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do Prado Padovani R, Duarte FB, Nascimento C. Current practice in intermediate risk differentiated thyroid cancer - a review. Rev Endocr Metab Disord 2024; 25:95-108. [PMID: 37995023 DOI: 10.1007/s11154-023-09852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Although the overall prognosis for differentiated thyroid cancer (DTC) is excellent, a subset of patients will experience disease recurrence or may not respond to standard treatments. In recent years, DTC management has become more personalized in order to enhance treatment efficacy and avoid unnecessary interventions.In this context, major guidelines recommend post-surgery staging to assess the risk of disease persistence, recurrence, and mortality. Consequently, risk stratification becomes pivotal in determining the necessity of postoperative adjuvant therapy, which may include radioiodine therapy (RIT), the degree of TSH suppression, additional imaging studies, and the frequency of follow-up.However, the intermediate risk of recurrence is a highly heterogeneous category that encompasses various risk criteria, often combined, resulting in varying degrees of aggressiveness and a recurrence risk ranging from 5 to 20%. Furthermore, there is not enough long-term prognosis data for these patients. Unlike low- and high-risk DTC, the available literature is contradictory, and there is no consensus regarding adjuvant therapy.We aim to provide an overview of intermediate-risk differentiated thyroid cancer, focusing on criteria to consider when deciding on adjuvant therapy in the current context of personalized approach, including molecular analysis to enhance the accuracy of patient management.
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Affiliation(s)
- Rosalia do Prado Padovani
- Section of Endocrinology and Metabolism, Department of Medicine, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Doutor Cesário Mota Junior, , 61 - SAO PAULO -CEP, São Paulo, 1221020, Brazil.
| | - Fernanda Barbosa Duarte
- Section of Endocrinology and Metabolism, Department of Medicine, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Doutor Cesário Mota Junior, , 61 - SAO PAULO -CEP, São Paulo, 1221020, Brazil
| | - Camila Nascimento
- Nuclear Medicine Department, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
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Deguelte S, Colas PA, Guerin C, Leboulleux S, Najah H, Lifante JC. Extent of thyroidectomy: When should hemithyroidectomy be performed? Recommendations from the Francophone Association for Endocrine Surgery, the French Society of Endocrinology and the French Society of Nuclear Medicine. J Visc Surg 2023:S1878-7886(23)00077-2. [PMID: 37150665 DOI: 10.1016/j.jviscsurg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
These recommendations, drawn from current data in the medical literature, incorporate the risks of hemithyroidectomy (HT) and total thyroidectomy (TT) and clarify the place of these two procedures in clinical settings. Discussions leading to a consensus were then assessed by the Francophone Association for Endocrine Surgery (Association francophone de chirurgie endocrinienne [AFCE]), along with the French Society of Endocrinology (Société française d'endocrinologie [SFE]), and the French Society of Nuclear Medicine (Société française de médecine nucléaire [SFMN]). The complication rate was twice as high after TT compared to HT. Total thyroidectomy requires life-long thyroid hormone supplementation, whereas such supplementation is required in only 30% of patients after HT. When surgery is indicated for Bethesda category II nodules, and in the absence of any indication for surgery on the contralateral lobe, HT is recommended. In patients with thyroid cancer (TC)≤1cm requiring surgical management or TC≤2cm, in the absence of risk factors for TC and in the absence of pre- or intraoperative detection of extrathyroidal extension, lymph node metastases (cN0) and/or suspected contra-lateral disease, HT is the preferred technique as long as the patient accepts the possibility of TT which might be required when aggressive forms of cancer are detected on definitive cytohistology (extrathyroidal extension, lymphovascular invasion, high-grade histology). For TC measuring between 2 and 4cm, the debate between HT and TT remains open today, although some surgeons tend to prefer TT. In patients with TC>4cm, macroscopic lymph node involvement (cN1), signs of extrathyroidal extension or predisposing factors for TC, TT is the treatment of choice.
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Affiliation(s)
- Sophie Deguelte
- Department of endocrine, digestive and oncological surgery, Robert-Debré university hospital, Reims, France; EA 3797, Reims medical school, 51095 Reims, France; Reims medical school, university of Champagne-Ardennes, Reims, France.
| | - Pierre Antoine Colas
- Department of general, visceral and endocrine surgery, Pitié-Salpêtrière university hospital, 75013 Paris, France
| | - Carole Guerin
- Department of endocrine surgery, CHU de la Conception, Aix-Marseille university, Marseille, France
| | - Sophie Leboulleux
- Department of Endocrinology, diabetology, Nutrition and Therapeutic Education, Hôpitaux Universitaires de Genève, Switzerland
| | - Haythem Najah
- Department of digestive and endocrine surgery, university hospital of Bordeaux, Bordeaux, France
| | - Jean Christophe Lifante
- Health services and performance research lab (EA 7425 HESPER) and EA 3738 CICLY, université Lyon 1, Claude-Bernard, 69921 Lyon, France; Department of endocrine surgery , hospices civils de Lyon, groupement hospitalier Sud, 69495 Pierre-Bénite, France
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3
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Tsai CH, Kuo CY, Leu YS, Lee JJ, Cheng SP. Impact of completion thyroidectomy on postoperative recovery in patients with differentiated thyroid cancer. Updates Surg 2023; 75:209-216. [PMID: 36201137 DOI: 10.1007/s13304-022-01394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/29/2022] [Indexed: 01/14/2023]
Abstract
While an increasing number of patients now undergo lobectomy for low-risk differentiated thyroid cancer, a subset of patients require completion thyroidectomy to facilitate radioactive iodine therapy. Completion thyroidectomy is generally as safe as the initial operation, but a previous study showed that a longer hospitalization is required for completion thyroidectomy. In this study, we reviewed 61 consecutive patients who had been treated with an initial lobectomy and subsequent completion thyroidectomy at our institution from 2012 to 2021. We detected a changepoint in 2016 for the proportion of patients who were treated with a thyroid lobectomy (Pettitt's test P = 0.049). The rate of completion thyroidectomy remained stable throughout the study period. There was no difference in operating time, intraoperative blood loss, perioperative drop in calcium levels, and postoperative hospital stay between surgeries. The patients reported higher pain scores on the day of operation (P = 0.007) and the postoperative day 1 (P = 0.022). Occult papillary microcarcinomas were identified in the contralateral thyroid lobe in 13 (21%) patients. Multifocality was the only predictor for residual malignancy in multivariate regression. In conclusion, patients with differentiated thyroid cancer experienced more pain in the immediate postoperative period following completion thyroidectomy. Hospital stays do not change with appropriate opioid-free pain control.
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Affiliation(s)
- Chung-Hsin Tsai
- Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chi-Yu Kuo
- Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Shing Leu
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jie-Jen Lee
- Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan.
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan.
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan.
- Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Brooks JA, Abdelhamid Ahmed AH, Al-Qurayshi Z, Kamani D, Kyriazidis N, Hammon RJ, Ma H, Sritharan N, Wasserman I, Trinh LN, Iwata AJ, Saito Y, Soylu S, Randolph GW. Recurrent Laryngeal Nerve Invasion by Thyroid Cancer: Laryngeal Function and Survival Outcomes. Laryngoscope 2022; 132:2285-2292. [PMID: 35363394 DOI: 10.1002/lary.30115] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) invasion by thyroid carcinoma represents an advanced disease status with potentially significant co-morbidity. METHODS In a retrospective single-center study, we included patients with invaded RLNs operated on while using nerve monitoring techniques. We studied pre-, intra-, and postoperative parameters associated with postoperative vocal cord paralysis (VCP); 5-year recurrence-free survival (RFS); and 5-year overall survival (OS) in addition to two subgroup analyses of postoperative VCP in patients without preoperative VCP and based on source of RLN invasion. RESULTS Of 65 patients with 66 nerves-at-risk, 39.3% reported preoperative voice complaints. Preoperative VCP was documented in 43.5%. The RLN was invaded by primary tumor in 59.3% and nodal metastasis in 30.5%. Papillary thyroid carcinoma was the most common pathologic subtype (80%). After 6 months, 81.8% had VCP. Complete tumor resection of the RLN was not associated with 5-year RFS (p = 0.24) or 5-year OS (p = 0.9). Resecting the RLN did not offer statistically significant benefit on 5-year RFS (p = 0.5) or 5-year OS (p = 0.38). Radioactive Iodine (RAI) administration was associated with improvement in 5-year RFS (p = 0.006) and 5-year OS (p = 0.004). Patients without preoperative VCP had higher IONM amplitude compared with patients with VCP. After a mean follow-up of 65.8 months, 35.9% of patients had distant metastases, whereas 36.4% had recurrence. CONCLUSION Preoperative VCP accompanies less than half of patients with RLN invasion. Invaded RLNs may have existent electrophysiologic stimulability. Complete tumor resection and RLN resection were not associated with better 5-year RFS or OS, but postoperative RAI was. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Jennifer A Brooks
- Department of Otolaryngology-Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Amr H Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Kyriazidis
- Department of Otolaryngology-Head & Neck Surgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Rebecca Jean Hammon
- Department of Head and Neck Surgery, Northwest Permanente, Portland, Oregon, USA
| | - Hongzhi Ma
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otorhinolaryngology-Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, China
| | - Niranjan Sritharan
- Department of Otolaryngology-Head and Neck Surgery, Westmead & Nepean Hospitals, Sydney, Australia
| | - Isaac Wasserman
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Lily N Trinh
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayaka J Iwata
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Santa Clara Medical Center, California, USA
| | - Yoshiyuki Saito
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Selen Soylu
- Department of General Surgery, Basaksehir Cam and Sakura City Hospital., Istanbul, Turkey
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hartl DM, Hadoux J, Garcia C, Ghuzlan AA, Guerlain J, Breuskin I, Baudin E, Lamartina L. [De-escalation strategies in differentiated thyroid cancer]. Bull Cancer 2021; 108:1132-1144. [PMID: 34649722 DOI: 10.1016/j.bulcan.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Thyroid cancer runs the gamut from indolent micropapillary carcinoma to highly aggressive metastatic disease. Today, using prognostic algorithms, treatment and follow-up can be tailored to each patient in order to decrease overtreatment and over-medicalization of indolent disease. Active surveillance of papillary thyroid carcinoma less than 1cm avoids surgery and thyroid hormone replacement in a large proportion of patient whose tumors remain stable for years. Total thyroidectomy, once a dogma in the treatment of all thyroid cancer, is being supplanted by thyroid lobectomy for low-risk cancers, thereby decreasing the surgical risks involved and improving patients' quality of life. Indications for prophylactic central neck dissection, once mandatory, are now being adapted to the risk of cancer recurrence. Radioactive iodine therapy, also previously mandatory for all, is now only employed according to risk factors and expected outcomes. Follow-up is also being tailored to risk factors for recurrence, with less frequent visits and less use of ultrasound and scintigraphy. For more advanced disease, molecular therapies tailored to somatic mutations are opening opportunities for redifferentiation of aggressive tumors which become amenable to radioactive iodine therapy which carries fewer side effects than other systemic therapies. These advances in the management of thyroid cancer with a personalized approach and de-escalation of treatment and follow-up are improving the way we treat thyroid cancer, avoiding overtreatment and improving patients' quality of life.
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Affiliation(s)
- Dana M Hartl
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de chirurgie, service de cancérologie cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - Julien Hadoux
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Camilo Garcia
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Abir Al Ghuzlan
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de biologie et de pathologie, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Joanne Guerlain
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de chirurgie, service de cancérologie cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Ingrid Breuskin
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de chirurgie, service de cancérologie cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Eric Baudin
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Livia Lamartina
- Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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Ronen O, Oichman M. National differences in cost analysis of Afirma Genomic sequencing classifier. Clin Endocrinol (Oxf) 2021; 94:717-724. [PMID: 33349964 DOI: 10.1111/cen.14400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/10/2023]
Abstract
CONTEXT Thyroid nodules of indeterminate cytology can be subjected to molecular testing such as the Afirma Genomic Sequencing Classifier (GSC), thereby minimizing the number of unnecessary diagnostic surgeries. OBJECTIVE This work aimed to evaluate and compare the cost of routine GSC testing of indeterminate thyroid nodules in different countries. DESIGN, PATIENTS AND MAIN OUTCOME MEASURES The cost of diagnostic hemithyroidectomy of indeterminate thyroid nodules was calculated by performing a Monte Carlo simulation cost analysis on a Markov decision-analytic model and then compared to that of GSC testing in the UK, Australia, USA, and Israel. RESULTS Assuming that patients are treated by surgical resection and routine GSC testing is performed for all nodules of indeterminate significance, we found the GSC test to be more cost effective compared with diagnostic hemithyroidectomy when malignancy rates of thyroid nodules are less than 22.6%-37.1%, depending on the country where the test is performed. Given the cost of a thyroidectomy in the UK, Australia and Israel, performing routine GSC tests on all Bethesda IV nodules is more expensive than routine diagnostic hemithyroidectomy and becomes cost effective for Bethesda III when the GSC cost is below 3,031-3,087 USD. In comparison, in the USA, higher cost of thyroidectomy makes the GSC test cost effective for Bethesda III nodules at its current cost, but not for Bethesda IV nodules where it becomes cost effective under the price of 3,031 USD. CONCLUSIONS Different molecular testing and surgical costs in different countries should be considered when performing cost analysis. In addition, since different medical centres have different malignancy rates, personalized in-house assessment of cost-effectiveness is warranted.
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Affiliation(s)
- Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maya Oichman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Wu CW, Huang TY, Randolph GW, Barczyński M, Schneider R, Chiang FY, Silver Karcioglu A, Wojtczak B, Frattini F, Gualniera P, Sun H, Weber F, Angelos P, Dralle H, Dionigi G. Informed Consent for Intraoperative Neural Monitoring in Thyroid and Parathyroid Surgery - Consensus Statement of the International Neural Monitoring Study Group. Front Endocrinol (Lausanne) 2021; 12:795281. [PMID: 34950109 PMCID: PMC8689131 DOI: 10.3389/fendo.2021.795281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
In the past decade, the use of intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery has been widely accepted by surgeons as a useful technology for improving laryngeal nerve identification and voice outcomes, facilitating neurophysiological research, educating and training surgeons, and reducing surgical complications and malpractice litigation. Informing patients about IONM is not only good practice and helpful in promoting the efficient use of IONM resources but is indispensable for effective shared decision making between the patient and surgeon. The International Neural Monitoring Study Group (INMSG) feels complete discussion of IONM in the preoperative planning and patient consent process is important in all patients undergoing thyroid and parathyroid surgery. The purpose of this publication is to evaluate the impact of IONM on the informed consent process before thyroid and parathyroid surgery and to review the current INMSG consensus on evidence-based consent. The objective of this consensus statement, which outlines general and specific considerations as well as recommended criteria for informed consent for the use of IONM, is to assist surgeons and patients in the processes of informed consent and shared decision making before thyroid and parathyroid surgery.
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Affiliation(s)
- Che-Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, and Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gregory W. Randolph
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Rick Schneider
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Feng-Yu Chiang
- Department of Otolaryngology, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | | | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Francesco Frattini
- Department of Surgery, Ospedale di Circolo, ASST, Settelaghi, Varese, Italy
| | - Patrizia Gualniera
- Forensics Division, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, University of Duisburg-Essen, Essen, Germany
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, United States
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, University of Duisburg-Essen, Essen, Germany
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- *Correspondence: Gianlorenzo Dionigi,
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Hartl DM, Guerlain J, Breuskin I, Hadoux J, Baudin E, Al Ghuzlan A, Terroir-Cassou-Mounat M, Lamartina L, Leboulleux S. Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer. Cancers (Basel) 2020; 12:cancers12113282. [PMID: 33171949 PMCID: PMC7694652 DOI: 10.3390/cancers12113282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Total thyroidectomy used to be recommended for all thyroid cancers. We now know that some thyroid cancers have a relatively low risk of recurrence. Today, for some of these cancers, depending on the type of tumor, its’ size and other tumor characteristics, a thyroid lobectomy (or hemithyroidectomy) can be performed without increasing the patient’s risk of cancer recurrence. Thyroid lobectomy has the advantages of having less risk of surgical complications and a less frequent need for thyroid hormone replacement therapy. This approach is not optimal for all thyroid cancers, however, and careful tumor and patient selection are necessary. This review explains the rationale and criteria for patient selection for thyroid lobectomy for selected thyroid cancers. Abstract Many recent publications and guidelines have promoted a “more is less” approach in terms of treatment for low to intermediate risk differentiated thyroid cancer (DTC), which comprise the vast majority of thyroid cancers: less extensive surgery, less radioactive iodine, less or no thyroid hormone suppression, and less frequent or stringent follow-up. Following this approach, thyroid lobectomy has been proposed as a means of decreasing short- and long-term postoperative morbidity while maintaining an excellent prognosis for tumors meeting specific macroscopic and microscopic criteria. This article will examine the pros and cons of thyroid lobectomy for low to intermediate risk cancers and discuss, in detail, criteria for patient selection and oncological outcomes.
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Affiliation(s)
- Dana M. Hartl
- Department of Surgery, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France; (J.G.); (I.B.)
- Correspondence:
| | - Joanne Guerlain
- Department of Surgery, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France; (J.G.); (I.B.)
| | - Ingrid Breuskin
- Department of Surgery, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France; (J.G.); (I.B.)
| | - Julien Hadoux
- Department of Nuclear Medicine and Endocrine Oncology, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France; (J.H.); (E.B.); (M.T.-C.-M.); (L.L.); (S.L.)
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France; (J.H.); (E.B.); (M.T.-C.-M.); (L.L.); (S.L.)
| | - Abir Al Ghuzlan
- Department of Biology and Pathology, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France;
| | - Marie Terroir-Cassou-Mounat
- Department of Nuclear Medicine and Endocrine Oncology, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France; (J.H.); (E.B.); (M.T.-C.-M.); (L.L.); (S.L.)
| | - Livia Lamartina
- Department of Nuclear Medicine and Endocrine Oncology, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France; (J.H.); (E.B.); (M.T.-C.-M.); (L.L.); (S.L.)
| | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Anesthesia and Interventional Medicine Gustave Roussy, 94805 Villejuif, France; (J.H.); (E.B.); (M.T.-C.-M.); (L.L.); (S.L.)
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9
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Kempfle JS, Löwenheim H, Huebner MJ, Iro H, Mueller SK. [Management of tracheostomy patients during the COVID-19 pandemic: review of the literature and demonstration]. HNO 2020; 68:828-837. [PMID: 32514605 PMCID: PMC7278214 DOI: 10.1007/s00106-020-00892-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since emergence of the new coronavirus in China in December 2019, many countries have been struggling to control skyrocketing numbers of infections, including among healthcare personnel. It has now been clearly demonstrated that SARS-CoV‑2 resides in the upper airways and transmits easily via aerosols and droplets, which significantly increases the risk of infection when performing upper airway procedures. Ventilated COVID-19 patients in a critical condition in the intensive care unit may require tracheotomy for long-term ventilation and to improve weaning. However, the risk of secondary infection of medical personnel performing subsequent tracheostomy care remains unclear. OBJECTIVE This study aimed to evaluate the risk of droplet dispersion during tracheostomy tube change and overview tracheostomy tube change in COVID-19 patients. MATERIALS AND METHODS The current literature was reviewed, quantitative and qualitative analyses of droplet formation during tracheostomy tube change in n = 8 patients were performed, and an overview of and checklist for tracheostomy tube change were compiled. RESULTS This study demonstrates that tracheostomy tube change, in particular insertion of the new tube, may cause significant droplet formation. The aerosolization of particles smaller than 5 µm was not analyzed. CONCLUSION Our data, together with the current literature, clearly emphasize that tracheostomy care is associated with a high infection risk and should only be performed by a small group of well-trained, maximally protected healthcare personnel.
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Affiliation(s)
- J S Kempfle
- Abteilung für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - H Löwenheim
- Abteilung für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M J Huebner
- Abteilung für Kinderkardiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - H Iro
- Abteilung für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 1054, Erlangen, Deutschland
| | - S K Mueller
- Abteilung für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 1054, Erlangen, Deutschland.
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