre, non-blinded, randomised controlled trial (RCT) and will be conducted at Beijing Friendship Hospital. Patients will be enrolled in the inpatient ward. Breast surgeons will notify patients who meet the inclusion and exclusion criteria with the instruction of this RCT. Patients will be randomly assigned to C-OM or SIE-NSM with a 3:1 allocation as per a computer-generated randomisation schedule. Patients will be followed-up for 12 months for analysing surgical outcomes. The primary outcome is the local recurrence rate at a 12-month follow-up. The secondary outcome is the distant metastasis rate, cosmetic satisfaction score and psychosocial well-being score after a 12-month follow-up. To ensure the accuracy of the cosmetic satisfaction score and psychosocial well-being score, the standard scale, Breast-Q score, will be applied. Ethics and dissemination This study will be conducted according to the medical ethics committee of the Beijing Friendship Hospital and according to the principles of the Declaration of Helsinki. All patients will receive clear instruction of their disease and treatment plan. Informed consent will be obtained from all patients when they agree to comply with our research plan. The results will be disseminated at academic presentations and publications in peer-reviewed journals. The raw data will be confidentially stored in our electronic data capture database. Data will not be shared unless an appropriate data request is submitted after the trial completion and peer-review journal publication. Trial registration number NCT04461847.

Background:This study aimed to compare the risk of hypoparathyroidism between the transoral vestibular approach (TOVA) and the breast approach (BA) in patients undergoing total endoscopic thyroidectomy (TET) for papillary thyroid carcinoma (PTC).Methods:The medical records of 121 PTC patients (all women) who underwent total TET from January 2015 to January 2021 were retrospectively analyzed. Patients were grouped according to surgical approach (BA or TOVA). Clinical status and concentrations of parathyroid hormone (PTH) and calcium were monitored in the perioperative period and 1, 6, and 12 months after surgery.Results:The BA and TOVA groups comprised 101 and 20 patients, respectively. Clinicopathologic and characteristics and surgical data were comparable between the groups. Incidence of transient hypoparathyroidism was significantly lower in the TOVA group than the BA group (10% vs 63.4%; p <0.01). Incidence of permanent hypoparathyroidism was comparable (5% vs 6.9%). Two days after TET, mean PTH concentration was significantly higher and incidence of abnormal PTH was significantly lower in the TOVA group. The incidence of abnormal calcium concentration 2 days after surgery was significantly lower in the TOVA group. One month after surgery, the mean calcium concentration was significantly higher in the TOVA group. Univariate and multivariate Cox regression analysis suggested that patients who underwent TOVA had a lower risk of transient hypoparathyroidism (hazard ratio 0.05, 95% confidence interval, 0.01-0.23; p<0.01). No clinicopathological factors examined were significantly associated with permanent hypoparathyroidism.Conclusion:In patients undergoing TET for PTC, the incidence of transient hypoparathyroidism may be lower with the TOVA than the BA. Surgeons should be aware of the relatively high risk of transient hypoparathyroidism when performing the BA.

BackgroundWe sought to explore the impact of changing treatment strategy based on circulating tumor cells (CTC) on postoperative survival of breast cancer.MethodsWe retrospectively analyzed records of patients who underwent surgery for early-stage breast cancer at Beijing Friendship Hospital from January 2016 to January 2018 and regularly underwent CTC examination after surgery. During the regular examination and CTC monitoring, the patients with positive CTC results and without distant metastasis had their treatment regimen changed.ResultsOf 109 patients who received CTC examination regularly after surgery, 61 (56.0%) were CTC-positive during postoperative follow-up, including 33 ER or PR-positive, and 28 ER and PR-negative patients. Of the 33 ER or PR-positive patients, 20 changed endocrine therapy drugs. Compared with those without replacement, those with changed endocrine therapy strategy had higher CTC clearance rates (90.0% vs. 53.8%, p=0.04) and significantly lower CTC-positive values (1.70 ± 1.72 vs. 0.62 ± 0.65, p = 0.04). Among the 28 patients who were CTC positive and ER and PR-negative, 11 used capecitabine. Compared with non-users, the capecitabine users had higher CTC clearance rates (100.0% vs. 52.9%, p=0.01) and more significant decrease in CTC-positive values (2.09 ± 1.14 vs. 0.82 ± 1.67, p=0.04). Disease-free survival (DFS) at 1, 3, and 5 years was significantly longer in those who changed treatment than in those who did not (respectively, 96.6% vs. 89.6%, 92.8% vs. 56.9%, 69.0% vs. 47.8%, p<0.01). By changing the treatment strategy, CTC-positive patients achieved DFS that was not significantly different from CTC-negative patients (95.0% vs. 97.7%, 77.5% vs. 82.9%, 57.6% vs. 59.9%, p=0.20).ConclusionTimely change of treatment strategy for breast cancer patients with positive CTC results after surgery may improve CTC clearance rate and DFS.

Objective:To investigate the surgical method and clinical application value of single-port inflatable endoscopic prepectoralis prosthesis implantation for breast reconstruction (external prosthesis wrapping Off-Label).Methods:From September 2021 to February 2022, 7 breast cancer patients who underwent single-port inflatable endoscopic prepectoralis prosthesis implantation breast reconstruction (Off-Label) in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Statistical analysis of surgical complications, postoperative movement deformities, postoperative chest wall pain, postoperative quality of life and satisfaction scores of patients were conducted.Results:All 7 patients successfully completed the operation. There were no complications such as postoperative bleeding, infection, ischemic necrosis of nipple-areola complex or skin flap, postoperative movement deformity, postoperative chest wall pain, capsular contracture, prosthesis exposure or removal. The BREAST-Q scale was used to evaluate the quality of life and satisfaction after breast reconstruction. Postoperative breast satisfaction (55-100 points), chest wall status (52-89 points), and social psychological status (62-100 points) can be compared High rating.Conclusion:The single-port inflatable endoscopic prepectoral prosthesis implantation breast reconstruction (Off-Label) can achieve better radical effect and cosmetic effect through a shorter operation time, and the postoperative quality of life and satisfaction of patients are higher.

Purpose: In this study, a novel surgical technique was developed for umbilical hernias, in which a laparoscopic cephalic approach plus a posterior sheath and an extraperitoneal approach was employed. The aim of this study was to determine the results of this new technique. Methods: From 2019 to 2020, 21 patients (81.8% men) with an umbilical hernia underwent a laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach, performed by two surgeons specializing in abdominal wall surgery, in two academic hospitals. Intraoperative and postoperative complications, operation time, blood loss, and hernia recurrence were assessed. Results: Twenty-one cases of umbilical hernia were successfully completed. The size of the hernia ring was 1.5–3 cm 2 , with an average of 2.39 ± 0.47 cm 2 . The operation time was 120–240 min (average, 177.3 ± 42.15 min), and the blood loss volume was 30–40 ml (average, 33.73 ± 3.55 ml). The mean follow-up period was 6 months, and there were no short-term complications and no cases of recurrence. Conclusion: A laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach is a safe alternative for the repair of an umbilical hernia. The intraoperative complication rate was low.

Purpose: This study aimed to explore the value of miR-181a-2-3p in cisplatin (DDP) treatment effectiveness prediction, and to reveal the function underlying the reversal of DDP resistance in patients with gastric cancer (GC). Methods: miRNA expression dataset of three DDP-resistant GC cell lines and their DDPsensitive parental cell lines obtained from GEO DataSets and GenBank, and functional miRNAs were annotated by bioinformatics analyses. Serum specimens and tumor samples were collected from 91 GC patients for understanding of the interrelation between chemotherapy response and miRNA expression. RT-qPCR validated these miRNAs at the transcriptional level in both gastric cancer cells and 91 gastric cancer patients. The correlation between the miRNAs expression and clinical parameters of the patients were analyzed. Receiver operating characteristics (ROC) analysis has been utilized to assess the diagnostic performance. The MTT and colony formation assays were performed to assess cell proliferation. Flow cytometry was conducted to detect cell apoptosis. DDP-resistant GC cells and their DDP-sensitive parental cells were transfected with miRNA mimic or inhibitor vector to overexpress or downregulate miRNA expression. Results: miR-181a-2-3p as a unique miRNA was found in the common differentially expressed-miRNAs (DE-miRNAs) after miRNA screening and validation from three DDPresistant and DDP-sensitive gastric cancer cell lines. Clinical data analysis displayed that miR-181a-2-3p expression was apparently increased in larger tumor size (>= 5 cm), higher T stage (T4), and chemotherapy resistance. miR-181a-2-3p (AUC=0.926, SE=0.028, 95% CI: 0.872-0.980, p< 0.0001) differentiated chemosensitive GC patients from chemoresistant GC patients. miR-181a-2-3p presented a higher level in gastric cancer, and could serve as a valid biomarker to predict the overall survival of GC patients. Upregulation of miR-181a-2-3p rendered the apoptosis-inducing and anti-proliferative effects of DDP, while downregulating it decreased these effects. Conclusion: miR-181a-2-3p can function as a therapeutic target and a tumor biomarker. Targeting oncogenic miR-181a-2-3p inhibits growth and suppresses cisplatin resistance of gastric cancer.