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BACKGROUND: The use of cervical drains to prevent cervical hematoma or seroma after thyroidectomy remains a controversial issue. OBJECTIVE: Identify clinical and surgical risk factors for hematoma or seroma and evaluate the usefulness of routine use of drains following thyroid surgery. MATERIAL AND METHODS: The authors conducted a retrospective multicentric study related to consecutive patients submitted to thyroid surgery in seven Portuguese hospitals between January 2018 and December 2020 (n=945). The data collected included the following parameters: age and gender of the patients, anticoagulation or anti-aggregating therapy, histological diagnoses, type of surgery, the presence or absence of postoperative drains, thyroid weight, length of hospital stay, postoperative complications, and reinterventions. In this study, surgical complications evaluated were limited to the presence of hematoma or seroma. A total of 945 patients who underwent thyroid surgery were included in the study. Twenty-seven patients (2.9%, n=27) experienced complications classified as hematomas or seromas. In the series, significant differences were observed between the two groups according to hypocoagulation or anti-aggregation status (OR=3.62; 95% CI 1.14-11.4) (p=0.001) and the nature of histological diagnosis (toxic vs. non-toxic benign disease) (OR=6.59; 95% CI 1.83-23.7). Hypocoagulation or anti-aggregation status were independently associated with a higher risk of complications. The presence of drains was associated with longer hospitalization periods (p<0.001) and not a decreased need for reintervention. CONCLUSION: Cervical hematoma or seroma are rare complications associated with both hypocoagulation and anti-aggregation therapy and with the presence of benign toxic pathology. The use of drains does not decrease the need for reintervention and is even associated with a longer length of hospital stay; therefore, their routine use should not be advised.

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Anastomotic leakage is a life-threatening complication for esophageal cancer patients who received McKeown esophagectomy. Cervical drainage tube penetrating anastomosis is a rare but noteworthy cause of long-term nonunion of esophagogastric anastomosis. Here we reported two cases of esophageal cancer patients who received McKeown esophagectomy. The first case acquired the anastomotic leakage on postoperative day (POD) 7, and lasted for 56 days. The cervical drainage tube was removed at POD 38, and the leakage healed in 25 days. The second case acquired the anastomotic leakage on POD 8 and lasted for 95 days. The cervical drainage tube was removed at POD 57, and the leakage healed in 46 days. The two cases demonstrated the duration-prolonging effect of drainage tube penetrating anastomosis, which should not be overlooked in clinical practice. We suggested paying attention to the duration of leakage, the drainage fluids amounts and characteristics, and the imaging manifestations to help diagnose. If the cervical drainage tube penetrated the anastomosis, the tube should be eliminated as soon.

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BACKGROUND: Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal cancer. Currently, transthoracic and abdominal esophagectomy with cervical anastomosis (McKeown esophagectomy) is a frequently used technique in Japan. However, cervical anastomosis is still an invasive procedure with a high incidence of anastomotic leakage. The use of a drainage tube to treat anastomotic leakage is effective, but the routine placement of a closed suction drain around the anastomosis at the end of the operation remains controversial. The objective of this study is to evaluate the postoperative anastomotic leakage rate, duration to oral intake, hospital stay, and analgesic use with nonplacement of a cervical drainage tube as an alternative to placement of a cervical drainage tube. METHODS: This is an investigator-initiated, investigator-driven, open-label, randomized controlled parallel-group, noninferiority trial. All adult patients (aged ≥20 and ≤85 years) with histologically proven, surgically resectable (cT1-3 N0-3 M0) squamous cell carcinoma, adenosquamous cell carcinoma, or basaloid squamous cell carcinoma of the intrathoracic esophagus, and European Clinical Oncology Group performance status 0, 1, or 2 are assessed for eligibility. Patients (n = 110) with resectable esophageal cancer who provide informed consent in the outpatient clinic are randomized to either nonplacement of a cervical drainage tube (n = 55) or placement of a cervical drainage tube (n = 55). The primary outcome is the percentage of Clavien-Dindo grade 2 or higher anastomotic leakage. DISCUSSION: This is the first randomized controlled trial comparing nonplacement versus placement of a cervical drainage tube during McKeown esophagectomy with regards to the usefulness of a drain for anastomotic leakage. If our hypothesis is correct, nonplacement of a cervical drainage tube will be recommended because it is associated with a similar anastomotic leakage rate but less pain than placement of a cervical drainage tube. TRIAL REGISTRATION: UMIN-CTR, 000031244. Registered on 1 May 2018.

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Objetivo: reportar un caso clínico de mediastinitis necrotizante descendente de origen odontogénico dada su baja incidencia y alta mortalidad asociada, el cual fue manejado con un drenaje cervical y mediastinal mediante toracoscopia. Caso clínico: se describe el caso de un paciente que desarrolla mediastinitis de origen odontogénico diagnosticado de manera oportuna y tratado multidisciplinariamente de manera temprana mediante drenaje cervicofacial abierto y toracoscopia bilateral. Discusión: la mediastinitis necrotizante descendente es una enfermedad con una baja incidencia pero con una alta mortalidad, cuyo manejo médico no es exitoso si no se realiza un diagnóstico temprano y un drenaje adecuado. El estándar de oro en cuanto al manejo es el drenaje cervicofacial más drenaje mediastínico por toracotomía. Conclusiones: con la finalidad de mejorar la sobrevida de los pacientes con mediastinitis necrotizante descendente es necesario un alto índice de sospecha para un diagnóstico temprano. En casos seleccionados el drenaje mediastinal puede realizarse por toracoscopia, siendo el marcador pronóstico favorable la respuesta inicial del paciente en el posquirúrgico inmediato.

Objective: to report a clinical case with diagnosis of a descending necrotizing mediastinitis of dental origin given its low incidence and high mortality, which was managed with an aggressive cervical drainage through thoracoscopy. Clinical Case: a case of a patient which develops mediastinitis of dental origin whom it is diagnosed in an early manner, and treated with open cervicofacial drainage and a bilateral thoracoscopy Discussion: descending necrotizing mediastinitis is a disease with a low incidence percentage but with a high mortality rate. Its medical treatment should be successful only if an early diagnosis is made and a correct drainage is performed. The gold standard in its management resides in cervicofacial drainage plus mediastinal drainage though thoracotomy. Conclusion: to improve the survival rate of patients suffering descending necrotizing mediastinitis, an early suspicion is required to perform an early diagnosis. In selected cases, mediastinal drainage can be made through thoracoscopy technique to improve the initial response in the immediate postsurgical time.

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