Total thyroidectomy is the treatment of choice for multinodular goiter and thyroiditis, when there is bilateral gland involvement posterior to middle thyroid veins, and for Graves disease because it decreases the likelihood of future repeat operations for recurrent disease and thus the associated risks, when performed safely.

Metastatic disease rate was similar to that found in the literature. Perineural and angiolymphatic invasion and tumor thickness were associated with occult metastasis, but only angiolymphatic invasion showed to be an independent risk factor.

Objective: The aim of this study is to investigate the clinical and pathological factors related to distant metastasis in patients with oral cavity squamous cell carcinoma (OCSCC) undergoing surgery. Study Design: A retrospective data review was conducted on patients who underwent primary surgery for OCSCC at the Instituto do Cancer do Estado de São Paulo (ICESP) between 2009 and 2015. Distant metastasis rates were calculated and predictive factors were determined by the Cox proportional-hazards model. Results: There was a total of 274 patients, including 210 (76.6%) men and 64 (23.4%) women, with a mean age of 59.9 ± 10.9 years. The incidence of distant metastasis was 9.6%, with the lung being the most common site. The mean time interval between surgical treatment and the diagnosis of distant metastasis was 12 months (range 2–40 months). In the multivariate analysis, angiolymphatic invasion (HR = 2,87; p = 0.023), contralateral cervical metastasis (HR = 3.3; p = 0,007), tumor thickness >25 mm (HR = 3.50; p = 0.009), and locoregional recurrence (HR = 6.59; p < 0.0001) were the only independent risk factors for distant metastasis. Conclusion: Patients with OCSCC who have contralateral lymph node metastasis, tumors with a thickness >25 mm, angiolymphatic invasion, or locoregional recurrence after surgical treatment have a greater risk of developing distant metastasis.

This report suggests a previously unknown potential effect of sorafenib on the pituitary-adrenal axis. Further studies will be necessary to investigate the role of sorafenib in other cases of ACTH excess and to understand the mechanisms by which it alters steroid synthesis, action, or secretion.

Among patients who already have advanced cancers, tumor volume can significantly impact their prognoses. © 2017 Wiley Periodicals, Inc. Head Neck 39: 960-964, 2017.

Introduction:In recent years, there has been a polarization around the discussion of neck management in patients with oral malignant neoplasm without evidence of lymph node involvement, regarding selective neck dissection (SND) of levels I, II and III, sentinel lymph node biopsy (SLB) and just surveillance. Objective: To describe the oncological results of a prospective study in the use of sentinel lymph node biopsy as part of the surgical treatment of squamous cell carcinoma T1/T2N0 of the oral cavity in comparison to the results of patients submitted to levels I, II and III SND. Methods: It was a prospective study in which seventy patients were divided into two groups, 35 being submitted to SND and the other 35 to SLB. Results: In the SND group, locoregional recurrence occurred in 17.1%, with a 2.9% development of distant metastasis and 8.8% evolved with a second primary tumor. In the SLB, locoregional recurrence was observed in 7 patients (20.0%), 5.7% developed distant metastasis, and 5.7% had a second primary tumor. There was no significant difference between the two groups for both overall (p = 0.521) and disease-free survival (p = 0.753). Conclusion: A SLB is reliable for the management of clinically negative neck in patients with oral T1/T2N0 squamous cell carcinoma.

The complication rate was not higher for operations performed by unsupervised trainees than those performed in the presence of a consultant.

RESUMOIntrodução: Preservar tecido tireóideo em cirurgias para bócio multinodular (BM) não evita a complementação hormonal e pode gerar recidiva. A reoperação aumenta em até 20 vezes o risco de complicações. Propomos no BM, a tireoidectomia total (TT) como tratamento definitivo quando existe acometimento bilateral do parênquima posterior à veia tireóidea média. Objetivo: Avaliar e justificar a utilização da TT em portadores de BM. Material e Método: Estudo retrospectivo de 1.789 pacientes submetidos a tireoidectomias de 06/90 a 12/00. A indicação cirúrgica foi avaliada conforme a apresentação clínica, a extensão da tireoidectomia, a incidência de câncer e as complicações. Resultados: A TT foi realizada em 81,2% de 872 portadores de BM atóxicos, 93,9% de 33 BM tóxicos e 93,9% de 66 bócios recidivados. Houve hipoparatireoidismo transitório ou definitivo, hematoma e lesões transitórias ou definitivas do nervo recorrente em respectivamente 11,5%, 0,5%, 0,4%, 2,7% e 0,2% dos pacientes com BM atóxicos, e 8,3%, 8,3%, zero, 5,0% e 5,0% dos com B recidivados. Complicações definitivas da TT para BM atóxico foram semelhantes à tireoidectomia não total, porém inferiores da TT para B recidivado. Ocorreu aumento da indicação da TT para BM atóxico, com a utilização da veia tireóidea média como referência anatômica, de 53,3% inicialmente para 93,6% atualmente, com elevação do diagnósti-co de câncer de 11,1% para 19,8%. Conclusão: TT é o tratamento de escolha para o BM, quando acomete extensamente a glândula, isto é, posteriormente às veias tireóideas médias; com baixo índice de complicações definitivas. We propose total thyroidectomy (TT) for MG as a definitive treatment. Objective: To evaluate and justify the TT in patients with MG. Material and method: Retrospective study of 1,789 patients who underwent thyroidectomies, from 06/90 to 12/00. Indication, extension of thyroidectomy, cancer incidence and complications were analyzed. Results: TT was performed in 81.2% of 872 patients with nontoxic and 93.9% of 33 with toxic MG and 93.9% of 66 with recurrent goiter. Transient and permanent hypoparathyroidism, hematoma, transient and permanent recurrent laryngeal nerve injury occurred in 11.5%, 0.5%, 0.4%, 2.7% and 0.2% of the patients with nontoxic MG and 8.3%, 8.3%, zero, 5.0% and 5.0% of those with recurrent goiter. Permanent complication of TT for non-toxic MG was similar to non-total thyroidectomy. Utilization of TT for non-toxic MG increased from 53.3% to 93.6% at present, with a concomitant increase of cancer diagnosis from 11.1% to 19.8%. Conclusion: TT is the treatment of choice for MG, when there is bilateral gland involvement posterior to middle thyroid veins, because it decreases the likelihood of future reop-