Reprint of: Laryngeal reinnervation in the treatment of unilateral and bilateral vocal cord palsy: Introducing these techniques into the UK

ABSTRACTS Presentation 9. Laryngeal reinnervation in the treatment of unilateral and bilateral vocal cord palsy: Introducing these techniques into the UK Kate Heathcote1, Martin Birchall2, Yakubu Karagama3, Jean-Paul Marie4 1 Poole General Hospital, UK 2 Royal National Throat Nose and Ear Hospital, UK 3 Central Manchester University Hospitals, UK 4 Rouen University Hospital, France Background: Permanent, post operative, recurrent laryngeal nerve palsy (RLNP) occurs in approximately 1% of thyroidectomy procedures (1). This results in a deterioration of voice and cough and risk of aspiration. In bilateral RLNP airway compromise may require urgent tracheostomy. The best outcome is achieved with early rehabilitation, traditionally by thyroplasty or injection augmentation depending on the nature of the palsy, the health and life expectancy of the patient and local expertise. In France and USA it is becoming common practice to offer laryngeal reinnervation. As a group we have trained in these techniques to introduce them to the UK. Method: Following 15 years of animal studies Prof Marie has pioneered the technique of “bilateral selective laryngeal reinnervation” for bilateral RLNP. Donor nerves are selected to restore inspiratory abduction and phonatory adduction of the cords. He has performed over 40 cases on international patients, many of whom had thyroid surgery, achieving high rates of tracheostomy decannulation whilst maintaining voice. He also routinely performs “non-selective reinnervation” for unilateral RLNP. This increases muscular tone in the paralysed hemi-larynx, maintaining position of the arytenoid and muscle bulk of the cord to facilitate complete closure of the glottis on phonation. By means of fellowships and observerships, Prof Marie has trained a group of UK surgeons in these techniques. Via training courses we are disseminating this technique nationally. Results: In cases of unilateral RLNP, non-selective reinnervation has been shown to restore phonatory function to normal or near normal (2). We perform this technique in our prospective centres and are working on a randomised controlled trial comparing it to thyroplasty. We have performed one case of bilateral reinnervation at the RNTNE. This is complex surgery to be performed in a national centre. Conclusions: These techniques are available in the UK and should be considered in patients with RLNP. Doi of original article: http://dx.doi.org/10.1016/j.ejso.2014.07.020

Presentation 10. Study of serum leptin in well differentiated thyroid carcinoma: Correlation with patient and tumor characteristics Tarek Ezzat Abdel-Aziz1,2, Rania Abdel Rehem MD 3, Reham Abo Elwafa4, Waleed Abo Elwafa1 1 Department of General Surgery, Endocrine unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt 2 Division of Surgery and Interventional Science, University College London, London, UK 3 Internal Medicine Department, Endocrinology, Faculty of Medicine, Alexandria University, Alexandria, Egypt 4 Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt Background: There is a proven relationship between obesity and several cancers including breast, endometrium, colorectal and esophagus. With the increasing incidence of both obesity and thyroid cancer, we designed this study to investigate a causal relationship between leptin which is one of the well known adipokines and well differentiated thyroid cancer (WDTC).

1803 Methods: Serum leptin levels were measured in 30 patients with WDTC and compared to 30 healthy control subjects before and one month after thyroid surgery. All patients underwent either total thyroidectomy or hemithyroidectomy. Central and/or modified radical neck dissections were done depending on compartmental nodal involvement. Other parameters studied included age, sex, body mass index, menopausal status in women, lymph node status, tumour size and disease multifocality. Results: There were no differences between both groups regarding age and sex. Preoperative leptin levels were higher in the WDTC patients when compared to the control patients (19.25 (1.50 - 109.60) ng/ml vs. 0.90 (0.50 - 11.80) ng/ml, p< 0.001, group 1 vs, group2 respectively). A significant drop in leptin levels one month after surgery occurred in WDTC group, falling from 19.25 (1.50 - 109.60) ng/ml to 0.90 (0.60 - 8.90) ng/ ml (p < 0.001). A similar drop did not occur in the control group (p=0.274). Lymph node involvement, tumour size and cancer multifocality had no effect on leptin levels although trends were observed (p=0.48, 0.079, and 0.064) respectively. Conclusion: Higher leptin levels were associated with a diagnosis of WDTC with a significant drop in the levels following surgery. Other prognostic factors like lymph node status, age, tumour size and multifocal disease had no effect on leptin levels. Future studies should focus on finding a correlation between cancer activation pathways, leptin receptor tissue expression and serum leptin levels which could then be used as a tumour marker in the clinic setting. Doi of original article: http://dx.doi.org/10.1016/j.ejso.2014.07.021

Presentation 11. Health-related quality of life and fear of recurrence in survivors of differentiated thyroid cancer Vishal Naran Mepani1, Simon Rogers2, Derek Lowe3, Shaun Jackson2, Linda Smith4 1 University of Liverpool, UK 2 Aintree University Hospitals Foundation NHS Trust, UK 3 Edge Hill University, UK 4 Royal Liverpool and Broadgreen University Hospital NHS Trust, UK Background: The diagnosis and treatment of malignant disease can have a considerable impact on health-related quality of life (HRQoL). Fear of recurrence (FoR) is a common cause of concern for cancer patients that can adversely affect emotional and psycho-social well-being. This issue has been researched in various types of cancer, but studies in thyroid cancer are lacking. This study was conducted to explore HRQoL and FoR in patients treated for differentiated thyroid cancer (DTC) through the thyroid multi-disciplinary team (MDT) in the Merseyside and Cheshire region. Methods: Patients treated with radioactive iodine ablation (RAI) +/surgery between April 2009 and November 2013 were sent a survey. This consisted of EORTC QLQ-C30, THYCA-QoL, single-item FoR, 7item FoR and Emotional Thermometer Tool questionnaires. Results: A total of 220 surveys were sent out. The response rate was 50% (109), with a female predominance and mean age of 52.7. Scores were lowest for emotional and global health domains of EORTC QLQC30. Tiredness, restlessness/agitation and ’feeling slowed down’ components of THYCA-QoL correlated significantly with the majority of QLQ-C30 domains. Significant FoR was present in 10% and 7%-19% for single and 7-item questionnaires respectively. Anxiety and depression scores were highest on the Emotional Thermometer tool (mean scores 2.15 and 1.79 respectively). Conclusion: Specific thyroid dysregulation symptoms such as tiredness and feeling slowed down can have a significant impact on HRQoL. FoR is a common issue in DTC patients, but requires further research to determine its impact on quality of life. Doi of original article: http://dx.doi.org/10.1016/j.ejso.2014.07.022