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Oh MY, Park D, Chai YJ, Kim K, Kim HY. Re-do transoral robotic thyroidectomy is feasible: preliminary results of the surgical feasibility and efficacy of completion transoral robotic thyroidectomy: cohort study. Int J Surg 2024; 110:2933-2938. [PMID: 38363985 DOI: 10.1097/js9.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Transoral robotic thyroidectomy (TORT) has proven to be a safe and effective procedure with favourable surgical and cosmetic outcomes, but its application in completion thyroidectomy procedures remains to be established. In this study, the authors present our experience with completion TORT, assessing its surgical feasibility and efficacy. between February 2017 and August 2023. METHODS The authors conducted a retrospective analysis of consecutive patients who underwent completion TORT after an initial TORT procedure between February 2017 and August 2023. RESULTS A total of 10 patients (three males and seven females) were included in the study, with a mean age of 42.2±13.5 years. The indications for completion thyroidectomy included five cases of aggressive initial lesions and five cases of metachronous papillary thyroid carcinoma detected in the remnant lobe. The median interval between the initial and completion TORT procedures was 6.5 months. Flap dissection time showed no significant difference between the initial TORT and completion TORT operations (43.3±7.5 vs. 36.2±11.2, P =0.125). However, the mean console time (127.9±42.6 vs. 86.4±26.3 min, P =0.019) and mean total operation time (206.7±65.9 vs. 146.0±34.9 min, P =0.021) were significantly longer during the initial TORT procedure than during the completion TORT procedure. Two patients experienced transient hypoparathyroidism, which resolved within four weeks postoperatively. No other complications, such as vocal cord palsy, mental nerve injury, or bleeding, were observed. The median follow-up period was 21.5 months, and no recurrences were detected in any of the patients. CONCLUSIONS Our study demonstrates that re-do TORT is feasible, showing excellent cosmetic results and minimal adverse effects. Completion TORT may be considered a viable option for selected patients who require completion thyroidectomy after an initial TORT procedure.
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Affiliation(s)
- Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine
| | - Dawon Park
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Korea University Hospital
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Korea University Hospital
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Laxague F, Gualtieri T, Brahm G, Yoo J, MacNeil SD, Fung K, Mendez A, Sahovaler A, Nichols AC. Ultrasound-guided wire localisation: a GPS for hidden head and neck tumours? A case series. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:375-381. [PMID: 37519136 PMCID: PMC10773541 DOI: 10.14639/0392-100x-n2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/11/2023] [Indexed: 08/01/2023]
Abstract
Objectives Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complications. We describe five cases of pre-operative USGW localisation of non-palpable head and neck lesions to facilitate surgical localisation and resection. Methods All patients undergoing pre-operative USGW localisation for non-palpable tumours of the head and neck region at London Health and Sciences Center, London, Ontario, Canada, were included. All the USGW localisations were performed by the same interventional radiologist, and the surgeries were performed by fellowship trained head and neck surgeons. Results Five patients were included. All patients were undergoing revision surgery for recurrent or persistent disease. All successfully underwent a pre-operative USGW localisation of the non-palpable lesion before revision surgery. All lesions were localised intra-operatively with no peri-operative complications. Conclusions USGW localisation is a safe and effective pre-operative technique for the identification of small non-palpable head and neck tumours.
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Affiliation(s)
- Francisco Laxague
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Tommaso Gualtieri
- Department of Otorhinolaryngology - Head & Neck Surgery, “Nuovo Santo Stefano” Civil Hospital, Prato, PO, Italy
| | - Gary Brahm
- Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - S. Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Axel Sahovaler
- Department of Head & Neck Surgery, University College London Hospitals, London, United Kingdom
| | - Anthony C. Nichols
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Vaish R, Mahajan A, Sable N, Dusane R, Deshmukh A, Bal M, D’cruz AK. Role of computed tomography in the evaluation of regional metastasis in well-differentiated thyroid cancer. FRONTIERS IN RADIOLOGY 2023; 3:1243000. [PMID: 38022790 PMCID: PMC10643764 DOI: 10.3389/fradi.2023.1243000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023]
Abstract
Background Accurate neck staging is essential for performing appropriate surgery and avoiding undue morbidity in thyroid cancer. The modality of choice for evaluation is ultrasonography (US), which has limitations, particularly in the central compartment, that can be overcome by adding a computed tomography (CT). Methods A total of 314 nodal levels were analyzed in 43 patients with CT, and US; evaluations were done between January 2013 and November 2015. The images were reviewed by two radiologists independently who were blinded to histopathological outcomes. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of US, CT, and US + CT were calculated using histology as the gold standard. Results The overall sensitivity, specificity, PPV, and NPV for US, CT, and US + CT were 53.9%, 88.8%, 74.1%, and 76.4%; 81.2%, 68.0%, 60.1%, and 85.9%; and 84.6%, 66.0%, 59.6%, and 87.8%, respectively. The overall accuracy of the US was 75.80%, the CT scan was 72.93%, and the US + CT scan was 72.93%. For the lateral compartment, the sensitivity, specificity, PPV, and NPV for the US, CT, and US + CT were 56.6%, 91.4%, 77.1%, and 80.5%; 80.7%, 70.6%, 58.3%, and 87.8%; and 84.3%, 68.7%, 57.9%, and 89.6%, respectively. The accuracy of the US was 79.67%, the CT scan was 73.98%, and the US + CT scan was 73.98% for the lateral compartment. For the central compartment, the sensitivity, specificity, PPV, and NPV for the US, CT, and US + CT were 47.1%, 76.5%, 66.7%, and 59.1%; 82.4%, 55.9%, 65.1%, and 76.0%; and 85.3%, 52.9%, 64.4%, and 78.3%, respectively. The accuracy of the US was 61.76%, the CT scan was 69.12%, and the US + CT scan was 69.12% for the central compartment. Conclusions This study demonstrated that CT has higher sensitivity in detecting nodal metastasis; however, its role is complementary to US due to low specificity.
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Affiliation(s)
- Richa Vaish
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rohit Dusane
- Department of Statistics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anuja Deshmukh
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil K. D’cruz
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Zheng V, Rajeev R, Pinto D, de Jong MC, Sreenivasan DK, Parameswaran R. Variant anatomy of non-recurrent laryngeal nerve: when and how should it be taught in surgical residency? Langenbecks Arch Surg 2023; 408:185. [PMID: 37160507 DOI: 10.1007/s00423-023-02928-y] [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: 02/15/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION While the performance of a thyroidectomy is generally associated with a low risk of injury to the recurrent laryngeal nerve (RLN), the presence of a non-recurrent nerve (NRLN) increases the risk of this complication. Generally, the intraoperative detection via visual appreciation of variant anatomy of the RLN has been regarded as poor, possibly due to a lack of knowledge of both the normal and aberrant anatomy of the RLN. MATERIALS AND METHODS Articles for the review were searched through PubMed using the search terms and their combinations: "non-recurrent laryngeal nerve," "thyroidectomy," "injury," "palsy," "variant anatomy," and "residency," from January 1, 2000, to December 2022. Papers considered for the review were the articles published in English, with additional classic and articles of surgical importance retrieved from the reference list of papers. Only papers relevant to the scope of the review were considered for this review. FINDINGS The NRLN has been found to be associated with concurrent vascular abnormalities, such as the presence of an aberrant right subclavian artery (ARSA) or an arteria lusoria originating from the aortic arch. However, it seems that both the normal as well as aberrant anatomy of the RLN is currently not emphasized enough during postgraduate surgical training. With the increased use of intraoperative neuromonitoring (IONM), detection of NRLN has become possible through appropriate neural mapping during thyroid surgery, besides other pointers such as visualization during surgery, computerised tomography, and duplex ultrasound scans to visualize the variant vascular anatomy. There is also a possible role for cadaveric courses, either during medical school or in a post-graduate setting-adapted to the student's level to teach the variant anatomy. With the development of newer techniques such as artificial intelligence, there are potential new options for teaching and training anatomy in the near future. CONCLUSIONS AND RELEVANCE Adequate knowledge of the normal and aberrant anatomy of the RLN remains essential for the best outcomes in thyroid surgery, even in the era of the IONM. Moving forward, the knowledge of (aberrant) anatomy should be made an integral part of the core competencies of both medical students and surgical trainees. It is imperative that leaders of the different field work closely together to combine their knowledge towards providing their trainees with the best possible training options.
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Affiliation(s)
- Victoria Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Reshma Rajeev
- University of Buckingham Medical School, Buckingham, UK
| | - Diluka Pinto
- Division of Endocrine Surgery, National University Hospital, Lower Kent Ridge Road, Buckingham, Singapore
| | | | - Dinesh Kumar Sreenivasan
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rajeev Parameswaran
- Division of Endocrine Surgery, National University Hospital, Lower Kent Ridge Road, Buckingham, Singapore.
- Department of Surgery, Yong Loo Lin School of Medicine, Medical Drive, Singapore, Singapore.
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Healthcare Liability and Thyroidectomy: When Is the Surgeon Wrong? Healthcare (Basel) 2023; 11:healthcare11040577. [PMID: 36833111 PMCID: PMC9956906 DOI: 10.3390/healthcare11040577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Thyroid surgeries can often lead to operative complications, sometimes with consequences on the patient's health. This often leads to claims for compensation but the assessments of consultants and judges are not always objective. Based on these considerations, the authors analyzed forty-seven sentences issued between 2013 and 2022 regarding claims of alleged medical malpractice. This analysis aims to examine the cases presented in the sentences and the evaluations proposed by the judges to offer ideas for objective evaluation by the legislation in force in Italy.
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Barua SMB, Yadav SK, Aggarwal V, Mishra A, Mishra SK, Chand G, Agarwal G, Agarwal A. Safe and Standard Thyroid Cancer Surgery, or Lack Thereof: Patterns and Correlates of Patient Referral to Tertiary Care Centre for Revision Thyroid Surgery in a LMIC. South Asian J Cancer 2022; 11:152-155. [DOI: 10.1055/s-0041-1739177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background A surgeon's characteristics such as volume and practice setup are essential elements in outcome of thyroid cancer. However, little information is available from the developing world regarding qualities of primary surgeon, such as level of knowledge, skill, and proper documentation while referring to higher center.
Methods Records of 164 patients of differentiated thyroid cancer (DTC) from January 1990 to December 2018 undergoing revision thyroid surgery following primary surgery elsewhere were retrospectively analyzed.
Results Out of 164 patients with postoperative diagnosis of DTC, referral patterns were as follows: low volume (LV) to high volume (HV) (n = 120, 73.2%), followed by HV to HV (n = 44, 26.8%). The primary surgery assessed by the extent of residual disease was in agreement with the documentation in only 55%. The type of thyroidectomy performed was not mentioned in 9.8%. The status of the parathyroid glands was mentioned only in 15.8% and recurrent laryngeal nerve in 12.2%. Less than recommended surgery was performed in 52.5% patients. Despite less than recommended surgery, 44.5% patients were directly referred for radioactive iodine ablation (RAIA). Thirty two percent patients were referred for RAIA after hemithyroidectomy. Central or lateral compartment lymphadenectomy, even after indication, was less likely at LV centers (risk ratio [RR], 0.71; 95% confidence interval [CI], 0.64–0.77). Similarly, for DTC patients, the relationship between LV center surgery and subsequent referral for RAIA was RR, 0.71 (95% CI, 0.48–1.02).
Conclusions Most patients referred from LV surgeons are less likely to have proper thyroidectomy, have inadequate documentation of the primary surgery, and are referred for RAIA after less than total thyroidectomy. Our study highlights the lacunae in the approach to and understanding of thyroid cancer surgery by secondary care physicians in our country. We believe that there is an urgent necessity of educational reform and training to rectify this problem.
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Affiliation(s)
| | - Sanjay Kumar Yadav
- Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Vivek Aggarwal
- Department of Breast and Endocrine Surgery, Fortis Hospital, New Delhi, India
| | - Anjali Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Saroj Kanta Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gyan Chand
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gaurav Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Park JJ, Frank E, Simental AA, Park JS, Kim S, Imperio-Lagabon K, Van der Werf O. Outcomes of Early Versus Delayed Completion Thyroidectomy for Malignancy. Am Surg 2022:31348211067999. [DOI: 10.1177/00031348211067999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To determine whether time interval between hemi-thyroidectomy and subsequent completion thyroidectomy impacts outcomes. Methods Retrospective review of 68 patients having completion thyroidectomy from August 2012 to December 2019. Patients were separated into two groups based on the time interval between surgeries: early (≤10 days) or delayed (≥90 days). Results Patients who underwent delayed completion thyroidectomy (n = 17) had significantly higher rates of hypocalcemia and/or hypoparathyroidism ( P = .03) and higher rates of requiring postoperative hospitalization ( P=.07) compared to those who underwent early completion thyroidectomy (n = 51). Delayed completion had significantly lower risk of developing one or more of dysphonia, dysphagia, or vocal cord paresis postoperatively ( P=.02). No patients developed hematoma or wound infection. Conclusions Delayed completion thyroidectomy is associated with increased rates of hypocalcemia, but lower rates of dysphonia and dysphagia. Given the low risk of long-term complications in both groups, it may be beneficial to perform completion thyroidectomy early in order to expedite cancer treatment.
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Affiliation(s)
- Jaimie J. Park
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ethan Frank
- Department of Otolaryngology, Loma Linda University Health, Loma Linda, CA, USA
| | - Alfred A. Simental
- Department of Otolaryngology, Loma Linda University Health, Loma Linda, CA, USA
| | - Joshua S. Park
- Department of Otolaryngology, Loma Linda University Health, Loma Linda, CA, USA
| | - Stephanie Kim
- Loma Linda University School of Medicine, Loma Linda, CA, USA
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Xu Y, Huang K, Huang P, Ke N, Zeng J, Wang L, Liu C, Shi X, Guo F, Su L, Lin M, Li X, Xiao F. Benefits and harms of hemithyroidectomy, total or near-total thyroidectomy in 1-4 cm differentiated thyroid cancer. Clin Endocrinol (Oxf) 2021; 95:668-676. [PMID: 33948971 DOI: 10.1111/cen.14495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/18/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE For 1-4 cm differentiated thyroid cancer (DTC), current ATA guideline recommended hemithyroidectomy (HT) as an acceptable alternative initial procedure to total or near-total thyroidectomy (TT). The aim of this study was to evaluate benefits and harms of HT, TT in 1-4 cm DTC. DESIGN Retrospective cohort study. PATIENTS DTC patients aged 18 years or older who underwent initial thyroidectomy in a tertiary medical centre were included from January 2008 to July 2018. MEASUREMENTS The structural persistent/recurrent disease, reoperation rates and surgical complications were compared using Cox proportional regression and logistic regression. Propensity score matching was performed to adjust for related clinicopathological variables. RESULTS Among 1824 DTC patients, 795 patients sized 1-4 cm were included. A total of 286 patients underwent HT and 509 patients underwent TT. In the matched analysis, no significant difference in disease-free survival (DFS) between HT and TT was observed during the median follow-up period of 56.5 months (hazard ratio [HR] 0.86; 95% CI, 0.37-2.00; p = .733). The difference in DFS between two groups was consistent regardless of age, sex, tumour size, follow-up duration. Meanwhile, HT was associated with a decreased risk of surgical complications (odds ratio [OR] 0.47, 95% CI 0.31-0.71, p < .001), as well as lower proportion of levothyroxine replacement (p = .007). Two cases in HT group received reoperation. Further multivariate analysis showed surgical procedure was not associated with structural persistence/recurrence (HR 0.68; 95%CI, 0.29-1.58, p = .367). CONCLUSIONS For patients with 1-4 cm DTC without clinical evidence of lymph node metastasis or extrathyroidal extension, HT was associated with lower risk of surgical complications than TT while provided similar benefits as TT.
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Affiliation(s)
- Yang Xu
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Kunzhai Huang
- Department of General Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Peiyin Huang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
- Teaching Hospital of Fujian Medical University, Fuzhou, China
| | - Najun Ke
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jinyang Zeng
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Liying Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Changqin Liu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
- Teaching Hospital of Fujian Medical University, Fuzhou, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Xiulin Shi
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
- Teaching Hospital of Fujian Medical University, Fuzhou, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Fangting Guo
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Lijia Su
- School of Medicine, Xiamen University, Xiamen, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
| | - Fangsen Xiao
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
- Teaching Hospital of Fujian Medical University, Fuzhou, China
- School of Medicine, Xiamen University, Xiamen, China
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Barberio M, Collins T, Bencteux V, Nkusi R, Felli E, Viola MG, Marescaux J, Hostettler A, Diana M. Deep Learning Analysis of In Vivo Hyperspectral Images for Automated Intraoperative Nerve Detection. Diagnostics (Basel) 2021; 11:1508. [PMID: 34441442 PMCID: PMC8391550 DOI: 10.3390/diagnostics11081508] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
Nerves are critical structures that may be difficult to recognize during surgery. Inadvertent nerve injuries can have catastrophic consequences for the patient and lead to life-long pain and a reduced quality of life. Hyperspectral imaging (HSI) is a non-invasive technique combining photography with spectroscopy, allowing non-invasive intraoperative biological tissue property quantification. We show, for the first time, that HSI combined with deep learning allows nerves and other tissue types to be automatically recognized in in vivo hyperspectral images. An animal model was used, and eight anesthetized pigs underwent neck midline incisions, exposing several structures (nerve, artery, vein, muscle, fat, skin). State-of-the-art machine learning models were trained to recognize these tissue types in HSI data. The best model was a convolutional neural network (CNN), achieving an overall average sensitivity of 0.91 and a specificity of 1.0, validated with leave-one-patient-out cross-validation. For the nerve, the CNN achieved an average sensitivity of 0.76 and a specificity of 0.99. In conclusion, HSI combined with a CNN model is suitable for in vivo nerve recognition.
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Affiliation(s)
- Manuel Barberio
- Department of Research, Institute of Image-Guided Surgery, IHU-Strasbourg, 67091 Strasbourg, France; (V.B.); (E.F.)
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
- Department of Surgery, Ospedale Card. G. Panico, 73039 Tricase, Italy;
| | - Toby Collins
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
| | - Valentin Bencteux
- Department of Research, Institute of Image-Guided Surgery, IHU-Strasbourg, 67091 Strasbourg, France; (V.B.); (E.F.)
| | - Richard Nkusi
- Department of Research, Research Institute against Digestive Cancer, IRCAD Africa, Kigali 2 KN 30 ST, Rwanda;
| | - Eric Felli
- Department of Research, Institute of Image-Guided Surgery, IHU-Strasbourg, 67091 Strasbourg, France; (V.B.); (E.F.)
| | | | - Jacques Marescaux
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
| | - Alexandre Hostettler
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
| | - Michele Diana
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
- ICUBE Laboratory, Photonics Instrumentation for Health, 67412 Strasbourg, France
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Fanget F, Demarchi MS, Maillard L, El Boukili I, Gerard M, Decaussin M, Borson-Chazot F, Lifante JC. Hypoparathyroidism: Consequences, economic impact, and perspectives. A case series and systematic review. ANNALES D'ENDOCRINOLOGIE 2021; 82:572-581. [PMID: 34400129 DOI: 10.1016/j.ando.2021.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Postoperative hypoparathyroidism (PH) is the most common complication after total thyroidectomy. Incidence varies from 2% to 83%, depending on the definition. OBJECTIVE We performed a systematic review of the literature to determine the medico-economic effects of PH and update understanding of long-term consequences, morbidity, and quality of life related to hypoparathyroidism. METHODS We considered relevant articles published between 2000 and 2020 concerning long-term consequences of PH and quality of life. All studies concerning the medico-economic assessment of PH were included. We compared data from 2018 to results in the literature. RESULTS A proportion of 64/403 (16.8%) patients presented with transient PH during 2018, and 7/403 (1.7%) had permanent PH. Seven patients needed supplementation with alfacalcidol at 6-month follow-up. Factors predicting the need for alfacalcidol were age <45, thyroidectomy for goiter, and lymph node dissection. Additional therapy costs related to PH were €9781.10, and additional hospital costs were €230,400. We qualitatively synthesized 41 studies. Most were retrospective studies and only a few reported costs. No series assessed direct or indirect costs of postoperative PH. CONCLUSION To our knowledge, no previous studies reported the medico-economic impact of PH. Decreasing PH associated with fluorescence usage should be considered, particularly concerning cost-effectiveness.
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Affiliation(s)
- Florian Fanget
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Marco Stefano Demarchi
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4, rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland
| | - Laure Maillard
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Ilies El Boukili
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Maxime Gerard
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - M Decaussin
- Department of Pathology, Hospices Civils de Lyon, Lyon, France
| | - Francoise Borson-Chazot
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Department of Pathology, Hospices Civils de Lyon, Lyon, France; Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude-Bernard Lyon 1, Lyon, France; Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4, rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland
| | - Jean-Christophe Lifante
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude-Bernard Lyon 1, Lyon, France.
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11
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Yan L, Deng C, Song Q, Li N, Ren L, He H, Li W, Zhang M, Luo Y. Radiofrequency ablation versus reoperation for benign thyroid nodules that developed after previous thyroid surgery. Int J Hyperthermia 2021; 38:176-182. [PMID: 33573406 DOI: 10.1080/02656736.2021.1873429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of radiofrequency ablation (RFA) versus reoperation for benign thyroid nodules that developed after previous thyroid surgery. METHODS A total of 53 patients with 53 benign nodules developed after previous thyroid surgery were evaluated in this retrospective study. Eighteen patients were treated by RFA (RFA group) and 35 patients underwent reoperation (reoperation group). The efficacy, safety, thyroid function, blood loss, hospitalization, total treatment time, and cost were compared between the two groups. RESULTS In the RFA group, the mean volume decreased significantly from 12.78 ± 17.57 ml to 0.94 ± 1.01 ml (p = 0.043) with a volume reduction rate of 85.27 ± 14.35% and significant improvement in symptom and cosmetic scores (all p = 0.001). Therapeutic efficacy was achieved with a single session in all thyroid nodules. The total treatment time (6.12 ± 3.17 min vs. 110.26 ± 44.41 min, p < 0.001), blood loss (0 ml vs. 82.58 ± 105.55 ml, p < 0.001) and hospitalization(0 days vs. 9.66 ± 4.28 days, p < 0.001) were significantly lower in the RFA group than those in reoperation group, but the costs of treatment were similar(2262.12 ± 221.54 USD vs. 2638.04 ± 1062.90 USD, p = 0.081). The incidence of complications was significantly higher in the reoperation group than in the RFA group(31.43 vs. 0%, p < 0.001). Furthermorre, 65.17% of patients developed hypothyroidism after reoperation, whereas the thyroid function of the patients in the RFA group was unaffected. CONCLUSION For patients with benign thyroid nodules developed after previous thyroid surgery, RFA can be considered as a safe and effective alternative to reoperation with advantages of maintenance of intact thyroid function and low incidence of complications.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Cuiai Deng
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, Xinhui People's Hospital of Jiangmen City, Jiangmen, China
| | - Qing Song
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ling Ren
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - HongYing He
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wen Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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12
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Van Slycke S, Van Den Heede K, Bruggeman N, Vermeersch H, Brusselaers N. Risk factors for postoperative morbidity after thyroid surgery in a PROSPECTIVE cohort of 1500 patients. Int J Surg 2021; 88:105922. [PMID: 33774174 DOI: 10.1016/j.ijsu.2021.105922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/20/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding are the most frequent postoperative complications after thyroid surgery, and therefore often used as quality indicators of thyroid surgery. We aimed to assess postoperative morbidity in a high-volume endocrine surgery unit, and to detect which factors are associated with higher risks. METHODS Prospective surgical cohort in a high-volume tertiary referral centre for endocrine surgery in xxx. The first 1500 patients operated with hemi or total thyroidectomy during 2010-2019 were included. Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and peri-operative characteristics using multivariable logistic regression analyses, expressed as odds ratios and 95% confidence intervals. RESULTS Overall, 1043 patients (69.5%) received a total thyroidectomy and 457 (30.5%) a hemithyroidectomy. Permanent hypocalcaemia occurred in 3.1%, permanent recurrent laryngeal nerve palsy in 1.8% and surgical reintervention for bleeding in 2.6%. Younger age, female sex and cancer were risk factors for permanent hypocalcaemia. No clear risk factors could be identified for permanent nerve palsy. Female sex, high body mass index and heavier thyroids were protective against postoperative bleeding after total thyroidectomy. CONCLUSIONS Surgical experience in endocrine surgery seems beneficial for clinical outcomes and contributes to organizational efficiency. A low complication risk can be obtained by trained high-volume endocrine surgeons, yet the risk is not negligible.
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Affiliation(s)
- Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium; Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium; Department of Endocrine Surgery, Hammersmith, 72 Du Cane Road, W12 0HS, London, UK
| | - Niels Bruggeman
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Plastic and Reconstructive Surgery, Department of Human Structure and Repair, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Brusselaers
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Karolinska Hospital, Solnavägen 9, 17165, Stockholm, Sweden.
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Yan L, Zhang M, Xie F, Ma J, Xiao J, Luo Y. Efficacy and safety of radiofrequency ablation for benign thyroid nodules in patients with previous thyroid lobectomy. BMC Med Imaging 2021; 21:47. [PMID: 33706713 PMCID: PMC7948381 DOI: 10.1186/s12880-021-00577-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Radiofrequency ablation (RFA) is recommended for the treatment of benign thyroid nodules. However, data on the clinical role of RFA for benign thyroid nodules in patients with history of thyroid lobectomy are insufficient. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign thyroid nodules in patients who had previously undergoing thyroid lobectomy. Methods From May 2015 to October 2018, a total of 20 patients (19 females, 1 male, mean age 49.50 ± 14.26 years, range 22–74 years) with 20 benign thyroid nodules (mean volume 15.04 ± 21.17 ml, range 0.40–69.67 ml) who had undergone previous thyroid lobectomy were included in this retrospective study. Patients were followed up at 3, 6, 12 months after RFA and every 12 months thereafter by ultrasound, clinical evaluation and thyroid function. Volume, volume reduction rate (VRR), symptom score and cosmetic score were evaluated. Results During the mean follow-up time of 21.24 ± 16.41 months, the mean nodule volume decreased significantly from 15.04 ± 21.17 ml to 1.29 ± 1.17 ml (P = 0.018) with a mean VRR of 85.41 ± 12.17%. Therapeutic success was achieved in a single session for all thyroid nodules. The symptom score (P = 0.001) and cosmetic score (P = 0.001) were both significantly reduced at the last follow-up. The levels of free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone were not significantly different at the last follow-up from those prior to treatment (all P > 0.05). No life-threatening complications or sequelae occurred after RFA. Conclusions As a minimally invasive modality, RFA was a safe, effective, and thyroid function-preserving option for patients with symptomatic benign thyroid nodules after a previous lobectomy.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Fang Xie
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jun Ma
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
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14
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Van Slycke S, Van Den Heede K, Brusselaers N, Vermeersch H. Feasibility of Autofluorescence for Parathyroid Glands During Thyroid Surgery and the Risk of Hypocalcemia: First Results in Belgium and Review of the Literature. Surg Innov 2020; 28:409-418. [PMID: 33372584 DOI: 10.1177/1553350620980263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Post-operative hypocalcemia remains the most frequent complication after total thyroidectomy. Recently, autofluorescence imaging was introduced to detect parathyroid glands early during dissection. Aim. We aimed to check the feasibility of autofluorescence regarding the number of parathyroid glands visualised and the risk of post-operative hypocalcemia. Methods. In a prospectively gathered cohort of patients undergoing thyroid surgery, we describe the risk of hypocalcemia in relation to the number of parathyroid glands visualised during surgery (and the risk reported in the scientific literature) and the feasibility to obtain an autofluorescence of the parathyroid glands. Results. From 2010 to 2019, 1083 patients were referred for total thyroidectomy in our tertiary referral centre for endocrine surgery, of which, 40 consecutive cases were operated using autofluorescence. Among the autofluorescence group, 14 (35.0%) had all 4 parathyroid glands visualised, compared to 147 (14.1%) in the other patients, without differences in the number of parathyroid glands reimplanted. No permanent hypocalcemia occurred in the autofluorescence group and 17.5% temporary hypoparathyroidism, compared to 3.1% and 31.9% among the other patients, and 4% (95% confidence interval [CI] 3-5%) and 19% (95% CI 15-24%) in the literature. Conclusion. Autofluorescence imaging provides reliable real-time visualisation at any point during thyroid surgery and helps to identify the parathyroid glands before detection with the naked eye. To date, it cannot be used as a standard technique and does not replace meticulous dissection. To become a useful adjunct in peroperative parathyroid management, large multicentre studies need to establish a potential clinical benefit of this novel technique.
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Affiliation(s)
- Sam Van Slycke
- Department of General and Endocrine Surgery, 74840Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium.,Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Department of General Surgery, 81800AZ Damiaan, Gouwelozestraat, Ostend, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, 74840Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium.,Department of Endocrine Surgery, 129363Hammersmith Hospital, London, UK
| | - Nele Brusselaers
- Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, 27106Karolinska Institute, Stockholm, Sweden
| | - Hubert Vermeersch
- Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Plastic and Reconstructive Surgery, Department of Human Structure and Repair, 60200University Hospital Ghent, Ghent, Belgium
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15
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Otsuki N, Shimoda H, Morita N, Furukawa T, Teshima M, Shinomiya H, Nibu KI. Salvage surgery for structural local recurrence of papillary thyroid cancer: recurrence patterns and surgical outcome. Endocr J 2020; 67:949-956. [PMID: 32461508 DOI: 10.1507/endocrj.ej20-0152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To clarify the patterns of the recurrence and to assess the oncological and functional outcomes after salvage surgery for the patients with structural local recurrence of papillary thyroid cancer (PTC), twenty-five patients who underwent salvage surgery for structural local recurrence of PTC were retrospectively reviewed. Structural recurrences were observed in the tracheal lumen in 5 patients, intraluminal or intramuscular esophagus in 5 patients, trachea, and cricoid cartilage in 9 patients, cricoid and thyroid cartilage in 2 patients, intra-lumen of the larynx in 1 patient and soft tissue around thyroid in 3 patients, respectively. Although all local disease was resected with macroscopically negative margin, 10 patients diagnosed as microscopically positive margin. Major surgical complications occurred in 6 patients, including common carotid artery injury (n = 1), unintentional pharyngeal or esophageal injury (n = 2), recurrent laryngeal nerve paralysis (n = 2), and pharyngeal fistula resulting in common carotid artery rupture (n = 1), and were successfully managed. During the follow-up periods, 6 patients were alive without disease, 15 patients survived with distant metastases and/or locoregional recurrence, and 4 patients died of the disease. While tracheocutaneous fistula remained in 7 patients, the vocal function was preserved in all patients but one who underwent total laryngectomy. Normal oral intake was retained in all patients. In conclusion, although salvage surgery for structural recurrence of PTC has a high risk of complications, it may be worthwhile when macroscopic curative resection is available. The decision should be made considering various factors including curability, risk of surgical procedure, functional outcome, and life expectancy.
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Affiliation(s)
- Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
| | - Hikari Shimoda
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
| | - Naruhiko Morita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
| | - Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
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Delayed Hypoparathyroidism following Thyroidectomy, a Diagnostic Conundrum: A Report of Three Cases from Sri Lanka. Case Rep Endocrinol 2020; 2020:1735351. [PMID: 33014478 PMCID: PMC7519448 DOI: 10.1155/2020/1735351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Hypoparathyroidism, which is a common complication following total thyroidectomy can be transient in majority and permanent in 1.5% of the patients and usually occurs secondary to an inadvertent removal of parathyroid glands, mechanical or thermal injury or disruption of the vasculature. In some patients, it is observed that symptoms of hypocalcemia can occur for the first time several years after the surgery, which is known as “delayed hypoparathyroidism.” We report three cases of delayed hypoparathyroidism from Sri Lanka, presenting several years after total thyroidectomy. Case Presentation. Case 1- a 60-year-old Sri Lankan woman who presented with symptomatic hypocalcemia for the first time, 30 years after total thyroidectomy for follicular thyroid carcinoma. Case 2- a 53-year-old Sri Lankan woman presenting with neuropsychiatric manifestations of hypocalcemia for the first time, 12 years after total thyroidectomy for papillary thyroid carcinoma. Case 3- a 49-year-old Sri Lankan woman developing symptoms of hypocalcemia for the first time, 11 years after completion of thyroidectomy for papillary thyroid carcinoma. All these patients were detected to have low parathyroid hormone levels, without an alternative etiology for hypoparathyroidism, hence leading to a diagnosis of delayed post-thyroidectomy hypoparathyroidism. Conclusion Delayed hypoparathyroidism is a rare phenomenon, which is secondary to progressive atrophy of parathyroid glands and slowly progressive hypovascularization of parathyroids due to scar tissue retraction following thyroidectomy. The nonspecific nature of hypocalcemic symptoms and lack of continuous follow-up for a long time after thyroidectomy could contribute to a further delay in diagnosis. However, it is an important diagnosis to consider in any patient with a history of neck surgery presenting with hypocalcemia, irrespective of the time duration of surgery, as timely diagnosis and treatment can prevent long-term complications of hypocalcemia and improve the quality of life.
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Clinical Presentation, Treatment, and Outcome of Parathyroid Carcinoma: Results of the NEKAR Retrospective International Multicenter Study. Ann Surg 2020; 275:e479-e487. [PMID: 32649472 DOI: 10.1097/sla.0000000000004144] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this retrospective cohort study, we describe the clinical presentation and workup of parathyroid carcinoma (PC) and determine its clinical prognostic parameters. Primary outcome was recurrence free survival. SUMMARY BACKGROUND DATA PC is an orphan malignancy for which diagnostic workup and treatment is not established. METHODS Eighty-three patients were diagnosed with PC between 1986 and 2018. Disease-specific and recurrence-free survivals were estimated with the Kaplan-Meier method. Risk factors for recurrence were identified by binary logistic regression with adjustment for age and sex. Thirty-nine tumors underwent central histopathological review. RESULTS Renal (39.8%), gastrointestinal (24.1%), bone (22.9%), and psychiatric (19.3%) symptoms were the most common symptoms. Surgical treatment was heterogeneous [parathyroidectomy [PTx)] alone: 22.9%; PTx and hemithyroidectomy: 24.1%; en bloc resection 15.7%; others 37.3%] and complications of surgery were frequent (recurrent laryngeal nerve palsy 25.3%; hypoparathyroidism 6%). Recurrence of PC was observed in 32 of 83 cases. In univariate analysis, rate of recurrence was reduced when extended initial surgery had been performed (P = 0.04). In multivariate analysis low T status [odds ratio (OR) = 2.65, 95% confidence interval (CI) 1.02-6.88, P = 0.045], N0 stage at initial diagnosis (OR = 6.32, 95% CI 1.33-30.01, P = 0.02), Ki-67 <10% (OR = 14.07, 95% CI 2.09-94.9, P = 0.007), and postoperative biochemical remission (OR = 0.023, 95% CI 0.001-0.52, P = 0.018) were beneficial prognostic parameters for recurrence-free survival. CONCLUSION Despite a favorable overall prognosis, PC shows high rates of recurrence leading to repeated surgery and postoperative recurrent laryngeal nerve palsy and hypoparathyroidism. In view of the reduced recurrence rate in cases of extended surgery, ipsilateral completion surgery may be considered when PC is confirmed.
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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A rare case of spondyloarthropathy: Iatrogenic hypoparathyroidism. Turk J Phys Med Rehabil 2020; 66:92-95. [PMID: 32318681 DOI: 10.5606/tftrd.2020.2944] [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: 03/28/2018] [Accepted: 10/12/2018] [Indexed: 11/21/2022] Open
Abstract
Hypoparathyroidism is an endocrinopathy that can develop idiopathically, as well as due to reasons associated with genetics, autoimmunity, surgery and radiotherapy. It usually presents with neuromuscular signs and symptoms, including enthesopathy caused by calcification of the ligament and enthesis sites, soft tissue calcification, hypertension, cataract and extrapyramidal findings due to basal ganglia calcification. Hypoparathyroidism-associated spondyloarthropathy (SpA) is a rarely seen clinical entity. Hypoparathyroidism-associated SpA differs from other inflammatory SpAs in that the results for human leukocyte antigen B27 and inflammatory markers are negative and bone density is normal. The symptoms are relieved by calcium and vitamin D, rather than anti-inflammatory drugs. Due to this difference in treatment modalities, the diagnosis of this type of SpA is important. This article presents the case report of a 52-year-old female patient with iatrogenic hypoparathyroidism accompanied by asymptomatic hypocalcemia and SpA clinic.
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Ponce de León-Ballesteros G, Velázquez-Fernández D, Hernández-Calderón FJ, Bonilla-Ramírez C, Pérez-Soto RH, Pantoja JP, Sierra M, Herrera MF. Hypoparathyroidism After Total Thyroidectomy: Importance of the Intraoperative Management of the Parathyroid Glands. World J Surg 2019; 43:1728-1735. [PMID: 30919027 DOI: 10.1007/s00268-019-04987-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Total thyroidectomy is the most common surgical procedure for the treatment of thyroid diseases. Postoperative hypocalcemia/hypoparathyroidism is the most frequent complication after total thyroidectomy. The aim of this study was to evaluate the rate of postoperative hypocalcemia and permanent hypoparathyroidism after total thyroidectomy in order to identify potential risk factors and to evaluate the impact of parathyroid autotransplantation. PATIENTS AND METHODS We performed a retrospective analysis of 1018 patients who underwent total thyroidectomy at our institution between 2000 and 2016. Medical records were reviewed to analyze patient features, clinical presentation, management and postoperative complications. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Statistical significance was set at p ≤ 0.05. RESULTS Mean ± SD age was 46.79 ± 15.9 years; 112 (11.7%) were males and 844 (88.3%) females. A total of 642 (67.2%) patients underwent surgery for malignant disease. The rate of postoperative hypocalcemia, transient, protracted and permanent hypoparathyroidism was 32.8%, 14.43%, 18.4% and 3.9%, respectively. Permanent hypoparathyroidism was significantly associated with the number of parathyroid glands remaining in situ (4 glands: 2.5%, 3 glands: 3.8%, 1-2 glands: 13.3%; p ˂ 0.0001) [OR for 1-2 glands in situ = 5.32, CI 95% 2.61-10.82]. Other risk factors related to permanent hypoparathyroidism were obesity (OR 3.56, CI 95% 1.79-7.07), concomitant level VI lymph node dissection (OR 3.04, CI 95% 1.46-6.37) and incidental parathyroidectomy without autotransplantation (OR 3.6, CI 95% 1.85-7.02). CONCLUSIONS Identification and in situ preservation of at least three parathyroid glands were associated with a lower rate of postoperative hypocalcemia (30.4%) and permanent postoperative hypoparathyroidism (2.79%).
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Affiliation(s)
- Guillermo Ponce de León-Ballesteros
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - David Velázquez-Fernández
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - F Javier Hernández-Calderón
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Carlos Bonilla-Ramírez
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Rafael H Pérez-Soto
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Juan Pablo Pantoja
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Mauricio Sierra
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Miguel F Herrera
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico.
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Baerbock N, Mittelstädt A, Jähne J. Morbidity and long-term survival in patients with cervical re-exploration for papillary thyroid carcinoma. Innov Surg Sci 2019; 4:91-99. [PMID: 31709300 PMCID: PMC6817731 DOI: 10.1515/iss-2018-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/05/2019] [Indexed: 01/15/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) has a favorable prognosis following one-stage surgical therapy, whereas two-stage resections bear the risk of increased morbidity and possibly impaired prognosis. To further elucidate the value of surgical re-exploration in PTC, a retrospective study was performed. Methods The study involved 187 patients with PTC who underwent total thyroidectomy with central lymph node dissection between 2001 and 2011. The number of two-stage surgeries, the rates of recurrent laryngeal nerve paralysis (RLNP) as well as hypocalcemia, and the long-term survival were assessed. Results Two-stage surgeries were performed in 43%. No statistically significant difference was seen between the one- and two-stage resection groups regarding the rate of RLNP (transient 5.6% vs. 6.3%, permanent 2.6% vs. 0%) nor for hypocalcemia (transient 25.2% vs. 18.8%, permanent 14.0% vs. 22.5%). The 10-year recurrence-free survival was 95.5% and the 10-year disease-specific survival was 98.9% with no difference between groups. Conclusion Even though two-stage surgeries do not lead to a higher incidence of RLNP and hypocalcemia, optimal preoperative and intraoperative diagnostics have to be carried out to reduce the amount of completion surgeries.
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Affiliation(s)
- Nenia Baerbock
- Clinic of Anaesthesiology and Intensive Care, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Anke Mittelstädt
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Hannover, Germany
| | - Joachim Jähne
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Hannover, Germany
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Aygun N, Uludag M, Ozel A. The Clinical Importance of Tumor Thrombus in Internal Jugular Vein Related to Papillary Thyroid Cancer. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: We aimed to present a case with a previous thyroid surgery, who developed an internal jugular vein thrombus due to papillary thyroid cancer (PTC) in the remnant tissue.
Case: A 54-year-old female patient, with a previous subtotal thyroidectomy, presented with a mass on the left side of her neck. Thyroid ultrasound disclosed a heterogeneous nodule of 67x48x32 mm in the left thyroid lobe. An isoechoic tumor thrombus was observed extending intraluminally from the middle thyroid vein to the internal jugular vein. No lymph node or solid organ invasion were detected in the neck. Fine needle aspiration biopsy revealed cytological findings consistent with PTC. Total thyroidectomy, left sided central neck dissection and partial left jugular vein resection was performed. The pathologic examination revealed mid-differentiated unifocal encapsulated follicular variant of PTC. The whole-body scan performed after the postoperative treatment of 150 mCi of radioactive iodine, revealed multiple lung metastases.
Conclusion: The presence of a tumor thrombus in the thyroid vein or internal jugular vein is strongly suspicious for malignancy even in the absence of malignant findings on cytology. It is an important finding that is highly suspicious for distant metastasis in the cytologically diagnosed patients.
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Fan C, Zhou X, Su G, Zhou Y, Su J, Luo M, Li H. Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta-analysis. BMC Surg 2019; 19:98. [PMID: 31340806 PMCID: PMC6657038 DOI: 10.1186/s12893-019-0559-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 07/09/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to determine the risk factors associated with neck hematoma requiring surgical re-intervention after thyroidectomy. METHODS We systematically searched all articles available in the literature published in PubMed and CNKI databases through May 30, 2017. The quality of these articles was assessed using the Newcastle-Ottawa Quality Assessment Scale, and data were extracted for classification and analysis by focusing on articles related with neck hematoma requiring surgical re-intervention after thyroidectomy. Our meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. RESULTS Of the 1028 screened articles, 26 met the inclusion criteria and were finally analyzed. The factors associated with a high risk of neck hematoma requiring surgical re-intervention after thyroidectomy included male gender (odds ratio [OR]: 1.86, 95% confidence interval [CI]: 1.60-2.17, P < 0.00001), age (MD: 4.92, 95% CI: 4.28-5.56, P < 0.00001), Graves disease (OR: 1.81, 95% CI: 1.60-2.05, P < 0.00001), hypertension (OR: 2.27, 95% CI: 1.43-3.60, P = 0.0005), antithrombotic drug use (OR: 1.92, 95% CI: 1.51-2.44, P < 0.00001), thyroid procedure in low-volume hospitals (OR: 1.32, 95% CI: 1.12-1.57, P = 0.001), prior thyroid surgery (OR: 1.93, 95% CI: 1.11-3.37, P = 0.02), bilateral thyroidectomy (OR: 1.19, 95% CI: 1.09-1.30, P < 0.0001), and neck dissection (OR: 1.55, 95% CI: 1.23-1.94, P = 0.0002). Smoking status (OR: 1.19, 95% CI: 0.99-1.42, P = 0.06), malignant tumors (OR: 1.00, 95% CI: 0.83-1.20, P = 0.97), and drainage used (OR: 2.02, 95% CI: 0.69-5.89, P = 0.20) were not significantly associated with postoperative neck hematoma. CONCLUSION We identified certain risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy, including male gender, age, Graves disease, hypertension, antithrombotic agent use, history of thyroid procedures in low-volume hospitals, previous thyroid surgery, bilateral thyroidectomy, and neck dissection. Appropriate intervention measures based on these risk factors may reduce the incidence of postoperative hematoma and yield greater benefits for the patients.
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Affiliation(s)
- Chunlei Fan
- Department of Gastrointestinal Surgery III, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Xin Zhou
- Department of Gastrointestinal Surgery III, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Guoqiang Su
- Department of Gastrointestinal Surgery III, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China.
| | - Yanming Zhou
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jingjun Su
- Department of Ultrasound, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China.
| | - Mingxu Luo
- Department of Gastrointestinal Surgery III, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Hui Li
- Department of Hepatic Surgery and Liver transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Reiter R, Heyduck A, Hoffmann TK, Brosch S, Buchberger MA, Schorer K, Weber T, Pickhard A. Quality of Voice and Prognostic Markers for the Recovery of Vocal Fold Paralysis After Thyroid Surgery. Ann Otol Rhinol Laryngol 2019; 128:1104-1110. [DOI: 10.1177/0003489419858629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This study is set to analyze clinicopathological factors predicting the recovery of unilateral vocal fold paralysis (UVP) in patients after thyroid gland surgery. The quality of voice was additionally assessed in these patients. Methods: The charts and videolaryngostroboscopy (VLS) examinations of 84 consecutive patients with a complete UVP after surgery of the thyroid gland were retrospectively reviewed. Patients were divided into 2 groups: patients who fully recovered from vocal fold paralysis and those who failed to recover after a follow-up of 12 months. The quality of voice was analyzed among other things by determining the Voice Handicap Index (VHI). Results: The UVP fully recovered in 52 of 84 (61.9%) patients. Positive mucosal waves (pMWs) on the paralyzed side, a minimal glottic gap <3 mm seen at the first postoperative VLS, age ≤50 years, and surgery duration ≤120 minutes were associated factors for a complete recovery of nerve function. The voice parameters improved independently from recovery of the paralysis in 90% of the patients. Conclusions: For patients with a poor prognosis of a UVP, early intervention may be beneficial. Thus, predicting factors for a full recovery of vocal fold motion would be a valuable tool. In our cohort, about 60% of recoveries could have been predicted using the above-mentioned parameters. Good quality of voice was independently reached in 90% of the cases.
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Affiliation(s)
- Rudolf Reiter
- Ulm University Medical Center, Universitatsklinikum Ulm, Germany
| | | | | | - Sibylle Brosch
- Ulm University Medical Center, Universitatsklinikum Ulm, Germany
| | - Maria Anna Buchberger
- Department of Otolaryngology Head and Neck Surgery, Technical University, Munich, Germany
| | - Katharina Schorer
- Section of Phoniatrics and Pedaudiology, Department of Otolaryngology, Head and Neck Surgery, University of Ulm, Frauensteige12, Ulm, Germany
| | - Theresa Weber
- Department of Endocrine Surgery, Katholisches Klinikum Mainz, Mainz, Germany
| | - Anja Pickhard
- Department of Otolaryngology Head and Neck Surgery, Technical University, Munich, Germany
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Ferraro V, Sgaramella LI, Di Meo G, Prete FP, Logoluso F, Minerva F, Noviello M, Renzulli G, Gurrado A, Testini M. Current concepts in parathyroid carcinoma: a single Centre experience. BMC Endocr Disord 2019; 19:46. [PMID: 31142320 PMCID: PMC6541564 DOI: 10.1186/s12902-019-0368-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parathyroid carcinoma is a rare neoplasm that may present sporadically or in the context of a genetic syndrome. Diagnosis and management are challenging due to the lack of clinical and pathological features that may reliably distinguish malignant from benign disease. METHODS From January 2013 to December 2017, from 358 consecutive patients affected by parathyroid diseases, 3 patients with parathyroid carcinoma were treated at our academic Department of General Surgery. We present our experience as illustrative of the different features of clinical presentation of parathyroid carcinoma and review its management considering the recent relevant literature. RESULTS Case 1: A 62-year-old man was hospitalized for left-sided palpable neck mass, hypercalcemia and elevated PTH. US-guided FNA was suspect for parathyroid carcinoma. A large cystic mass was excised in bloc with total thyroidectomy and central neck dissection. Genetic studies framed a pathologically confirmed parathyroid carcinoma within MEN1 syndrome. Case 2: A 48-year-old woman with hypothyroidism had total thyroidectomy performed for a suspect for right follicular thyroid lesion. Pathology revealed parathyroid carcinoma. Case 3: A 47 year-old man was admitted for hypercalcaemic crisis and renal failure in the context of PHPT. A lesion suggestive on US and MIBI scan for parathyroid adenoma in the right lower position was removed by mini-invasive approach. Pathology revealed parathyroid cancer and patient had completion hemythyroidectomy and central neck dissection. CONCLUSION Parathyroid cancer is a particularly rare endocrine malignancy, however it should be suspected in patients with primary hyperparathyroidism when severe hypercalcemia is associated to cervical mass, renal and skeletal disease. Parathyroid surgery remains the mainstay of treatment. Radical tumour resection and expedited treatment in a dedicated endocrine Center represent crucial prognostic factors.
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Affiliation(s)
- Valentina Ferraro
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Lucia Ilaria Sgaramella
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Giovanna Di Meo
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Francesco Paolo Prete
- Department of Emergency and Organ Transplant, University Medical School of Bari, Bari, Italy
| | - Francesco Logoluso
- Department of Emergency and Organ Transplant, University Medical School of Bari, Bari, Italy
| | - Francesco Minerva
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Marica Noviello
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Giuseppina Renzulli
- Interdisciplinary Department of Medicine, University Medical School of Bari, Bari, Italy
| | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology – Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy
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Medas F, Tuveri M, Canu GL, Erdas E, Calò PG. Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases. Updates Surg 2019; 71:705-710. [PMID: 30937820 DOI: 10.1007/s13304-019-00647-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
Abstract
Reoperative thyroid surgery is an uncommon procedure that is indicated in recurrent benign or malignant disease. It is associated with a high complication rate, especially of hypoparathyroidism and recurrent nerve palsy. We retrospectively reviewed our series of patients on whom reoperative thyroid surgery was performed and we compared this group with patients who underwent primary thyroidectomies. From 2002 to 2015, 4572 thyroidectomies were performed at our institution; among these, 152 (3.3%) were for benign or malignant recurrent disease. We observed a higher rate of transient hypoparathyroidism in secondary vs primary surgery (56.6% vs 25.9%; p < 0.0001), of permanent hypoparathyroidism (10% vs 2.0%; p < 0.0001) and of transient recurrent nerve injury (4.6% vs 1.4%; p < 0.05). Reoperative thyroid surgery is a technical challenge with a high incidence of complications. Scarring, edema, and friability of the tissues together with distortion of the landmarks make reoperative surgery hazardous. Careful assessment of patient's risk factors, physical examination, and if necessary fine needle aspiration cytology are crucial for selecting the patients who should undergo reoperation. Research registry n. 2617 registered 5 June 2017 (retrospectively registered).
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Massimiliano Tuveri
- Istituto Pancreas, Policlinico Borgo Roma, AOUI Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Ernico Erdas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
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Completion Thyroidectomy in Patients Diagnosed with Papillary Thyroid Cancer: Is There a Predictive Factor for Contralateral Lobe Tumor? MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:262-267. [PMID: 32774088 PMCID: PMC7406558 DOI: 10.14744/semb.2018.83713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/05/2018] [Indexed: 11/20/2022]
Abstract
Objectives: Completion thyroidectomy (CT) is defined as the removal of the residual thyroid tissue in the case of detected malignancy after lobectomy for an indeterminate or non-diagnostic biopsy. Factors such as tumor diameter, aggressive histology, extrathyroidal spread, and positive surgical margin in papillary thyroid cancer (PTC) constitute CT indications. However, the type of surgery is controversial especially in patients with a tumor diameter of 1-4 cm. Determination of predictive factors for contralateral lobe tumors (CLTs) in PTC may be helpful for rough or excessive treatment of patients with this common thyroid pathology. The aim of the present study was to determine the predictive factors and rate of detection of CLTs after CT in patients with papillary thyroid carcinoma after lobectomy. Methods: Medical records of patients who underwent lobectomy with the final histological diagnosis of papillary thyroid carcinoma for the study period 2011 to 2016 were reviewed. Demographic data of the patients, diameter, multicentricity and subtype of tumor, extrathyroidal spread, and vascular invasion rate were obtained. Patients were divided into 2 groups as final histological examination after CT revealed benign (Group 1) and malignant (Group 2). Results: Data of 49 patients were retrospectively analyzed during the study period. The female-to-male ratio was 33/16. The mean age of the patients was 47.59 (23–77) years. Groups 1 and 2 consisted of 30 and 19 patients, respectively. No significant difference was found between the two groups regarding demographic data and tumor characteristics. Conclusion: Despite the fact that we have not been detecting any predictive factor in predicting the presence of tumor on the contralateral lobe in our study, the detection of a tumor on the contralateral lobe is frequent.
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Bin Saleem R, Bin Saleem M, Bin Saleem N. Impact of completion thyroidectomy timing on post-operative complications: a systematic review and meta-analysis. Gland Surg 2018; 7:458-465. [PMID: 30505767 DOI: 10.21037/gs.2018.09.03] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Despite a number of studies, the optimal timing of completion thyroidectomy is still controversial. This systematic review and meta-analysis aims to compare the outcomes of early versus delayed completion thyroidectomy regarding post-operative complications. Methods We performed a systematic review in electronic databases including: bumped, Scopus, Medline and Google Scholar to identify relevant studies. Eligibility criteria included studies comparing the outcomes of early versus delayed completion thyroidectomy with no language restriction. Publication bias was assessed by funnel plot, and Heterogeneity was assessed using I2 statistic. Finally, pooled odds ratios (OR) with a 95% confidence interval (CI) was reported for comparing the overall complications rate. Results Eventually 7 studies were included. Delayed completion thyroidectomy was found to be associated with significantly lower rates of post-operative complications (OR =1.55; 95% CI, 1.00-2.42; Z=1.95; P=0.05) with low heterogeneity (I2=0%, P=0.55), and low risk of publication bias. The rate of transient hypocalcemia and persistent hypocalcemia were 8.97% and 1.52% in early completion thyroidectomy group, and 8.2% and 0.72%, in delayed completion thyroidectomy group. Transient vocal cord paresis occurred in 5.38% of the early CT group versus 3.27% in the delayed CT group. Conclusions This review is the first to summarize the outcome of early verse delayed completion thyroidectomy. The result of our systematic review and meta-analysis suggest that delayed completion thyroidectomy is associated with lower rate of post-operative complications compared to early completion thyroidectomy.
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Affiliation(s)
- Reem Bin Saleem
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Moneera Bin Saleem
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Nada Bin Saleem
- Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
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Wang B, Su AP, Xing TF, Luo H, Zhao WJ, Zhu JQ. The function of carbon nanoparticles to improve lymph node dissection and identification of parathyroid glands during thyroid reoperation for carcinoma. Medicine (Baltimore) 2018; 97:e11778. [PMID: 30095634 PMCID: PMC6133593 DOI: 10.1097/md.0000000000011778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To evaluate the function of carbon nanoparticles during the thyroid reoperation for carcinoma, we conducted this study by retrospectively analyzing the data of patients who underwent at least completion thyroidectomy with bilateral central lymph nodes dissection for thyroid carcinoma from January 2009 to June 2016. The clinicopathologic characteristics and surgical details were compared between the patient who accepted intraoperative carbon nanoparticles injection and those who accepted nothing injection during the surgery. The main monitoring indicators were the number of dissected lymph nodes and metastatic lymph nodes in central zone, the number of identified parathyroid glands and autoplastic parathyroid glands and unintentionally resected parathyroid glands. A total of 69 patients were enrolled into the carbon nanoparticles group and 128 patients were enrolled into the control group.The average number of lymph nodes harvested in the central zone was higher in the carbon nanoparticles group than that in the control group (11.2 ± 5.7 vs 7.7 ± 4.0, P < .001), so was the average number of metastatic lymph nodes (4.5 ± 4.5 vs 2.7 ± 2.9, P = .004). The average number of identified parathyroid gland was greater in the carbon nanoparticles group than that in the control group (2.4 ± 1.2 vs 1.6 ± 1.1, P < .001). The average number of autoplastic parathyroid gland was comparable between the 2 groups (0.6 ± 0.6 vs 0.4 ± 0.7, P = .052). But the average number of unintentionally resected parathyroid gland was less in the carbon nanoparticles group than that in the control group (0.1 ± 0.2 vs 0.2 ± 0.4, P = .007). Carbon nanoparticles can improve lymph nodes dissection and identification of parathyroid gland during thyroid reoperation for carcinoma.
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Affiliation(s)
- Bin Wang
- Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu Department of Thyroid and Breast Surgery, Dazhou Central Hospital, Dazhou, Sichuan Province, China
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30
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The Prevalence of Incidental Thyroid Carcinoma in Patients Who Underwent Thyroidectomy for Multinodular Goiter. Indian J Surg 2018. [DOI: 10.1007/s12262-017-1611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Gulcelik MA, Dogan L, Akgul GG, Güven EH, Ersöz Gulcelik N. Completion Thyroidectomy: Safer than Thought. Oncol Res Treat 2018; 41:386-390. [PMID: 29734197 DOI: 10.1159/000487083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 01/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to find out whether a substantial difference in terms of complication rates exists between primary and completion thyroidectomies following initial bilateral subtotal thyroidectomy in the light of current literature and our series. PATIENTS AND METHODS Total number of 696 patients who received completion thyroidectomy (Group 1, n = 289) and total thyroidectomy for differentiated thyroid cancer (Group 2, n = 407) and their data were reviewed and postoperative complications were compared between the groups and with the literature. RESULTS Transient and permanent hypocalcaemia rates were 20% and 5.8% in Group 1 and 10.5% and 5.1% for Group 2 respectively. Unilateral transient, bilateral transient and unilateral permanent recurrent laryngeal nerve palsy rates were 6.2%, 1.3% and 4.4% for patients in Group 1 whereas same complications were seen in 4.6%, 0.7% and 3.6% of patients in Group 2. When groups were compared for complications; temporary hypocalcaemia, unilateral temporary nerve palsy, and minor wound infection rates were statistically higher in Group 1, with no significant difference in permanent complications. CONCLUSION When complication rates of re-operation after bilateral subtotal thyroidectomy and primary total thyroidectomy for differentiated thyroid cancer were compared in an unbiased fashion, completion thyroidectomy was shown to be as safe as a primary operation with regard to permanent complications.
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Wojtczak B, Sutkowski K, Kaliszewski K, Barczyński M, Bolanowski M. Thyroid reoperation using intraoperative neuromonitoring. Endocrine 2017; 58:458-466. [PMID: 29052179 PMCID: PMC5693961 DOI: 10.1007/s12020-017-1443-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/25/2017] [Indexed: 12/03/2022]
Abstract
PURPOSE Thyroid reoperations are at a high risk of recurrent laryngeal nerve (RLN) injury. The aim of the study was to investigate whether the use of intraoperative neuromonitoring (IONM) can aid in the RLN identification and minimize the risk of its injury, in comparison with visual RLN identification. METHODS This was a retrospective cohort study of patients who underwent thyroid reoperations with and without the use of IONM. Primary endpoint was the RLN identification rate; secondary: the prevalence of RLN injury, the frequency of total thyroidectomies, and the course of the RLN. RESULTS The study involved 61 patients undergoing thyroid reoperation among whom 24 were operated on with visual RLN identification only, while 37 procedures used IONM. In the non-monitored reoperations, 44.4% of the RLN were visually identified, as opposed to 91.6% in the IONM group (p < 0.001). Transient paresis occurred in three nerves with visualization (6.6%), and in one in IONM group 1.6% (p = 0.185). Permanent paresis occurred in the group with visualization (6.6%), as opposed to none with neuromonitoring. The extent of resection in both groups was significantly different (p = 0.043). Total, near-total thyroidectomies, Dunhill operations and subtotal thyroidectomies were performed in 71, 17, 4, and 8% in the visualization group, and in 94, 0, 3, and 3%, respectively, in the IONM group. A non-anatomical RLN course was observed in 80% of the reoperations with IONM. CONCLUSIONS Thyroid reoperation should be performed using IONM, because it allows for a significantly improved RLN identification rate and a significantly more radical resection.
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Affiliation(s)
- Beata Wojtczak
- Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.
| | - Krzysztof Sutkowski
- Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kaliszewski
- Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
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Su AP, Wang B, Gong YP, Wu WS, Gong RX, Li ZH, Zhu JQ. Carbon nanoparticles facilitate lymph nodes dissection and parathyroid glands identification in reoperation of papillary thyroid cancer. Medicine (Baltimore) 2017; 96:e8380. [PMID: 29095266 PMCID: PMC5682785 DOI: 10.1097/md.0000000000008380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to investigate whether carbon nanoparticles (CNs) can improve the dissection of lymph nodes and protect parathyroid glands (PGs) during reoperation for patients with papillary thyroid carcinoma (PTC).PTC patients who previously underwent thyroidectomy and later received reoperation between January 2009 and January 2016 were retrospectively recruited. We compared the patients who had CN suspension injected into the residual thyroid gland with a control group of patients who did not have the injection. The primary endpoints were the number of lymph nodes dissected, the number of PGs identified and reimplanted, and the rate of postoperative hypoparathyroidism.CN suspension injection was conducted in 55 of 174 patients. The total number of lymph nodes and metastatic lymph nodes dissected between the 2 groups were not different (22.8 ± 13.7 vs 21.0 ± 13.3, P = .481 and 5.5 ± 3.8 vs 4.8 ± 4.0, P = .695). The number of central lymph nodes and metastatic central lymph nodes in the CN group was significantly higher than those dissected in the control group (8.7 ± 6.9 vs 6.2 ± 5.2, P = .037 and 2.7 ± 1.9 vs 2.1 ± 1.6, P = .012). More PGs were identified (2.42 ± 1.15 vs 1.58 ± 1.12, P = .001) and fewer were reimplanted (48 vs 90, P = .040) in the CN group. Patients who had CN suspension injection had a lower rate of transient hypoparathyroidism (14/55 vs 50/119, P = .043) but no significant difference in the rate of permanent hypoparathyroidism (1/55 vs 9/119, P = .173).CN suspension injection improves dissection of central lymph nodes and identification of PG in PTC patients undergoing reoperation and lowers the rate of postoperative transient hypoparathyroidism.
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Vamvakidis K, Rellos K, Tsourma M, Christoforides C, Anastasiou E, Zorbas KA, Arambatzi A, Falagas ME. Antibiotic prophylaxis for clean neck surgery. Ann R Coll Surg Engl 2017; 99:410-412. [PMID: 28462662 DOI: 10.1308/rcsann.2017.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The frequency of surgical site infections (SSIs) after clean neck surgery is low and antibiotic prophylaxis is not recommended. This retrospective study investigated the effect of perioperative prophylactic antimicrobial therapy on the development of infections. A total of 807 consecutive patients undergoing clean neck surgery were included in the study. Antimicrobial prophylaxis with intravenous cefuroxime was administered in 518 cases. Although patients who received prophylaxis had a lower rate of SSIs than those who did not receive antibiotics, this was not statistically significant (0.4% vs 1.4% respectively, p=0.19). Older age was the only variable associated with the development of SSIs (p=0.014).
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Affiliation(s)
- K Vamvakidis
- Department of Endocrine Surgery, Central Clinic, Athens, Greece
| | - K Rellos
- Department of Endocrine Surgery, Central Clinic, Athens, Greece.,Alfa Institute of Biomedical Sciences, Athens, Greece
| | - M Tsourma
- National Technical University of Athens, Greece
| | | | - E Anastasiou
- Department of Endocrine Surgery, Central Clinic, Athens, Greece
| | - K A Zorbas
- Department of Endocrine Surgery, Central Clinic, Athens, Greece
| | - A Arambatzi
- Department of Endocrine Surgery, Central Clinic, Athens, Greece
| | - M E Falagas
- Alfa Institute of Biomedical Sciences, Athens, Greece.,Department of Internal Medicine and Infectious Diseases, Iaso General Hospital, Iaso Group, Athens, Greece.,Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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Liu J, Sun W, Dong W, Wang Z, Zhang P, Zhang T, Zhang H. Risk factors for post-thyroidectomy haemorrhage: a meta-analysis. Eur J Endocrinol 2017; 176:591-602. [PMID: 28179452 DOI: 10.1530/eje-16-0757] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/05/2017] [Accepted: 02/07/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Post-thyroidectomy haemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. In this study, we analysed the potential risk factors for the occurrence of post-thyroidectomy haemorrhage. METHODS The PubMed and SCIE databases were comprehensively searched for studies published before June 30, 2016. Studies on patients who underwent an open thyroidectomy with or without neck dissection were included, and RevMan 5.3 software was used to analyse the data. RESULTS Twenty-five studies and 424 563 patients were included in this meta-analysis, and post-thyroidectomy haemorrhage occurred in 6277 patients (incidence rate = 1.48%). The following variables were associated with an increased risk of post-thyroidectomy haemorrhage: older age (MD = 4.30, 95% CI = 3.09-5.52, P < 0.00001), male sex (OR = 1.73, 95% CI = 1.54-1.94, P < 0.00001), Graves' disease (OR = 1.76, 95% CI = 1.44-2.15, P < 0.00001), antithrombotic agents use (OR = 1.96, 95% CI 1.55-2.49, P < 0.00001), bilateral operation (OR = 1.71, 95% CI = 1.50-1.96, P < 0.00001), neck dissection (OR = 1.53, 95% CI = 1.11-2.11, P = 0.01) and previous thyroid surgery (OR = 1.62, 95% CI = 1.12-2.34, P = 0.01). Malignant tumours (OR = 1.07, 95% CI = 0.89-1.28, P = 0.46) and drainage device use (OR = 1.27, 95% CI = 0.74-2.18, P = 0.4) were not associated with post-thyroidectomy haemorrhage. CONCLUSION Our systematic review identified a number of risk factors for post-thyroidectomy haemorrhage, including older age, male sex, Graves' disease, antithrombotic agents use, bilateral operation, neck dissection and previous thyroid surgery. Early control of modifiable risk factors could improve patient outcomes and satisfaction.
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Affiliation(s)
- Jinhao Liu
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Wei Sun
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Wenwu Dong
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Zhihong Wang
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Ping Zhang
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Ting Zhang
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Hao Zhang
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
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Benkhadoura M, Taktuk S, Alobedi R. Recurrent laryngeal nerve injury and hypoparathyroidism rates in reoperative thyroid surgery. Turk J Surg 2017; 33:14-17. [PMID: 28589182 DOI: 10.5152/ucd.2017.3369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/05/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Reoperative thyroid surgery is rare and has a high complication rate. This retrospective cohort study was performed to determine the recurrent laryngeal nerve injury and hypoparathyroidism rates after reoperative thyroid surgery in two university hospitals in Benghazi, Libya. MATERIAL AND METHODS All consecutive patients who underwent reoperative thyroid surgery between January 2002 and July 2014 were included retrospectively. The cohort was divided according to whether the reoperation was in the previously operated lobe or both lobes (ipsilateral group), or only in the previously non-operated lobe (contralateral group). RESULTS Of the 73 patients, 66 were female and seven were male. The median age was 37 (19-80) years. Nine (12.3%), five (6.8%), and one (1.4%) patient developed postoperative transient hypocalcemia, transient recurrent laryngeal nerve palsy, and permanent recurrent laryngeal nerve injury, respectively. None of the patients developed permanent hypocalcemia. The ipsilateral group had a higher rate of permanent recurrent laryngeal nerve injury after reoperation than the contralateral group (3.1% vs. 0%). It also had higher rates of transient recurrent laryngeal nerve injury (12.5% vs. 2.4%) and transient hypocalcemia (28.1% vs. 0%), but the two groups did not differ in terms of permanent hypocalcemia rates (both 0%). CONCLUSION Reoperative thyroid surgery is technically challenging with a high incidence of complications. The ipsilateral group had more complications after reoperative thyroid surgery than the contralateral group. Hemi- or total thyroidectomy at the primary surgery is recommended to reduce the frequency of reoperative thyroid surgery.
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Affiliation(s)
- Mohamed Benkhadoura
- Department of Surgery, Faculty of Medicine, University of Benghazi, Benghazi, Libya
| | - Salah Taktuk
- Department of Surgery, Faculty of Medicine, University of Benghazi, Benghazi, Libya
| | - Reem Alobedi
- General Practitoner, Boatni Health Center, Benghazi, Libya
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Zhao WJ, Luo H, Zhou YM, Gou ZH, Wang B, Zhu JQ. Preoperative ultrasound-guided carbon nanoparticles localization for metastatic lymph nodes in papillary thyroid carcinoma during reoperation: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e6285. [PMID: 28272249 PMCID: PMC5348197 DOI: 10.1097/md.0000000000006285] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/30/2017] [Accepted: 02/10/2017] [Indexed: 02/05/2023] Open
Abstract
Due to the damaged anatomical structure and a large amount of fibrous and scar tissues in the surgical field, reoperation of papillary thyroid carcinoma is difficult. This study introduces a new method of locating metastatic lymph nodes during reoperation and evaluates the effectiveness and safety of the preoperative ultrasound-guided carbon nanoparticles (CNs) localization. This retrospective cohort study enrolled 52 patients who were diagnosed with lymph node metastasis by histopathology and underwent reoperation from October 2015 to February 2016. The modified radical neck dissection or selective neck node dissection was performed. A total of 26 patients underwent preoperative ultrasound-guided CNs injection, and other 26 patients did not. Tolerance, the result of injection, the number of resected metastatic lymph nodes, and postoperative complications were recorded and analyzed. In CNs group, 102 suspicious nonpalpable lesions in 26 patients were injected with CNs, and 99 of the 102 lesions were successfully identified by surgeon in the reoperation. The positive rate of resected lymph nodes in total, in the central compartment, and in the lateral compartment were 31.6%, 31.2%, and 32.8%, respectively, which was significantly higher than that in the control group (P < 0.001, P < 0.001, and P = 0.041). In addition, the positive rates of levels III, IV, and V in the CNs group were 35.6%, 21.9%, and 30.5%, respectively, which was significantly higher than that in the control group (P < 0.001, P = 0.005, and P = 0.01). In additional, in the CNs group, the rate of temporary hypoparathyroidism was significantly lower compared with the control group (0% vs 26.9%, P = 0.021). Preoperative ultrasound-guided CNs injection is a safe and effective method for localization of the metastatic lymph nodes during reoperation.
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Affiliation(s)
| | - Han Luo
- Department of Thyroid & Parathyroid Surgery
| | - Yi-mei Zhou
- West China School of Stomotology, Sichuan University, Chengdu, PR China
| | - Ze-hui Gou
- Department of Ultrasound, West China Hospital
| | - Bin Wang
- Department of Thyroid & Parathyroid Surgery
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Eng OS, Grant SB, Weissler J, Simon M, Roychowdhury S, Davidov T, Trooskin SZ. Operative bed recurrence of thyroid cancer: utility of a preoperative needle localization technique. Gland Surg 2017; 5:571-575. [PMID: 28149802 DOI: 10.21037/gs.2016.12.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surgical management of recurrent disease after total thyroidectomy and/or neck dissection for thyroid carcinoma remains a challenging clinical problem. Reoperation is associated with a significant increase in morbidity. Preoperative needle localization technique for non-palpable breast tumors has recently been extrapolated to head and neck surgery. We report on the use of preoperative ultrasound-guided needle localization for non-palpable recurrent operative bed disease as an intraoperative aid in resection. METHODS Patients with thyroid carcinoma were identified from a retrospective database at a tertiary care center from 2011-2014. Inclusion criteria were history of thyroidectomy and/or neck dissection, non-palpable recurrent disease in the resection bed on surveillance, and ultrasound-guided needle localization of recurrent disease before resection. Perioperative data and outcomes were analyzed. RESULTS Seventeen patients were identified using the inclusion criteria listed above. Median patient age was 46 years (53% male, 47% female). A total of 23 masses in the previous operative bed were needle-localized successfully with no major long-term sequelae from this technique. The recurrent laryngeal nerve was involved with tumor in six patients. Two patients, in whom the tumor surrounded the nerve circumferentially, experienced recurrent laryngeal nerve injuries. No patients experienced postoperative hypocalcemia. With a routine surveillance and a median follow-up of 558 days, sixteen of the patients remain with no evidence of disease. CONCLUSIONS Preoperative ultrasound-guided needle localization of non-palpable recurrent operative bed disease after thyroidectomy and/or neck dissection is a potentially safe method to aid in resection and cure.
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Affiliation(s)
- Oliver S Eng
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Scott B Grant
- Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Jason Weissler
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Mitchell Simon
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Sudipta Roychowdhury
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Tomer Davidov
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Stanley Z Trooskin
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
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Wojtczak B, Barczyński M. Intermittent neural monitoring of the recurrent laryngeal nerve in surgery for recurrent goiter. Gland Surg 2016; 5:481-489. [PMID: 27867862 DOI: 10.21037/gs.2016.09.07] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Reoperative thyroid surgery is still challenging even for skilled surgeons, and is associated with a higher incidence of complications, such as hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Displacement of the RLN, scar tissue from previous neck surgery and difficulty in maintaining good hemostasis are risk factors in reoperations. The prevalence of RLN injury in reoperative thyroid surgery ranges as high as 12.5% for transient injury and up to 3.8% for permanent injury. Bilateral paresis can also occur during reoperations, and is a dangerous complication influencing the quality of life, sometimes requiring tracheostomy. RLN identification is the gold standard during thyroidectomy, and the use of intraoperative neuromonitoring (IONM) can be a valuable adjunct to visual identification. This technique can be used to identify the RLN and the external branch of the superior laryngeal nerve (EBSLN), both of which are standardized procedures. The aim of this review was to evaluate the use of intermittent neural monitoring of the RLN in surgery for recurrent goiter, and to assess the prevalence of RLN injury while using IONM reported in the current literature.
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Affiliation(s)
- Beata Wojtczak
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Barczyński
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
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40
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Lytrivi M, Kyrilli A, Burniat A, Ruiz Patino M, Sokolow Y, Corvilain B. Thyroid lobectomy is an effective option for unilateral benign nodular disease. Clin Endocrinol (Oxf) 2016; 85:602-8. [PMID: 27106627 DOI: 10.1111/cen.13088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/14/2016] [Accepted: 04/20/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The use of thyroid lobectomy in the treatment of unilateral, benign nodules is limited by the potential of nodular recurrence in the remaining lobe. This study aimed to assess the rate and clinical impact of nodular recurrence in the contralateral lobe after thyroid lobectomy and to identify predictive factors of recurrence. DESIGN Single-centre retrospective study. PATIENTS Records of patients that underwent lobectomy for unilateral thyroid nodules between 1991 and 2010 were reviewed and 270 patients were included. Exclusion criteria were: presence of contralateral nodule(s) ≥5 mm on preoperative ultrasound, diagnosis of cancer necessitating completion thyroidectomy or pseudonodules. Recurrence was defined as the occurrence of nodule(s) ≥5 mm in the remaining lobe on at least one postoperative ultrasound. A set of clinical, imaging, histological and biochemical parameters was tested as predictors of recurrence using logistic regression. RESULTS After a median follow-up of 78 months (range, 12-277 months), the global recurrence rate was 42% and recurrence of nodules of a size ≥1 cm occurred in 19%. Reoperation rate was 1·1%. 90% of patients were treated postoperatively by levothyroxine. Median time to nodular recurrence was 4 years. Preoperative contralateral lobe volume and resected thyroid weight were identified as significant predictors of recurrence (P = 0·045 and P = 0·03 respectively). CONCLUSIONS Thyroid lobectomy is an effective therapeutic strategy for unilateral, benign nodules, resulting in a low rate of clinically relevant nodular relapse in a mildly iodine-deficient area. Patients with uninodular disease and a contralateral lobe of normal size are particularly good candidates for lobectomy.
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Affiliation(s)
- Maria Lytrivi
- Department of Endocrinology and Diabetes, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Aglaia Kyrilli
- Department of Endocrinology and Diabetes, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnès Burniat
- Department of Endocrinology and Diabetes, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Ruiz Patino
- Department of Thoracic Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Youri Sokolow
- Department of Thoracic Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology and Diabetes, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Dzodic R, Markovic I, Santrac N, Buta M, Djurisic I, Lukic S. Recurrent Laryngeal Nerve Liberations and Reconstructions: A Single Institution Experience. World J Surg 2016; 40:644-51. [PMID: 26552911 PMCID: PMC4746230 DOI: 10.1007/s00268-015-3305-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Recurrent laryngeal nerve (RLN) palsy rates vary from 0.5 to 10 %, even 20 % in thyroid cancer surgery. The aim of this paper was to present our experience with RLN liberations and reconstructions after various mechanisms of injury. Methods Patients were treated in our institution from year 2000 to 2015. First group (27 patients) had large benign goiters, locally advanced thyroid/parathyroid carcinomas, or incomplete previous surgery of malignant thyroid disease. Second group (5 patients) had reoperations due to RLN paralysis on laryngoscopy. Liberations and reconstructions of injured RLNs were performed. Results Surgical exploration of central compartment enabled identification of the RLN injury mechanism. Liberations were performed in 11 patients, 2 months to 16 years after RLN injury, by removing misplaced ligations. Immediate or delayed (18 months to 23 years) RLN reconstructions were performed in 21 patients, by direct suture or ansa cervicalis-to-RLN anastomosis (ARA). RLN liberation provided complete voice recovery within 3 weeks in all patients. Patients with direct sutures had better phonation 1 month after reconstruction. Improved phonation was observed 2–6 months after ARA in 43 % of patients. Conclusions Vocal cords do not regain normal movement once being paralyzed after RLN transection, but they restore tension during phonation by reconstruction. Nerve liberation is a useful method which enables patients with RLN paresis/paralysis a significant improvement in phonation, even complete voice recovery. Reinnervation of vocal cords, using one of the mentioned techniques, should be a standard in thyroid and parathyroid surgery, with aim to improve quality of patient’s life.
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Affiliation(s)
- Radan Dzodic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia
| | - Ivan Markovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia
| | - Nada Santrac
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia.
| | - Marko Buta
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia
| | - Igor Djurisic
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia
| | - Silvana Lukic
- Department of Pathology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
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Polistena A, Di Lorenzo P, Sanguinetti A, Buccelli C, Conzo G, Conti A, Niola M, Avenia N. Medicolegal implications of surgical errors and complications in neck surgery: A review based on the Italian current legislation. Open Med (Wars) 2016; 11:298-306. [PMID: 28352812 PMCID: PMC5329845 DOI: 10.1515/med-2016-0058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/07/2016] [Indexed: 11/15/2022] Open
Abstract
Aim of the present paper is the review of the principal complications associated to endocrine neck surgery considering how expertise, full adoption of guidelines, appropriate technology and proper informed consent may limit the medicolegal claims at the light of the incoming new regulation of the medical professional legal responsibility. A literature search, using the Medline/PubMed database for full-length papers, was used. Postoperative recurrent laryngeal nerve (RLN) palsy and hypoparathy-roidism remain the principal causes of surgical malpractice claims . In the procedure of neck lymphadenctomy intra-operative haemorrhage, thoracic duct injury, injuries to loco-regional nerves can be observed and can be source of claims. After many years of increased medicolegal litigations, the Italian government is proposing a drastic change in the regulations of supposed medical malpractice in order to guarantee the patient's right to a safe treatment and in the meantime to defend clinicians from often unmotivated and prejudicial legal cases. Surgical errors and complications in neck surgery are a relevant clinical issue. Only the combination of surgical and clinical expertise, application of guidelines, appropriate technology and a routinely use of specific informed consent can contain potential medicolegal implications.
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Affiliation(s)
- Andrea Polistena
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy
| | - Pierpaolo Di Lorenzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandro Sanguinetti
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Conzo
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - Adelaide Conti
- Department of Surgery, Radiology and Public Health, Public Health and Humanities Section, University of Brescia - Centre of Bioethics Research, Brescia, Italy
| | - Massimo Niola
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola Avenia
- University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy
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Kranthikumar G, Syed N, Nemade H, Pawar S, Chandra Sekhara Rao LM, Subramanyeshwar Rao T. Safety of Completion Thyroidectomy for Initially Misdiagnosed Thyroid Carcinoma. Rambam Maimonides Med J 2016; 7:RMMJ.10249. [PMID: 27487312 PMCID: PMC5001794 DOI: 10.5041/rmmj.10249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures of less than total or near-total thyroidectomy. Whether thyroid reoperations are associated with an increased complication risk is controversial. OBJECTIVE A retrospective analysis was done of patients undergoing completion thyroidectomy for cancer of the thyroid who had undergone surgery elsewhere for solitary thyroid nodule. The incidence of surgical complications in these patients after reoperation was investigated in this study. MATERIAL AND METHODS The study included a total of 53 patients who had undergone thyroid lobectomy for a solitary nodule as initial surgery elsewhere and were referred to our institute for completion thyroidectomy when the histopathology revealed malignancy. RESULTS There were 53 patients, 43 females and 10 males. Their mean age was 34.7±12.12 years (range 19-65 years). After initial surgery, the histopathology revealed papillary carcinoma in 46 patients (86.8%), follicular carcinoma in 7 (13.2%). Fourteen out of 53 patients had recurrent laryngeal nerve palsy after initial surgery (26.4%). None of the patients had clinical hypocalcemia after the first surgery. One or more parathyroid glands were identified and preserved in 52 patients (98.1%) in the process of completion thyroidectomy. No patient had additional recurrent nerve injury at the second surgery. The mean serum calcium value preoperatively was 8.96±0.39 mg/dL, and six months after surgery serum calcium was 8.74±0.56 mg/dL. Mean follow-up was 18 months. Transient hypoparathyroidism occurred in 24.5% patients. Five patients were lost to follow-up. Permanent and symptomatic hyperparathyroidism occurred in eight patients (16.67%). CONCLUSIONS Completion thyroidectomy is a safe and appropriate option in the management of well-differentiated thyroid cancer. It removes disease on the ipsilateral and contralateral side of the thyroid and carries a low risk of recurrent laryngeal nerve damage, but a higher risk of permanent hypoparathyroidism.
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Reoperative thyroid surgery: can endoscopic areola approach be used? Surg Endosc 2016; 31:1296-1304. [PMID: 27422250 DOI: 10.1007/s00464-016-5110-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
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Lin YS, Wu HY, Yu MC, Hsu CC, Chao TC. Patient outcomes following surgical management of multinodular goiter: Does multinodularity increase the risk of thyroid malignancy? Medicine (Baltimore) 2016; 95:e4194. [PMID: 27428220 PMCID: PMC4956814 DOI: 10.1097/md.0000000000004194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND the difference in the risk of thyroid malignancy for patients with multinodular goiter (MNG) and solitary nodular goiter (SNG) remains controversial. Although total thyroidectomy (TT) is the current preferred surgical option for MNG, permanent hypothyroidism in these patients may be a concern. Therefore, we discuss whether nontotal thyroidectomy is a reasonable alternative surgical option. METHODS A retrospective cohort study was performed for 1598 consecutive patients who underwent thyroid surgery for nodular goiter between January 2007 and December 2012. Numerous clinical parameters were collected and analyzed. RESULTS We reviewed 795 patients with MNG and 803 patients with SNG. The prevalence of malignancy on final pathology was significantly higher in the patients with MNG than in the patients with SNG (15.6% vs 10.1%, P = 0.001). However, a multivariate analysis revealed that this difference was insignificant (P = 0.50). Papillary carcinoma was the predominant type in both groups, but papillary microcarcinoma was more frequently found (41.1%) in the patients with MNG. The only multifocal cancers were of the papillary carcinoma histologic type, and the incidence of multifocal papillary carcinoma was significantly higher in the patients with MNG (23.4% vs 7.4%, P = 0.005). Reoperation was not required for the patients who underwent TT for goiter recurrence or incidental carcinoma. The overall rate of recurrence following nontotal thyroidectomy was 12.2%. Among the patients who underwent reoperation for goiter recurrence, 2 (20.0%) were complicated with permanent hypoparathyroidism. Among the patients who underwent a nontotal bilateral thyroidectomy, an average of 56.5% had permanent hypothyroidism. CONCLUSIONS Multinodularity does not increase the risk of thyroid malignancy. However, patients with MNG who develop papillary carcinoma are at an increased risk of cancer multifocality. If a patient can tolerate lifelong thyroid hormone replacement, TT is the preferred surgical option because it helps avoid reoperation and the associated complications. Nontotal bilateral thyroidectomy does not ensure the preservation of thyroid hormone function.
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Affiliation(s)
- Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Hsin-Yi Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Chih-Chieh Hsu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Tzu-Chieh Chao
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
- Correspondence: Tzu-Chieh Chao, Chang Gung Memorial Hospital, Linkou, Taiwan (e-mail: )
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Zhou HY, He JC, McHenry CR. Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res 2016; 205:70-5. [PMID: 27621001 DOI: 10.1016/j.jss.2016.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/18/2016] [Accepted: 06/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Parathyroid glands are ≤5 mm, often subcapsular or intrathyroidal, and obscured by lymph nodes, making preservation a challenge. The purpose of this study was to determine the incidence of inadvertent parathyroidectomy (IP) and whether it contributes to hypoparathyroidism after thyroidectomy. MATERIALS AND METHODS A retrospective review of all thyroidectomies by a single surgeon from January 2010 to August 2014 was completed to determine the rate of IP and permanent hypoparathyroidism. Medical records were assessed for demographics, extent of thyroidectomy, central compartment neck dissection, thyroid gland weight, parathyroid autotransplantation, reoperation, pathology, postoperative calcium levels, and number of parathyroid glands removed. RESULTS A total of 386 patients underwent thyroidectomy. Mean age was 52 y, and 327 (85%) patients were women. There were 25 (7%) patients who underwent reoperation, 40 (10%) who underwent central compartment neck dissection, and 128 (33%) who underwent parathyroid autotransplantation. IP occurred in 78 (20%) patients. Permanent hypoparathyroidism occurred in 7 (2.7%) of 258 patients after total or completion thyroidectomy, four (6.7%) with IP compared with three (1.5%) without IP (P = 0.033). Logistic regression analysis revealed that female gender (odds ratio = 2.768, P = 0.040), central compartment neck dissection (odds ratio = 9.584, P = 0.001), and thyroid gland weight (odds ratio = 0.994, P = 0.022) were independent factors associated with IP. CONCLUSIONS IP, which occurred in 20% of patients undergoing thyroidectomy, is a potentially remediable factor associated with a higher rate of hypoparathyroidism. Central compartment neck dissection is an independent risk factor for IP.
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Affiliation(s)
- Hannah Y Zhou
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jack C He
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Christopher R McHenry
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio.
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Schols RM, Alic L, Wieringa FP, Bouvy ND, Stassen LPS. Towards automated spectroscopic tissue classification in thyroid and parathyroid surgery. Int J Med Robot 2016; 13. [PMID: 27198506 DOI: 10.1002/rcs.1748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/14/2016] [Accepted: 03/18/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND In (para-)thyroid surgery iatrogenic parathyroid injury should be prevented. To aid the surgeons' eye, a camera system enabling parathyroid-specific image enhancement would be useful. Hyperspectral camera technology might work, provided that the spectral signature of parathyroid tissue offers enough specific features to be reliably and automatically distinguished from surrounding tissues. As a first step to investigate this, we examined the feasibility of wide band diffuse reflectance spectroscopy (DRS) for automated spectroscopic tissue classification, using silicon (Si) and indium-gallium-arsenide (InGaAs) sensors. METHODS DRS (350-1830 nm) was performed during (para-)thyroid resections. From the acquired spectra 36 features at predefined wavelengths were extracted. The best features for classification of parathyroid from adipose or thyroid were assessed by binary logistic regression for Si- and InGaAs-sensor ranges. Classification performance was evaluated by leave-one-out cross-validation. RESULTS In 19 patients 299 spectra were recorded (62 tissue sites: thyroid = 23, parathyroid = 21, adipose = 18). Classification accuracy of parathyroid-adipose was, respectively, 79% (Si), 82% (InGaAs) and 97% (Si/InGaAs combined). Parathyroid-thyroid classification accuracies were 80% (Si), 75% (InGaAs), 82% (Si/InGaAs combined). CONCLUSIONS Si and InGaAs sensors are fairly accurate for automated spectroscopic classification of parathyroid, adipose and thyroid tissues. Combination of both sensor technologies improves accuracy. Follow-up research, aimed towards hyperspectral imaging seems justified. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rutger M Schols
- Department of Surgery, Maastricht University Medical Center & NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.,van't Hoff Program on Medical Photonics, Netherlands Organization for Applied Scientific Research TNO, Delft, The Netherlands
| | - Lejla Alic
- van't Hoff Program on Medical Photonics, Netherlands Organization for Applied Scientific Research TNO, Delft, The Netherlands
| | - Fokko P Wieringa
- van't Hoff Program on Medical Photonics, Netherlands Organization for Applied Scientific Research TNO, Delft, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center & NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center & NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
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D’ORAZI V, PANUNZI A, DI LORENZO E, ORTENSI AL, CIALINI M, ANICHINI S, ORTENSI A. Use of loupes magnification and microsurgical technique in thyroid surgery: ten years experience in a single center. G Chir 2016; 37:101-107. [PMID: 27734792 PMCID: PMC5119695 DOI: 10.11138/gchir/2016.37.3.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM The use of microsurgical technique and loupes magnification as a support to traditional surgery can help surgical performance and prevent complications in thyroid surgery. PATIENTS AND METHODS Between January 2004 and December 2014, 782 patients with thyroid diseases were operated by our team with microsurgical technique and loupes magnification 4.5x. All patients had pre and postoperative vocal cords assessment and calcemia and the collected data were analysed. RESULTS Among the 782 patients, only six patients (0.77%) had unilateral vocal fold immobility treated with medical therapy, phoniatric and neck physiotherapy. All six patients showed complete laryngeal recovery of motility 6/8 weeks after treatment. There were not cases of permanent monolateral or bilateral vocal cord palsy. In 84 patients there were signs and symptoms of hypocalcemia. In 81 patients (10.36%) the restoring of biochemical parameters and the resolution of symptoms occurred between 2 and 6 weeks and in 3 cases (0.38%) there was permanent hypocalcemia more than six months. CONCLUSION The use of microsurgical technique and loupes magnification in thyroid surgery are safety and effective procedures, that require an appropriate training in reconstructive microsurgery, but may significantly reduce post-operative complications. Here, we report for the first time the largest series of thyroid surgery performed with the use of microsurgical technique and loupes magnification, analysing the postoperative morbidity. In view of our results, we suggest the routine use of 4.5X loupes and microsurgical technique in thyroid surgery.
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Affiliation(s)
- V. D’ORAZI
- Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Rome, Italy
| | - A. PANUNZI
- Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Rome, Italy
| | - E. DI LORENZO
- Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Rome, Italy
| | - AL. ORTENSI
- Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Rome, Italy
| | - M. CIALINI
- Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Rome, Italy
| | - S. ANICHINI
- Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Rome, Italy
| | - A. ORTENSI
- Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Rome, Italy
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THY3 cytology: What surgical treatment? Retrospective study and literature review. Int J Surg 2016; 28 Suppl 1:S59-64. [DOI: 10.1016/j.ijsu.2015.05.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/06/2015] [Accepted: 05/22/2015] [Indexed: 12/28/2022]
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Chang H, Yoo RN, Kim SM, Kim BW, Lee YS, Lee SC, Chang HS, Park CS. The Clinical Significance of the Right Para-Oesophageal Lymph Nodes in Papillary Thyroid Cancer. Yonsei Med J 2015; 56:1632-7. [PMID: 26446647 PMCID: PMC4630053 DOI: 10.3349/ymj.2015.56.6.1632] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/02/2015] [Accepted: 02/09/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Although guidelines indicate that routine dissection of the central lymph nodes in patients with thyroid carcinoma should include the right para-oesophageal lymph nodes (RPELNs), located between the right recurrent laryngeal nerve and the cervical oesophagus and posterior to the former, RPELN dissection is often omitted due to high risk of injuries to the recurrent laryngeal nerve and the right inferior parathyroid gland. MATERIALS AND METHODS We retrospectively identified all patients diagnosed with papillary thyroid carcinoma who underwent total thyroidectomy with central lymph node dissection, including the RPELNs, between January 1, 2009 and December 31, 2013 at the Thyroid Cancer Center of Yonsei University College of Medicine, Seoul, Korea. RESULTS Of 5556 patients, 148 were positive for RPELN metastasis; of the latter, 91 had primary tumours greater than 1 cm (p<0.001). Extrathyroidal extension by the primary tumour (81.8%; p<0.001), bilaterality, and multifocality were more common in patients with than without RPELN metastasis; however, there were no significant differences in age and sex between groups. A total of 95.9% of patients with RPELN metastasis had central node (except right para-oesophageal lymph node) metastasis, and the incidence of lateral neck node metastasis was significantly higher in patients with than without RPELN metastasis (63.5% vs. 14.3%, p<0.001). Forty-one patients underwent mediastinal dissection, with 11 patients confirmed as having mediastinal lymph node metastasis with RPELN metastasis on pathological examination. CONCLUSION RPELN metastasis is significantly associated with lateral neck and mediastinal lymph node metastasis.
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Affiliation(s)
- Hojin Chang
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ri Na Yoo
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seok-Mo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bup-Woo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Chul Lee
- Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Cheong Soo Park
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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