1
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Smaxwil CA, Zielke A. [Modern thyroid surgery : Efficient and safe thyroidectomy technique]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:785-792. [PMID: 38862785 DOI: 10.1007/s00104-024-02100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 06/13/2024]
Abstract
After decades of bilateral "subtotal" and later "total" thyroidectomy, the extent of resection is now determined individually depending on the dominant thyroid condition. The leading indication by far in the study, documentation and quality center (StuDoQ) register of the Surgical Working Group Endocrinology (CAEK) is currently the suspicion of malignancy, which is followed by benign symptomatic nodular goiter, functional disorders and confirmed malignancy. The decision for an intervention as well as the extent of resection must be rigorously established. Aids for intraoperative nerve monitoring, vessel-sealing and parathyroid autofluorescence increase the safety of thyroid resections but also the complexity. The surgical technique of lobectomy using modern devices for vessel sealing is an intricate process in which the positioning, access to the neck and a modified sequence of dissection steps are equally important. While the usefulness of neuromonitoring is nowadays no longer in doubt, this is not yet so clear for other technologies. Above all, however, modern thyroid surgery is characterized by the knowledge of one's own results and a clear positioning to follow-ups. The selection of any surgical aid should be based on this knowledge.
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Affiliation(s)
- Constantin Aurel Smaxwil
- Endokrine Chirurgie, Diakonie-Klinikum Stuttgart, Rosenbergstraße 38, 70176, Stuttgart, Deutschland
| | - Andreas Zielke
- Endokrine Chirurgie, Diakonie-Klinikum Stuttgart, Rosenbergstraße 38, 70176, Stuttgart, Deutschland.
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2
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Newman SK, Patrizio A, Boucai L. Decision Variables for the Use of Radioactive Iodine in Patients with Thyroid Cancer at Intermediate Risk of Recurrence. Cancers (Basel) 2024; 16:3096. [PMID: 39272954 PMCID: PMC11394252 DOI: 10.3390/cancers16173096] [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: 07/27/2024] [Revised: 08/13/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
The use of radioactive iodine (RAI) after total thyroidectomy for patients at the American Thyroid Association (ATA) who are at intermediate risk of recurrence is controversial. This is due to the lack of prospective randomized trials proving a benefit to recurrence or survival of RAI therapy in this group. In the absence of such evidence, clinicians struggle to recommend for or against this therapeutic approach which frequently results in overtreatment. This review describes key elements in the decision-making process that help clinicians more comprehensively evaluate the need for RAI therapy in patients with thyroid cancer at intermediate risk of recurrence. A clear definition of the purpose of RAI therapy should be conveyed to patients. In this sense, adjuvant RAI therapy intends to decrease recurrence, and ablation therapy is used to facilitate surveillance. Better stratification of the intermediate risk category into a low-intermediate subgroup and an intermediate-high-risk subgroup results in less heterogeneity and a more precise prediction of recurrence risk. The evaluation of post-operative thyroglobulin levels may prevent the overtreatment of low-intermediate-risk patients when their thyroglobulin level is <2.5 ng/mL. the integration of tumor genomics (when available) alongside pathologic features can enhance the ability of the clinician to predict iodine concentration in thyroid cancer cells. Finally, a detailed consideration of the adverse effects of RAI, patients' comorbidities, and patient preferences will result in a patient-centered personalized approach. Systematic examination of these variables will ultimately provide a framework for making more educated decisions on the use of RAI in patients at intermediate risk of recurrence that will prevent overtreatment and minimize harm.
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Affiliation(s)
- Samantha K Newman
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Armando Patrizio
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Laura Boucai
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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3
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Dughiero S, Torresan F, Censi S, Mian C, Carrillo Lizarazo JL, Iacobone M. Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients. Cancers (Basel) 2024; 16:2867. [PMID: 39199638 PMCID: PMC11352404 DOI: 10.3390/cancers16162867] [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: 07/02/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Postoperative hypoparathyroidism (HypoPTH) is the most common complication following total thyroidectomy. Several risk factors have been identified, but data on postoperative follow-up are scarce. METHODS The study focused on 1965 patients undergoing surgery for benign and malignant thyroid diseases at a tertiary-level academic center. Anamnestic, biochemical, surgical, pathological, and follow-up data were evaluated. HypoPTH was defined by a serum concentration of PTH < 10 pg/mL on the first or the second post-operative day. Persistent HypoPTH was defined by the need for calcium/active vitamin D treatment > 12 months after surgery. RESULTS Postoperative HypoPTH occurred in 542 patients. Multivariate analysis identified the association of central lymph-nodal dissection, reduced preoperative PTH levels, a lower rate of parathyroid glands preserved in situ, and longer duration of surgery as independent risk factors. At a median follow-up of 47 months, HypoPTH regressed in 443 patients (more than 6 months after surgery in 7%) and persisted in 53 patients. Patients receiving a lower dose of calcium/active vitamin D treatment at discharge (HR 0.559; p < 0.001) or undergoing prolonged, tailored, and direct follow-up by the operating endocrine surgeon team had a significantly lower risk of persistent HypoPTH (2.4% compared to 32.8% for other specialists) (HR 2.563; p < 0.001). CONCLUSIONS Various patient, disease, and surgeon-related risk factors may predict postoperative HypoPTH. Lower postoperative calcium/active vitamin D treatment and prolonged, tailored follow-up directly performed by operating endocrine surgeons may significantly reduce the rate of persistent HypoPTH.
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Affiliation(s)
- Silvia Dughiero
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, 35128 Padova, Italy; (S.D.); (F.T.)
| | - Francesca Torresan
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, 35128 Padova, Italy; (S.D.); (F.T.)
| | - Simona Censi
- Unit of Endocrinology, Department of Medicine, University of Padua, 35128 Padova, Italy; (S.C.); (C.M.)
| | - Caterina Mian
- Unit of Endocrinology, Department of Medicine, University of Padua, 35128 Padova, Italy; (S.C.); (C.M.)
| | - José Luis Carrillo Lizarazo
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, 35128 Padova, Italy; (S.D.); (F.T.)
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, 35128 Padova, Italy; (S.D.); (F.T.)
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4
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Raffaelli M, Voloudakis N, Barczynski M, Brauckhoff K, Durante C, Gomez-Ramirez J, Koutelidakis I, Lorenz K, Makay O, Materazzi G, Pandev R, Randolph GW, Tolley N, Vriens M, Musholt T. European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. Br J Surg 2024; 111:znae199. [PMID: 39158073 PMCID: PMC11331340 DOI: 10.1093/bjs/znae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità (CREO), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joaquin Gomez-Ramirez
- Endocrine Surgery Unit, General Surgery Department, Hospital Universitario La Paz, IdiPaz Madrid, Madrid, Spain
| | - Ioannis Koutelidakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ozer Makay
- Centre for Endocrine Surgery, Ozel Saglik Hospital, Izmir, Turkey
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Rumen Pandev
- Department of General Surgery, University Hospital St Marina, Medical University Pleven, Pleven, Bulgaria
| | - Gregory W Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Tolley
- Endocrine Surgery Service, Imperial College NHS Healthcare Trust, London, UK
| | - Menno Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thomas Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Mainz, Germany
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5
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Manzella A, Kheng M, Chao J, Laird AM, Beninato T. Association of Medicaid expansion with access to thyroidectomy for benign disease at high-volume centers. Surgery 2024; 176:336-340. [PMID: 38762382 DOI: 10.1016/j.surg.2024.04.004] [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: 10/16/2023] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Insurance-based disparities in access to thyroidectomy are well established. Patients undergoing thyroidectomy by high-volume surgeons have fewer complications and better postoperative outcomes. The aim of this study was to evaluate the association of Medicaid expansion with access to high-volume centers for thyroidectomy for benign disease. METHODS The Vizient Clinical Data Base was queried for adult operations for benign thyroid disease from 2010 to 2019. Centers were sorted by volume into quartiles. Difference-in-difference analysis evaluated changes in insurance populations in expansion and non-expansion states after Medicaid expansion. Odds of patients undergoing operations in the 4 volume quartiles after stratifying by insurance and Medicaid expansion status were calculated. RESULTS A total of 82,602 patients underwent operations at 364 centers. Expansion states increased Medicaid coverage in all volume quartiles compared to non-expansion states after Medicaid expansion (Q1, +4.87%, Q2, +5.35%, Q3, +8.57%, Q4, +4.62%, P < .002 for all). After Medicaid expansion, Medicaid patients had higher odds of undergoing operation at lower volume hospitals compared to the highest volume centers in both expansion states (Q1, ref, Q2, 1.82, Q3, 1.76, Q4, 1.67, P < .001) and non-expansion states (Q1, ref, Q2, 1.54, Q3, 2.04, Q4, 1.44, P < .001). Privately insured patients were most likely to undergo their operation at the highest volume centers in all states (E: Q1, ref, Q2, 0.78, Q3, 0.74, Q4, 0.66, P < .001; NE: Q1, ref, Q2, 0.89, Q3, 0.58, Q4, 0.85, P < .001). CONCLUSION Medicaid expansion increased Medicaid coverage in expansion states, but Medicaid patients in both expansion and non-expansion states were less likely to be operated on at the highest volume centers compared to privately insured patients. Persistent barriers to accessing high-volume care still exists for Medicaid patients.
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Affiliation(s)
- Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
| | - Marin Kheng
- Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Joshua Chao
- Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Amanda M Laird
- Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ. https://twitter.com/BeninatoToni
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Huang BL, Carneiro-Pla D. Intraoperative Adjuncts in Thyroid Surgery. Surg Clin North Am 2024; 104:767-777. [PMID: 38944497 DOI: 10.1016/j.suc.2024.02.006] [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] [Indexed: 07/01/2024]
Abstract
Thyroidectomy is relatively safe and often can be done as a minimally invasive procedure. Although they may be associated with a learning curve, thoughtful use of intraoperative adjuncts such as energy devices, recurrent laryngeal nerve monitoring, and parathyroid autofluorescence have the potential to make incremental improvements in the safety and efficiency of thyroid surgery. Perhaps many of these adjuncts may be of greatest benefit when used routinely by less experienced surgeons or selectively in higher-risk operations, although their adoption in practice continues to increase overall.
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Affiliation(s)
- Bernice Liying Huang
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery at the Medical University of South Carolina, 30 Courtenay Drive, Suite 240, MSC 295, Charleston, SC 29425, USA
| | - Denise Carneiro-Pla
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery at the Medical University of South Carolina, 30 Courtenay Drive, Suite 240, MSC 295, Charleston, SC 29425, USA.
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7
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Graceffa G, Lopes A, Orlando G, Mazzola S, Vassallo F, Curione F, Richiusa P, Radellini S, Melfa G, Scerrino G. Risk Factors for Transient Hypoparathyroidism after Total Thyroidectomy: Insights from a Cohort Analysis. J Clin Med 2024; 13:3326. [PMID: 38893037 PMCID: PMC11173213 DOI: 10.3390/jcm13113326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Transient hypoparathyroidism (TH) is the main post-thyroidectomy complication, significantly impacting surgical outcomes, hospitalization length, and perceived perceived quality of life understood as mental and physical well-being. This study aims to identify possible associated risk factors. Methods: We analyzed 238 thyroidectomies (2020-2022), excluding instances of partial surgery, primary hyperparathyroidism, neck irradiation history, and renal failure. The variables considered were as follows: demographics, histology, autoimmunity, thyroid function, pre- and postoperative Vitamin D levels (where available), type of surgery, number of incidentally removed parathyroid glands (IRP), and surgeons' experience (>1000 thyroidectomies, <500, in training). Univariate analysis applied: χ2, Fisher's exact test for categorical variables, and Student's t-test for continuous variables. Subsequently, logistic multivariate analysis with stepwise selection was performed. Results: Univariate analysis did not yield statistically significant results for the considered variables. The 'No Complications' group displayed a mean age of 55 years, whereas the TH group showed a mean age of 51 (p-value = 0.055). We considered this result to be marginally significant. Subsequently, we constructed a multivariate logistic model. This model (AIC = 245.02) indicated that the absence of incidental parathyroidectomy was associated with the age class >55 years, presenting an odds ratio (OR) of 9.015 (p-value < 0.05). Simultaneously, the age class >55 years exhibited protective effects against TH, demonstrating an OR of 0.085 (p-value < 0.01). Similarly, the absence of incidental parathyroidectomy was found to be protective against TH, with an OR of 0.208 (p-value < 0.01). Conclusions: Multivariate analysis highlighted that having "No IRP" was protective against TH, while younger age was a risk factor. Surgeon experience does not seem to correlate with IRP or outcomes, assuming there is adequate tutoring and a case volume close to 500 to ensure good results. The effect of reimplantation has not been evident in transient hypoparathyroidism.
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Affiliation(s)
- Giuseppa Graceffa
- Unit of General and Oncology Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.G.); (A.L.)
| | - Antonella Lopes
- Unit of General and Oncology Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.G.); (A.L.)
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (F.V.); (F.C.); (G.M.)
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy;
| | - Fabrizio Vassallo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (F.V.); (F.C.); (G.M.)
| | - Francesco Curione
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (F.V.); (F.C.); (G.M.)
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Stefano Radellini
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (F.V.); (F.C.); (G.M.)
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy;
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8
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Guo H, Zhang Y, Ren S, Yang X, Tian L, Huang Y, Zhang C, Zhang X. Real-time imaging of ipsilateral parathyroid glands by retrograde injection of methylene blue into the superior thyroid artery: a new intraoperative parathyroid protection method. BMC Surg 2024; 24:108. [PMID: 38615003 PMCID: PMC11015547 DOI: 10.1186/s12893-024-02360-z] [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: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Postoperative hypoparathyroidism caused by parathyroid injury is a problem faced by thyroid surgeons. The current technologies for parathyroid imaging all have some defects. METHODS Patients with differentiated thyroid carcinoma (DTC) who underwent unilateral thyroidectomy plus ipsilateral central lymph node dissection were recruited. We dissected the main trunk of the superior thyroid artery entering the thyroid gland and placed the venous indwelling tube into the artery. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS A total of 132 patients enrolled in this single-arm clinical trial, 105 of them completed retrograde catheterization via the superior artery. The sensitivity was 69.23 and 83.33% respectively. The specificity was 72.91 and 64.89%. The accuracy was 72.91 and 64.89%. The PPV was 85.71 and 81.08%. The NPV was 22.58 and 45.45%. There were no patients with allergic reactions to the methylene blue, or methylene blue toxicity. CONCLUSIONS Retrograde injection of methylene blue via the superior thyroid artery is an effective and safe method to visualize parathyroid glands. This method can accurately locate the target organ by ultraselecting the blood vessel and injecting the contrast agent while avoiding background contamination and reducing the amount of contrast agent. TRIAL REGISTRATION Clinical trial registration numbers and date of registration: ChiCTR2300077263、02/11/2023.
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Affiliation(s)
- Hanjie Guo
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China
| | - Yuxing Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Saiyu Ren
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China
| | - Xiaodong Yang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Lei Tian
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Yun Huang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Chaojun Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China.
| | - Xiliang Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China.
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China.
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China.
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9
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Gonzales J, Adilbay D, de Souza Franca PD, Artschwager R, Chow CY, Viray T, Johnson DS, Jiang Y, Patel SG, Ganly I, Schroeder CI, Lewis JS, King GF, Reiner T, Pillarsetty N. Na V1.7 targeted fluorescence imaging agents for nerve identification during intraoperative procedures. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.06.588368. [PMID: 38617358 PMCID: PMC11014580 DOI: 10.1101/2024.04.06.588368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Surgeries and trauma result in traumatic and iatrogenic nerve damage that can result in a debilitating condition that approximately affects 189 million individuals worldwide. The risk of nerve injury during oncologic surgery is increased due to tumors displacing normal nerve location, blood turbidity, and past surgical procedures, which complicate even an experienced surgeon's ability to precisely locate vital nerves. Unfortunately, there is a glaring absence of contrast agents to assist surgeons in safeguarding vital nerves. To address this unmet clinical need, we leveraged the abundant expression of the voltage-gated sodium channel 1.7 (NaV1.7) as an intraoperative marker to access peripheral nerves in vivo, and visualized nerves for surgical guidance using a fluorescently-tagged version of a potent NaV1.7-targeted peptide, Tsp1a, derived from a Peruvian tarantula. We characterized the expression of NaV1.7 in sensory and motor peripheral nerves across mouse, primate, and human specimens and demonstrated universal expression. We synthesized and characterized a total of 10 fluorescently labeled Tsp1a-peptide conjugates to delineate nerves. We tested the ability of these peptide-conjugates to specifically accumulate in mouse nerves with a high signal-to-noise ratio in vivo. Using the best-performing candidate, Tsp1a-IR800, we performed thyroidectomies in non-human primates and demonstrated successful demarcation of the recurrent laryngeal and vagus nerves, which are commonly subjected to irreversible damage. The ability of Tsp1a to enhance nerve contrast during surgery provides opportunities to minimize nerve damage and revolutionize standards of care across various surgical specialties.
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Affiliation(s)
- Junior Gonzales
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Dauren Adilbay
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Paula Demetrio de Souza Franca
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, SP, Brazil
| | - Raik Artschwager
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Chun Yuen Chow
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
- Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Research, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Tara Viray
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Delissa S. Johnson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Yan Jiang
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Snehal G. Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Otorhinolaryngology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Otorhinolaryngology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
| | - Christina I. Schroeder
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Jason S. Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Pharmacology, Weill-Cornell Medical College, New York, New York, 10065, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
| | - Glenn F. King
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
- Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Research, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Pharmacology, Weill-Cornell Medical College, New York, New York, 10065, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
| | - Nagavarakishore Pillarsetty
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Pharmacology, Weill-Cornell Medical College, New York, New York, 10065, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
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10
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Shamsodini J, Molnár D. A Computed Tomography Study on the Prevalence of Lusorian Artery Among Hungarian Adults. Cureus 2024; 16:e58622. [PMID: 38770487 PMCID: PMC11103453 DOI: 10.7759/cureus.58622] [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] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The aberrant right subclavian artery (ARSA), also called as lusorian artery (LA) is a developmental anomaly that exists in conjunction with a right non-recurrent laryngeal nerve (NRLN) in almost all cases. The average prevalence of such a vascular variation is estimated as 1%, although, studies have reported very different population means. Up to date, there is no available data on the frequency of this pattern in the Hungarian population. It can be treated as an indirect marker of a NRLN. Any preoperative information on the course of the inferior laryngeal nerves can help surgeons reduce the risk of an iatrogenic injury during thyroidectomies, especially in an environment where access to intraoperative neuromonitoring is limited. Objectives The primary aims were to determine the prevalence of an ARSA, predict the existence of an NRLN in the Hungarian population, and provide demographic analysis. Methods A retrospective, computed tomography-based study was carried out. Demographic description and statistical analysis were provided where applicable. Detected anomalous vasculatures were visualized with 3D segmentation, and images were interpreted. Results The imaging database review identified three patients with ARSA out of 686 eligible recordings, resulting in a frequency of 0.437% in the study population. All three patients were female and had a retroesophageal LA. Two of them had a Kommerell's diverticulum. One patient had common carotid arteries with a single origin. Conclusions The frequency of an ARSA and a concomitant NRLN among Hungarians fits into the results of recent meta-analyses. Preoperative assessment of this anomaly may reduce vocal cord complication rates of thyroidectomies.
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Affiliation(s)
- Julia Shamsodini
- Department of Otolaryngology, Semmelweis University, Budapest, HUN
| | - Dávid Molnár
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, HUN
- Department of Otorhinolaryngology and Head and Neck Surgery, Central Hospital of Northern Pest - Military Hospital, Budapest, HUN
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11
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Chaker L, Cooper DS, Walsh JP, Peeters RP. Hyperthyroidism. Lancet 2024; 403:768-780. [PMID: 38278171 DOI: 10.1016/s0140-6736(23)02016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/07/2023] [Accepted: 09/16/2023] [Indexed: 01/28/2024]
Abstract
Thyrotoxicosis causes a variety of symptoms and adverse health outcomes. Hyperthyroidism refers to increased thyroid hormone synthesis and secretion, most commonly from Graves' disease or toxic nodular goitre, whereas thyroiditis (typically autoimmune, viral, or drug induced) causes thyrotoxicosis without hyperthyroidism. The diagnosis is based on suppressed serum concentrations of thyroid-stimulating hormone (TSH), accompanied by free thyroxine and total or free tri-iodothyronine concentrations, which are raised (overt hyperthyroidism) or within range (subclinical hyperthyroidism). The underlying cause is determined by clinical assessment, detection of TSH-receptor antibodies and, if necessary, radionuclide thyroid scintigraphy. Treatment options for hyperthyroidism include antithyroid drugs, radioactive iodine, and thyroidectomy, whereas thyroiditis is managed symptomatically or with glucocorticoid therapy. In Graves' disease, first-line treatment is a 12-18-month course of antithyroid drugs, whereas for goitre, radioactive iodine or surgery are preferred for toxic nodules or goitres. Evidence also supports long-term treatment with antithyroid drugs as an option for patients with Graves' disease and toxic nodular goitre.
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Affiliation(s)
- Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - David S Cooper
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Walsh
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
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12
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Cappellacci F, Canu GL, Rossi L, De Palma A, Mavromati M, Kuczma P, Di Filippo G, Morelli E, Demarchi MS, Brazzarola P, Materazzi G, Calò PG, Medas F. Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation. Front Surg 2024; 11:1341683. [PMID: 38379818 PMCID: PMC10876881 DOI: 10.3389/fsurg.2024.1341683] [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: 11/20/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy. Methods In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B). Results We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, p < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, p = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, p = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, p = 0.015). Discussion Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, p = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable.
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Affiliation(s)
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Andrea De Palma
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Maria Mavromati
- Service D'endocrinologie, Diabétologie, Nutrition et éducation du Patient, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Paulina Kuczma
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Giacomo Di Filippo
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Eleonora Morelli
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | | | | | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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13
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Boucai L, Zafereo M, Cabanillas ME. Thyroid Cancer: A Review. JAMA 2024; 331:425-435. [PMID: 38319329 DOI: 10.1001/jama.2023.26348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Importance Approximately 43 720 new cases of thyroid carcinoma are expected to be diagnosed in 2023 in the US. Five-year relative survival is approximately 98.5%. This review summarizes current evidence regarding pathophysiology, diagnosis, and management of early-stage and advanced thyroid cancer. Observations Papillary thyroid cancer accounts for approximately 84% of all thyroid cancers. Papillary, follicular (≈4%), and oncocytic (≈2%) forms arise from thyroid follicular cells and are termed well-differentiated thyroid cancer. Aggressive forms of follicular cell-derived thyroid cancer are poorly differentiated thyroid cancer (≈5%) and anaplastic thyroid cancer (≈1%). Medullary thyroid cancer (≈4%) arises from parafollicular C cells. Most cases of well-differentiated thyroid cancer are asymptomatic and detected during physical examination or incidentally found on diagnostic imaging studies. For microcarcinomas (≤1 cm), observation without surgical resection can be considered. For tumors larger than 1 cm with or without lymph node metastases, surgery with or without radioactive iodine is curative in most cases. Surgical resection is the preferred approach for patients with recurrent locoregional disease. For metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy (eg, lenvatinib, dabrafenib). Antiangiogenic multikinase inhibitors (eg, sorafenib, lenvatinib, cabozantinib) are approved for thyroid cancer that does not respond to radioactive iodine, with response rates 12% to 65%. Targeted therapies such as dabrafenib and selpercatinib are directed to genetic mutations (BRAF, RET, NTRK, MEK) that give rise to thyroid cancer and are used in patients with advanced thyroid carcinoma. Conclusions Approximately 44 000 new cases of thyroid cancer are diagnosed each year in the US, with a 5-year relative survival of 98.5%. Surgery is curative in most cases of well-differentiated thyroid cancer. Radioactive iodine treatment after surgery improves overall survival in patients at high risk of recurrence. Antiangiogenic multikinase inhibitors and targeted therapies to genetic mutations that give rise to thyroid cancer are increasingly used in the treatment of metastatic disease.
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Affiliation(s)
- Laura Boucai
- Department of Medicine, Division of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Zafereo
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, Texas
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14
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Sartori PV, Andreani S, De Pasquale L, Pauna I, Bulfamante AM, Aiello PSL, Melcarne R, Giacomelli L, Boniardi M. How to Manage Advanced Differentiated Thyroid Cancer: Step-by-Step Analysis from Two Italian Tertiary Referral Centers. J Clin Med 2024; 13:708. [PMID: 38337400 PMCID: PMC10856418 DOI: 10.3390/jcm13030708] [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: 11/28/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) has an excellent prognosis; however, advanced disease is associated with a worse prognosis and is relatively common. Surgery followed by RAI treatment remains the mainstream treatment for a large majority of patients with high- and intermediate-risk DTC, but its benefits should be carefully weighed against the potential for harm. The aim of this paper is to critically review the experience in treating advanced DTC at two tertiary referral centers in Italy. METHODS Retrospective analysis of 300 patients who underwent surgery for ADTC over 30 years. RESULTS The complication rate was 50.33%. A total of 135 patients (45%) remained at regular follow-up, 118 (87.4%) were alive, while 17 (12.6%) were deceased. The mean overall survival at 12 years was 84.8% with a mean of 238 months. Eleven patients (8.1%) experienced a relapse after a median of 13 months. CONCLUSIONS ADTC patients adequately treated can achieve prolonged survival even in the case of metastasis or disease relapse. Patients with ADTC should be referred to high-volume centers with the availability of an extended multidisciplinary team to receive tailored treatment.
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Affiliation(s)
| | - Sara Andreani
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy;
| | - Iuliana Pauna
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Antonio Mario Bulfamante
- Pediatric Otolaryngology Unit, ASST Fatebenefratelli-Sacco, Buzzi Children Hospital, 20162 Milan, Italy;
| | | | - Rossella Melcarne
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Laura Giacomelli
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Marco Boniardi
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
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15
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Maniam P, Ishii H, Stechman MJ, Watkinson J, Farnell K, Kim D, Nixon IJ. A study of variation in therapeutic approach to low-risk differentiated thyroid cancer in the UK. J Laryngol Otol 2024; 138:83-88. [PMID: 37194495 DOI: 10.1017/s0022215123000841] [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] [Indexed: 05/18/2023]
Abstract
BACKGROUND The British Thyroid Association and American Thyroid Association guideline definitions for low-risk differentiated thyroid cancers are susceptible to differing interpretations, resulting in different clinical management in the UK. OBJECTIVE To explore the national effect of these guidelines on the management of low-risk differentiated thyroid cancers. METHODS Anonymised questionnaires were sent to multidisciplinary teams performing thyroidectomies in the UK. Risk factors that multidisciplinary teams considered important when managing low-risk differentiated thyroid cancers were established. RESULTS Most surgeons (71 out of 75; 94.7 per cent) confirmed they were core multidisciplinary team members. More than 80 per cent of respondents performed at least 30 hemi- and/or total thyroidectomies per annum. A majority of multidisciplinary teams (50 out of 75; 66.7 per cent) followed British Thyroid Association guidelines. Risk factors considered important when managing low-risk differentiated thyroid cancers included: type of tumour histology findings (87.8 per cent), tumour size of greater than 4 cm (86.5 per cent), tumour stage T3b (85.1 per cent) and central neck node involvement (85.1 per cent). Extent of thyroid surgery (e.g. hemi- or total thyroidectomy) was highly variable for low-risk differentiated thyroid cancers. CONCLUSION Management of low-risk differentiated thyroid cancers is highly variable, leading to a heterogeneous patient experience.
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Affiliation(s)
- Pavithran Maniam
- Department of ENT, Head and Neck Surgery, NHS Lothian, Edinburgh, Scotland, UK
| | - Hiro Ishii
- Department of ENT, Head and Neck Surgery, St George's Hospital, London, UK
| | - Michael J Stechman
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, Wales, UK
| | - John Watkinson
- Department of Surgery, Great Ormond Street Hospital, London, UK
| | - Kate Farnell
- Butterfly Thyroid Cancer Trust, Rowlands Gill, Tyne and Wear, UK
| | - Dae Kim
- Department of ENT, Head and Neck Surgery, St George's Hospital, London, UK
| | - Ian J Nixon
- Department of ENT, Head and Neck Surgery, NHS Lothian, Edinburgh, Scotland, UK
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16
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Gao TP, Green RL, Kuo LE. Disparities in Access to High-Volume Surgeons and Specialized Care. Endocrinol Metab Clin North Am 2023; 52:689-703. [PMID: 37865482 DOI: 10.1016/j.ecl.2023.05.006] [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] [Indexed: 10/23/2023]
Abstract
The significant volume-outcome relationship has triggered interest in improving quality of care by directing patients to high-volume centers and surgeons. However, significant disparities exist for different racial/ethnic, geographic, and socioeconomic groups for thyroid, parathyroid, adrenal, and pancreatic neuroendocrine surgical diseases disease.
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Affiliation(s)
- Terry P Gao
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA
| | - Rebecca L Green
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA
| | - Lindsay E Kuo
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA.
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17
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Yang X, Wang Y, Luo Y, Guo T, Zhang G. A dynamic study of the postoperative management of thyroid cancer from 2003 to 2022: a bibliometric analysis. Gland Surg 2023; 12:1579-1593. [PMID: 38107489 PMCID: PMC10721565 DOI: 10.21037/gs-23-218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/22/2023] [Indexed: 12/19/2023]
Abstract
Background Over the past 20 years, the global incidence of thyroid cancer has continued to increase. The volume of literature on the postoperative management of thyroid cancer comprises 1,040 articles, from 64 countries, with 1,400 journals publishing the relevant literature, and several guidelines on the treatment of thyroid cancer. This study used bibliometric methods to identify research hotspots and explore future directions in this field. Methods We comprehensively searched the Science Citation Index Expanded (SCI-E) database of the Web of Science Core Collection (WOSCC) for articles published from 2003 to 2022 on the postoperative management of thyroid cancer. Using CiteSpace 6.1.R6 and Microsoft Office Excel 2010, we evaluated and visualized the search results. Using R Studio, we generated a network of spatial geographic distribution maps and cooperative network. Results A total of 1,040 publications were included in the study. The results revealed an overall upward trend in the number of publications and citations over the past 20 years. The United States of America (USA) had the largest number of publications and the highest centrality (n=282, centrality =0.28). Johns Hopkins University had highest centrality (centrality =0.15) and was the academic center of the field. Thyroid was the journal with the highest number of citations (n=826), and the American Journal of Surgical Pathology was the journal with the highest centrality (centrality =0.08). The top 10 citations in the literature were mainly guidelines and consensus statements on the management of thyroid cancer. A keyword-based clustering analysis revealed the prominence of clusters of keywords, such as follow-up, recurrent laryngeal nerve, and medullary thyroid carcinoma (MTC). A keyword burst detection analysis showed that the term papillary had the highest burst intensity (strength =8.02), while management guidelines, association guidelines, active surveillance (AS), microcarcinoma, and differentiated thyroid cancer were the current burst words. Conclusions Over the past two decades, the number of relevant publications in the postoperative management of thyroid cancer field has continued to grow. Among the many research directions, follow-up, recurrent laryngeal nerve, and MTC are research hotspots. Future research is likely to revolve around guidelines and consensus statements on the management of thyroid cancer, AS, and microcarcinoma in differentiated thyroid cancer.
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Affiliation(s)
- Xi Yang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yiming Wang
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yunpeng Luo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Teng Guo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Guangde Zhang
- Department of Endocrinology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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18
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Paladino NC, Remde H, Guerin C, Morange I, Taïeb D, Sebag F. Accidental parathyroidectomy during total thyroidectomy and hypoparathyroidism in a large series of 766 patients: incidence and consequences in a referral center. Langenbecks Arch Surg 2023; 408:393. [PMID: 37817055 DOI: 10.1007/s00423-023-03130-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Transient hypoparathyroidism is the most common complication after total thyroidectomy, and accidental parathyroidectomy (AP) may be a cause. The aim of this study was to investigate the incidence of AP and its impact on postoperative calcemia. MATERIALS AND METHODS From February 2016 to May 2018, 766 patients undergoing total thyroidectomy were prospectively included. Surgical indications, hormonal status, definitive histology, and postoperative calcium and PTH levels were analyzed. RESULTS 578/(75.45%) were women and 188/(24.55%) men with mean age of 53.4 years. Parathyroid tissue on the thyroid specimen was observed in 40 (5.2%) patients: 30 APs and 10 parathyroid fragments. Among the 30 APs, 12 glands were intrathyroid and 18 (2.3%) in eutopic location. 97 (12.6%) patients were treated for postoperative hypocalcemia: 90 (11.7%) had transient and 5 (0.6%) definitive hypoparathyroidism; 2 were lost in follow-up. 13/30 (43.3%) with AP had transient hypoparathyroidism. A strong correlation was found (p < 0.0001) between AP and postoperative hypocalcemia. 1/30 (3.3%) patient with APs had definitive hypoparathyroidism. Transient and persistent nerve palsies were found in 10 (1.3%) and 3 (0.4%) patients, respectively. DISCUSSION A careful examination of the thyroid gland after resection help to identify an AP that could be autotransplanted. Surgeon and hospital activity volume per years seem to reduce the risk of hypoparathyroidism. CONCLUSION Total thyroidectomy and intrathyroid localization of parathyroid glands are risk factors for the AP. The incidence of AP was 2.3%, and this remains low due to our longstanding experience in thyroid and parathyroid surgery.
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Affiliation(s)
- Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France.
| | - Hanna Remde
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France
| | - Carole Guerin
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France
| | - Isabelle Morange
- Department of Endocrinology, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Frédéric Sebag
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France
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19
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Ezzy M, Alameer E. Predictors and Preventive Strategies of Bleeding After Thyroid Surgery. Cureus 2023; 15:e47575. [PMID: 38021981 PMCID: PMC10666654 DOI: 10.7759/cureus.47575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Postoperative compressive neck hematoma occurs in approximately 0.1% to 1.7% of cases, most occurring within the first six hours after surgery. Thyroid pathology, patient predisposition, and surgical technique are major risk factors for postoperative hematoma. This narrative review describes current perspectives on predicting and preventing bleeding following thyroid surgery. Predictors of bleeding after thyroid surgery include patient-related factors such as male sex and age, surgery-related factors like total thyroidectomy and operations for thyroid malignancy, and surgeon-related factors. Hemostasis is the primary focus after preserving critical structures in thyroid surgery. The clamp-and-tie technique has been the standard method for dividing the thyroid gland's main vascular pedicles for many years. Bipolar electrocautery has been used for vessels of small size. However, advanced bipolar and ultrasound energy and hybrid devices are now available options that may reduce operative time without increasing costs or complications. In cases where small bleeders close to critical structures are present and the clamp-and-tie technique is not feasible, hemostatic agents are commonly used. Drains do not appear to provide any significant benefits in preventing the sequelae of bleeding after thyroid surgery.
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Affiliation(s)
- Mohsen Ezzy
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Ehab Alameer
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
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20
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Orlando G, Graceffa G, Mazzola S, Vassallo F, Proclamà MP, Richiusa P, Radellini S, Paladino NC, Melfa G, Scerrino G. The Role of "Critical" Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1484. [PMID: 37629774 PMCID: PMC10456377 DOI: 10.3390/medicina59081484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Bethesda III (BIII) thyroid nodules have an expected malignancy rate of 5-15%. Our purpose was to assess which US criteria are most associated with cancer risk, and the value of critical ultrasound (US) reassessment. Methods: From 2018 to 2022, 298 BIII nodules were enrolled for thyroidectomy (79 malignancies). We evaluated ultrasonographic data: hechogenicity, intralesional vascularization, spiculated margins, micro-calcifications, "taller than wide" shape, extra-thyroidal growth, size increase, as well as their association with histology. We also evaluated if the ultrasound reassessment modified the strategy. Results: Spiculated margins and microcalcification were significantly correlated with malignancy risk. Spiculated margins showed a specificity of 0.95 IC95% (0.93-0.98); sensitivity 0.70 IC95% (0.59-0.80). Microcalcifications showed a sensitivity of 0.87 CI95% (0.80-0.94); specificity 0.75 CI95% (0.72-0.83). The presence of these signs readdressed the strategy in 76/79 cases Then, the indication for surgery was appropriate in 75% of cases. Conclusions: Microcalcifications and spiculated margins should be routinely sought during a final ultrasound reassessment in BIII nodules. These signs allowed for a modification of the strategy in favor of surgery in 96% of the cases that were not otherwise referred to surgery. The importance of integrating ultrasound and cytology in the evaluation of BIII thyroid nodules is confirmed. Reassessment with ultrasound of BIII nodules allowed for a redirection of the surgical choice.
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Affiliation(s)
- Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Giuseppa Graceffa
- Unit of Oncological Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone”, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
| | - Fabrizio Vassallo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Maria Pia Proclamà
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Stefano Radellini
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005 Marseille, France
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
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21
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Canu GL, Cappellacci F, Abdallah A, Elzahaby I, Figueroa-Bohorquez D, Lori E, Miller JA, Pavia SZ, Pinillos P, Pongtippan A, Saleh SS, Sorrenti S, Sriphrapradang C, Calò PG, Medas F. Surgical Management of Indeterminate Thyroid Nodules across Different World Regions: Results from a Retrospective Multicentric (the MAIN-NODE) Study. Cancers (Basel) 2023; 15:3996. [PMID: 37568811 PMCID: PMC10416924 DOI: 10.3390/cancers15153996] [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: 06/07/2023] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Indeterminate thyroid nodules (ITNs) are characterized by an expected malignancy ranging from 5% to 30%, with most patients undergoing a diagnostic, rather than therapeutic, operation. The aim of our study was to compare the approach to ITNs across different regions of the world. In this retrospective, multicentric, international study, according to the WHO classification, we identified the South East Asian Region (SEAR), the Americas Region (AMR), the Eastern Mediterranean Region (EMR), the Europe Region (EUR), and the Western Pacific Region (WPR). One high-volume thyroid centre was included for each region. Demographic, preoperative, and pathologic data were compared among the different regions. Overall, 5737 patients from five high-volume thyroid centres were included in this study. We found that the proportion of ITNs over the global activity for thyroid disease was higher in the EUR (37.6%) than in the other regions (21.1-23.6%). In the EMR, the patients were significantly younger (with a mean of 43.1 years) than in the other regions (range, 48.8-57.4 years). The proportion of lobectomy was significantly higher in the WPR, where 83.2% (114/137) of patients received this treatment, than in the other regions, where lobectomies were performed in 44.1-58.1% of patients. The pathological diagnosis of malignancy was significantly higher in the SEAR centre, being over 60%, than in centres of the other regions, where it ranged from 26.3% to 41.3%. The occurrence of lymph node metastases was higher in the WPR (27.8%), AMR (26.9%), and EMR (20%) centres than in the EUR and SEAR centres, where it was lower than 10%. In summary, we found in our study different approaches and outcomes in the diagnosis and treatment of ITNs among countries. Overall, almost 60% of patients with ITNs who underwent surgery actually presented a benign disease, potentially undergoing an unnecessary operation.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (P.G.C.)
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (P.G.C.)
| | - Ahmed Abdallah
- Surgical Oncology, Mansoura University, Mansoura 35516, Egypt; (A.A.); (I.E.); (S.S.S.)
| | - Islam Elzahaby
- Surgical Oncology, Mansoura University, Mansoura 35516, Egypt; (A.A.); (I.E.); (S.S.S.)
| | - David Figueroa-Bohorquez
- Head and Neck Surgery, Hospital Universitario Nacional de Colombia, Bogotá 250247, Colombia; (D.F.-B.); (S.Z.P.); (P.P.)
| | - Eleonora Lori
- Department of Surgery, “Sapienza” University of Rome, 00185 Rome, Italy; (E.L.); (S.S.)
| | - Julie A. Miller
- The Royal Melbourne Hospital and Epworth Hospital, Melbourne, VIC 3121, Australia;
| | - Sergio Zúñiga Pavia
- Head and Neck Surgery, Hospital Universitario Nacional de Colombia, Bogotá 250247, Colombia; (D.F.-B.); (S.Z.P.); (P.P.)
| | - Pilar Pinillos
- Head and Neck Surgery, Hospital Universitario Nacional de Colombia, Bogotá 250247, Colombia; (D.F.-B.); (S.Z.P.); (P.P.)
| | - Atcharaporn Pongtippan
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Saleh Saleh Saleh
- Surgical Oncology, Mansoura University, Mansoura 35516, Egypt; (A.A.); (I.E.); (S.S.S.)
| | - Salvatore Sorrenti
- Department of Surgery, “Sapienza” University of Rome, 00185 Rome, Italy; (E.L.); (S.S.)
| | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (P.G.C.)
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (P.G.C.)
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22
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Yang Z, Heng Y, Zhao Q, Hao D, Tao L, Deng X, Cai W, Qiu W. The proposed modification of TNM staging and therapeutic strategy for skip metastasis in papillary thyroid carcinoma: A multicenter retrospective cohort study. Cancer Med 2023. [PMID: 37140212 DOI: 10.1002/cam4.6018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/18/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Skip metastasis is a special type of lateral lymph node metastasis, which is not classified definitely by the eighth edition of the AJCC TNM staging system. The aim of the research was to study the prognosis of skip metastasis in PTC patients, and carry out a more appropriate N staging for skip metastasis. METHODS Study subjects were 3167 patients with papillary thyroid carcinoma (PTC), who underwent thyroidectomy at three clinical centers from 2016 to 2019. We identified two well-balanced cohorts matched on the basis of propensity score. RESULTS During a median follow-up of 42 months, recurrence occurred in 68 (4.3%) patients with lymph node metastasis. 34 cases recurred in 1120 patients with central lymph node metastasis (N1a), and 34 recurred in 461 patients with lateral lymph node metastasis (N1b), among which 73 patients were diagnosis with skip metastasis. The RFS of N1a was significantly lower than that of N1b (p < 0.001). After propensity-score matching, recurrence rate was significantly lower in the skip metastasis group than in the LLNM group (p = 0.039), whereas the rate was similar in the skip metastasis groups and the CLNM group (p = 0.29). CONCLUSIONS In conclusion, our study indicated that, among patients with LLNM, those with positive skip metastasis showed significantly lower recurrence, exhibiting a similar rucurrence tendency as patients with CLNM. Thus, skip metastasis could be categorized into N1a stage rather than N1b stage based on the AJCC TNM staging system. The downstaging of skip metastasis may reveal more conservative treatment strategy.
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Affiliation(s)
- Zheyu Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu Heng
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Qiwu Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ding Hao
- Department of General Surgery, Civil Aviation Shanghai Hospital, Shanghai, China
| | - Lei Tao
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Xiaxing Deng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of General Surgery, Civil Aviation Shanghai Hospital, Shanghai, China
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23
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Piyade HB, Başoğlu M, Gürsoy E. The effect of different therapeutic treatments on the frequency of postoperative hypocalcemia in patients with thyroidectomy. Turk J Surg 2023; 39:70-75. [PMID: 37275930 PMCID: PMC10234705 DOI: 10.47717/turkjsurg.2023.5886] [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: 09/01/2022] [Accepted: 01/16/2023] [Indexed: 06/07/2023]
Abstract
Objectives Thyroid gland surgery and its surgical complications are situations that a surgeon frequently encounters in his daily practice. In our study, it was aimed to examine the effect of different treatment methods given to patients who underwent thyroidectomy on hypocalcemia. Material and Methods Three hundred and seventy-one patients who underwent thyroidectomy at Ondokuz Mayıs University Medical Faculty General Surgery clinic between December 2016 and January 2021 were retrospectively included in the study. Parameters such as surgery indications, fine needle aspiration biopsy results, preoperative serum calcium values, type of surgery, serum calcium values at postoperative 1st day and 1st month, postoperative hospital stay, drugs prescribed at discharge, histopathological diagnosis of the patient, and whether there was incidental parathyroidectomy or not were included. Results Mean age of 371 patients who underwent thyroidectomy was 49 (19-82) years. Total thyroidectomy was the most common type of thyroidectomy with 61% (n= 225) of the patients. There was a significant decrease in pre-op and post-op calcium values in all three types of surgery performed on the patients, and there was no significant difference between the different types of surgery. Post-operative day one and month one serum calcium values were significantly increased in all groups (p= .000). The increase in post-op serum calcium level was most common in the group using calcium carbonate + cholecalciferol + calcitriol. Conclusion The use of post-op calcitriol in patients undergoing thyroidectomy seems to be quite effective in preventing the development of hypocalcemia.
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Affiliation(s)
| | - Mahmut Başoğlu
- Department of General Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Ersan Gürsoy
- Department of Family Medicine, Binali Yıldırım University Faculty of Medicine, Erzincan, Türkiye
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24
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Rajan S, Gracie D, Aspinall S. Does Surgeon Volume Impact Morbidity Following Parathyroidectomy? A Study of 16,140 Parathyroidectomies from the UK Registry of Endocrine and Thyroid Surgery (UKRETS) Database. World J Surg 2023; 47:1221-1230. [PMID: 36593341 DOI: 10.1007/s00268-022-06863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Outcomes in endocrine surgery have been shown to improve with surgeon volume. We aimed to study the effect of surgeon volume on morbidity following parathyroidectomy. METHODS UKRETS data from 2004 to 2019 was studied. Parathyroidectomies for primary hyperparathyroidism with complete data were included. Exclusion criteria were age <18 or >80 years; surgeons contributing <10 cases overall; and length of stay >28 days. Multivariable analysis was performed. Primary outcome was persistent hypercalcaemia; secondary outcomes were haemorrhage, length of stay, need for re-admission, post-operative hypocalcaemia, and need for calcium/vitamin D supplements to maintain eucalcaemia at 6 months. RESULTS 153 surgeons undertook mean 22.5 (median 17, range 2-115) parathyroidectomies/year. Persistent hypercalcaemia affected 4.8% (776/16140) overall; 5.7% (71/1242) in surgeons undertaking < 10 cases/year; 5.1% (3339/6617) for 10-30 cases/year; 5.0% (270/5397) for 30-50 cases; and 3.3% (96/2884) for >50 cases/year. High-volume (>50 parathyroidectomies/year) surgeons operated 23.4% (809/3464) of negative localisation cases compared to 16.4% (2074/12676) of positive localisation cases. Persistent hypercalcaemia was almost twice as common in image negative (7.9%) compared to image-positive (4%) cases. Persistent hypercalcaemia was significantly more likely to occur in the low volume (<10 parathyroidectomies/year) group than high volume (>50 parathyroidectomies/year), regardless of image positivity (p = 0.0006). Surgeon volume significantly reduced persistent hypercalcaemia on multivariable analysis (OR = 0.878, 95%CI 0.842-0.914, p < 0.001), along with age, sex, and positive localisation. BNE and re-operation significantly increased persistent hypercalcaemia. Post-operative hypocalcaemia occurred in 3.2% (509/16040) and was reduced with increasing surgeon volume (OR = 0.951, 95%CI 0.910-0.993, p < 0.001). Haemorrhage and length of stay were not significantly associated with surgeon volume. CONCLUSION The incidence of persistent hypercalcaemia, post-operative hypocalcaemia, and persistent hypoparathyroidism decreased with increasing surgeon volume. The relative reduction in persistent hypercalcaemia with surgeon volume was similar in image negative and positive groups, but the absolute reduction was higher in image negative cases. Restricting image negative parathyroidectomy to high-volume surgeons could be considered.
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Affiliation(s)
- Sendhil Rajan
- General and Endocrine Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, UK
| | - Dale Gracie
- Paediatric Surgery, Royal Hospital of Children and Young People, Edinburgh, UK
| | - Sebastian Aspinall
- General and Endocrine Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, UK.
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25
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Papini E, Crescenzi A, D’Amore A, Deandrea M, De Benedictis A, Frasoldati A, Garberoglio R, Guglielmi R, Lombardi CP, Mauri G, Miceli RE, Puglisi S, Rago T, Salvatore D, Triggiani V, Van Doorne D, Mitrova Z, Saulle R, Vecchi S, Basile M, Scoppola A, Paoletta A, Persichetti A, Samperi I, Cozzi R, Grimaldi F, Boniardi M, Camaioni A, Elisei R, Guastamacchia E, Nati G, Novo T, Salvatori M, Spiezia S, Vallone G, Zini M, Attanasio R. Italian Guidelines for the Management of Non-Functioning Benign and Locally Symptomatic Thyroid Nodules. Endocr Metab Immune Disord Drug Targets 2023; 23:876-885. [PMID: 36722479 PMCID: PMC10245801 DOI: 10.2174/1871530323666230201104112] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
AIM This guideline (GL) is aimed at providing a reference for the management of non-functioning, benign thyroid nodules causing local symptoms in adults outside of pregnancy. METHODS This GL has been developed following the methods described in the Manual of the National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology (AME) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" were considered in the systematic review of evidence and only those classified as "critical" were considered in the formulation of recommendations. RESULTS The present GL contains recommendations about the respective roles of surgery and minimally invasive treatments for the management of benign symptomatic thyroid nodules. We suggest hemithyroidectomy plus isthmectomy as the first-choice surgical treatment, provided that clinically significant disease is not present in the contralateral thyroid lobe. Total thyroidectomy should be considered for patients with clinically significant disease in the contralateral thyroid lobe. We suggest considering thermo-ablation as an alternative option to surgery for patients with a symptomatic, solid, benign, single, or dominant thyroid nodule. These recommendations apply to outpatients, either in primary care or when referred to specialists. CONCLUSION The present GL is directed to endocrinologists, surgeons, and interventional radiologists working in hospitals, in territorial services, or private practice, general practitioners, and patients. The available data suggest that the implementation of this GL recommendations will result in the progressive reduction of surgical procedures for benign thyroid nodular disease, with a decreased number of admissions to surgical departments for non-malignant conditions and more rapid access to patients with thyroid cancer. Importantly, a reduction of indirect costs due to long-term replacement therapy and the management of surgical complications may also be speculated.
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Affiliation(s)
- Enrico Papini
- Department of Endocrine and Metabolic Diseases, Ospedale Regina Apostolorum, Albano Laziale, Rome, Italy
| | - Anna Crescenzi
- Department of Endocrine Organs and Neuromuscolar Pathology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Annamaria D’Amore
- Endocrine Surgery Division, Agostino Gemelli School of Medicine, University Foundation Polyclinic, Rome, Italy
| | - Maurilio Deandrea
- Endocrinology and Center for Thyroid Diseases, Ospedale Mauriziano “Umberto I”, Turin, Italy
| | - Anna De Benedictis
- Quality Management - Clinical Direction, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Frasoldati
- Struttura Complessa di Endocrinologia, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Roberto Garberoglio
- Freelancer at Thyroid Multidisciplinary Center at Humanitas Cellin, Turin, Italy
| | - Rinaldo Guglielmi
- Department of Endocrine and Metabolic Diseases, Ospedale Regina Apostolorum, Albano Laziale, Rome, Italy
| | - Celestino Pio Lombardi
- Endocrine Surgery Division, Agostino Gemelli School of Medicine, University Foundation Polyclinic, Rome, Italy
| | - Giovanni Mauri
- Interventional Radiology, IRCCS European Institute of Oncology, Milan, Italy
| | | | - Soraya Puglisi
- Department of Clinical and Biological Sciences, Internal Medicine, AOU San Luigi di Orbassano, University of Turin, Turin, Italy
| | - Teresa Rago
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari, Bari, Italy
| | - Dominique Van Doorne
- Associazione Medici Endocrinologi, Relationship with Patients’ Associations, RomeItaly
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Michele Basile
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Agnese Persichetti
- Department of Firefighters, Public Rescue and Civil Defense, Ministry of Interior, Rome, Italy
| | - Irene Samperi
- Department of Endocrinology, ASL Novara, Novara, Italy
| | - Renato Cozzi
- President of Associazione Medici Endocrinologi, Milan, Italy
| | - Franco Grimaldi
- Past-president of Associazione Medici Endocrinologi, Udine, Italy
| | - Marco Boniardi
- General Oncologic and Mini-invasive Surgery Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Camaioni
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari, Bari, Italy
| | | | - Tommaso Novo
- Department of Endocrinology, Santa Maria Nuova Hospital, Turin, Italy
| | - Massimo Salvatori
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS and Department of Radiological and Hematological Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Stefano Spiezia
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, Naples, Italy
| | | | - Michele Zini
- Struttura Complessa di Endocrinologia, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy
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Melfa G, Siragusa G, Cocorullo G, Guzzino M, Raspanti C, Albanese L, Mazzola S, Richiusa P, Orlando G, Scerrino G. Effects of Intraoperative Nerve Monitoring Techniques on Voice and Swallowing Disorders after Uncomplicated Thyroidectomy: Preliminary Report of a Bi-Institutional Prospective Study. J Clin Med 2022; 12:jcm12010305. [PMID: 36615105 PMCID: PMC9821617 DOI: 10.3390/jcm12010305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Voice and swallowing problems are frequently associated with thyroidectomy. Intermittent nerve monitoring (i-IONM) seems to provide a positive effect in reducing its prevalence. The aim of this study was to test the hypothesis that continuous intraoperative nerve monitoring (c-IONM) may reduce the prevalence of these disorders even further than i-IONM. Methods: This 3-arm prospective bi-institutional study compared 179 consecutive patients that underwent thyroidectomy: 56 without IONM, 55 with i-IONM and 67 with c-IONM. Neck dissections and laryngeal nerve palsies were excluded. Two questionnaires (VHI-10 for voice disorders and EAT-10 for swallowing disorders; both validated for Italian language use) were administered before and 1 month after surgery. Statistical significance was analyzed by the chi-squared test. Results: After thyroidectomy, no statistically significant differences were found in the three groups concerning EAT-10. although these symptoms seemed to be influenced by gastro-esophageal reflux. VHI-10 worsened in the “no-IONM” group compared with both i-IONM (p < 0.09, not quite statistically significant) and c-IONM (p < 0.04). Conclusion: Both i- and c-IONM improve voice quality independently of laryngeal nerve integrity. Reduced dissection and particularly restrained manipulation could explain these results, being particularly favorable for c-IONM.
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Affiliation(s)
- Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | | | - Gianfranco Cocorullo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Marianna Guzzino
- Villa Serena Clinic—Unit of General Surgery, 90100 Palermo, Italy
| | - Cristina Raspanti
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Leone Albanese
- Villa Serena Clinic—Unit of General Surgery, 90100 Palermo, Italy
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Pierina Richiusa
- Section of Endocrinology—Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
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27
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Lebbink CA, Links TP, Czarniecka A, Dias RP, Elisei R, Izatt L, Krude H, Lorenz K, Luster M, Newbold K, Piccardo A, Sobrinho-Simões M, Takano T, Paul van Trotsenburg AS, Verburg FA, van Santen HM. 2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma. Eur Thyroid J 2022; 11:e220146. [PMID: 36228315 PMCID: PMC9716393 DOI: 10.1530/etj-22-0146] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022] Open
Abstract
At present, no European recommendations for the management of pediatric thyroid nodules and differentiated thyroid carcinoma (DTC) exist. Differences in clinical, molecular, and pathological characteristics between pediatric and adult DTC emphasize the need for specific recommendations for the pediatric population. An expert panel was instituted by the executive committee of the European Thyroid Association including an international community of experts from a variety of disciplines including pediatric and adult endocrinology, pathology, endocrine surgery, nuclear medicine, clinical genetics, and oncology. The 2015 American Thyroid Association Pediatric Guideline was used as framework for the present guideline. Areas of discordance were identified, and clinical questions were formulated. The expert panel members discussed the evidence and formulated recommendations based on the latest evidence and expert opinion. Children with a thyroid nodule or DTC require expert care in an experienced center. The present guideline provides guidance for healthcare professionals to make well-considered decisions together with patients and parents regarding diagnosis, treatment, and follow-up of pediatric thyroid nodules and DTC.
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Affiliation(s)
- Chantal A Lebbink
- Wilhelmina Children’s Hospital and Princess Máxima Center, Utrecht, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Renuka P Dias
- Department of Paediatric Endocrinology and Diabetes, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Louise Izatt
- Department of Clinical Genetics, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Heiko Krude
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin, Berlin, Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kate Newbold
- Thyroid Therapy Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, EO Ospedali Galliera, Genoa, Italy
| | - Manuel Sobrinho-Simões
- University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Toru Takano
- Thyroid Center, Rinku General Medical Center, Osaka, Japan
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanneke M van Santen
- Wilhelmina Children’s Hospital and Princess Máxima Center, Utrecht, The Netherlands
- Correspondence should be addressed to H M van Santen;
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Risk factors for difficult thyroidectomy and postoperative morbidity do not match: retrospective study from an endocrine surgery academic referral centre. Updates Surg 2022; 74:1943-1951. [PMID: 36063287 DOI: 10.1007/s13304-022-01371-w] [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: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51-310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (p = 0.005), BMI (p < 0.001), thyroiditis (p < 0.05), hypervascular goiter (p = 0.003) and thyroid adhesions to surrounding anatomical structures (p < 0.001) were associated with longer operating time. At multivariable analysis male male sex (p = 0.01), obesity (p = 0.001) and thyroid adhesions (p = 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (p < 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.
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de la Fuente Bartolomé M, Sánchez de Molina Rampérez ML, García Vasquez C, Vieiro Medina MV, Jiménez de Los Galanes Marchan SF. Management of thyroid and parathyroid surgery in major ambulatory surgery. Cir Esp 2022; 100:601-603. [PMID: 35697241 DOI: 10.1016/j.cireng.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 06/15/2023]
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Intra-operative nerve monitoring and recurrent laryngeal nerve injury during thyroid surgery: a network meta-analysis of prospective studies. Langenbecks Arch Surg 2022; 407:3209-3219. [PMID: 35953619 DOI: 10.1007/s00423-022-02651-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Recurrent laryngeal nerve (RLN) injury is a feared complication of thyroid surgery occurring in 1-5% of cases. The present approaches to RLN preservation include RLN visualization with no nerve monitoring (No-NM), intermittent intra-operative nerve monitoring (I-IONM) and continuous intra-operative nerve monitoring (C-IONM). There is ambiguity as to which of these strategies should be the preferred method of RLN preservation. METHODS A systematic review of the PubMed, Embase and the Cochrane Collaboration databases was undertaken with network meta-analysis (NMA) performed according to the PRISMA and Cochrane Collaboration guidelines. A Bayesian NMA was conducted using R packages netmeta with outcomes expressed as odds ratios (ORs) with 95% credible intervals (CrI). Only prospective studies were included. RESULTS Eighteen studies met inclusion criteria, including 22,080 patients and 40,642 nerves at risk (NAR). Overall, 23,364 NARs (57.5%) underwent I-IONM, 17,176 (42.3%) No-NM and 98 (0.2%) underwent C-IONM. There were no significant differences between groups regarding the incidence of permanent RLN injury following thyroid surgery (I-IONM vs.No-NM, OR 0.84, 95% CrI 0.55-1.19; C-IONM vs. No-NM, OR 0.44, 95% CrI 0.02-5.00). Pooled analysis showed that IONM (I-IONM or C-IONM) demonstrated a protective effect versus No-NM in reducing the incidence of transient RLN injury (OR 0.75, 95% CI 0.59-0.97, p = 0.03). CONCLUSIONS IONM strategies did not significantly reduce the incidence of permanent RLN injury following thyroid surgery. However, the small number of C-IONM NARs limits conclusions that may be drawn. Further well-designed prospective studies will be required to definitively assess the utility of C-IONM.
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Eskander A, Noel CW, Griffiths R, Pasternak JD, Higgins K, Urbach D, Goldstein DP, Irish JC, Fu R. Surgeon Thyroidectomy Case Volume Impacts Disease-free Survival in the Management of Thyroid Cancer. Laryngoscope 2022; 133 Suppl 4:S1-S15. [PMID: 35796293 DOI: 10.1002/lary.30276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To assess the association between surgeons thyroidectomy case volume and disease-free survival (DFS) for patients with well-differentiated thyroid cancer (WDTC). A secondary objective was to assess a surgeon volume cutoff to optimize outcomes in those with WDTC. We hypothesized that surgeon volume will be an important predictor of DFS in patients with WDTC after adjusting for hospital volume and sociodemographic and clinical factors. METHODS In this retrospective population-based cohort study, we identified WDTC patients in Ontario, Canada, who underwent thyroidectomy confirmed by both hospital-level and surgeon-level administrative data between 1993 and 2017 (N = 37,233). Surgeon and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively and divided into quartiles. A multilevel hierarchical Cox regression model was used to estimate the effect of volume on DFS. RESULTS A crude model without patient or treatment characteristics demonstrated that both higher surgeon volume quartiles (p < 0.001) and higher hospital volume quartiles (p < 0.001) were associated with DFS. After controlling for clustering and patient/treatment covariates and hospital volume, moderately low (18-39/year) and low (0-17/year) volume surgeons (hazard ratios [HR]: 1.23, 95% confidence interval [CI]: 1.09-1.39 and HR: 1.34, 95% CI: 1.17-1.53 respectively) remained an independent statistically significant negative predictor of DFS. CONCLUSION Both high-volume surgeons and hospitals are predictors of better DFS in patients with WDTC. DFS is higher among surgeons performing more than 40 thyroidectomies a year. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Griffiths
- ICES, Toronto, Ontario, Canada.,Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Jesse D Pasternak
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David Urbach
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital and Departments of Surgery, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rui Fu
- Department of Otolaryngology - Head & Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
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32
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Győry F, Lukács G, Fedor R, Andrási M, Kovács D, Tóth D. A pajzsmirigysebészet 100 éve, Akkor és Most. Magy Seb 2022; 75:29-32. [PMID: 35333758 DOI: 10.1556/1046.2021.10006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Ferenc Győry
- Debreceni Egyetem Klinikai Központ, Sebészeti Klinika, Debrecen,Magyarország
| | - Géza Lukács
- Debreceni Egyetem Klinikai Központ, Sebészeti Klinika, Debrecen,Magyarország
| | - Roland Fedor
- Debreceni Egyetem Klinikai Központ, Sebészeti Klinika, Debrecen,Magyarország
| | - Mónika Andrási
- Debreceni Egyetem Klinikai Központ, Sebészeti Klinika, Debrecen,Magyarország
| | - Dávid Kovács
- Debreceni Egyetem Klinikai Központ, Sebészeti Klinika, Debrecen,Magyarország
| | - Dezső Tóth
- Debreceni Egyetem Klinikai Központ, Sebészeti Klinika, Debrecen,Magyarország
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Caulley L, Eskander A, Yang W, Auh E, Cairncross L, Cho NL, Golbon B, Iyer S, Liu JC, Lee PJ, Lindeman B, Meltzer C, Molin N, Moore A, Noel J, Nozolino H, Pasternak J, Price B, Ramsay T, Rolighed L, Sajisevi M, Sharma A, Sinclair C, Sorensen M, Tae K, Tang AL, Tsao G, Williams M, Wrenn S, Xing MH, Zafereo M, Stack BC, Randolph G, Davies L. Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms. JAMA Otolaryngol Head Neck Surg 2021; 148:99-106. [PMID: 34817546 DOI: 10.1001/jamaoto.2021.3277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment. Objective To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size. Design, Setting, and Participants This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed. Main Outcomes and Measures Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period. Results Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]). Conclusions and Relevance Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Edel Auh
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lydia Cairncross
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bahar Golbon
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Jeffrey C Liu
- Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Paul J Lee
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenessa Lindeman
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | | | - Nicole Molin
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alessandra Moore
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Halie Nozolino
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Jesse Pasternak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendon Price
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mirabelle Sajisevi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Meredith Sorensen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Alice L Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gabriel Tsao
- The Permanente Medical Group, Santa Rosa, California
| | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean Wrenn
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer Foundation, New York, New York
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Greg Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Louise Davies
- VA Outcomes Group, White River Junction, Vermont.,Section of Otolaryngology-Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Seki Y, Vonlanthen R, Widmer J, Thalheimer A, Kasama K, Himpens J, Hollyman M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures. Ann Surg 2021; 274:821-828. [PMID: 34334637 DOI: 10.1097/sla.0000000000005117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define "best possible" outcomes for secondary bariatric surgery (BS). BACKGROUND Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. METHODS Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years. RESULTS The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. CONCLUSION Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marie Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Sietske Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | - Ellen Deleus
- Department of General Surgery, University Hospital Leuven, Leuven, Belgium
| | - Aaron Lloyd
- Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California
| | - Emanuele Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - George Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Ivana Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andres San Martin
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Marko Kraljević
- Department of Visceral Surgery, Clarunis: St.Clara Hosptital, Basel, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Sebastien Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d'Azur, Nice, France
| | - Lisa Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Henna Sammalkorpi
- Department ofGastroenterological Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - José Luis Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Amalia Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Las Condes, Santiago, Chile
| | - Talar Tatarian
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Tom Wiggins
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Ekhlas Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | | | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - René Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jeannette Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Jacques Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
- The European School of Laparoscopic Surgery, St Pierre University Hospital, Brussels, Belgium
| | - Marianne Hollyman
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Rajesh Aggarwal
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alec Beekley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Matias Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Las Condes, Santiago, Chile
| | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Anne Juuti
- Department ofGastroenterological Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | | | - Gerhard Prager
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d'Azur, Nice, France
| | - Michel Suter
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis: St.Clara Hosptital, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Camilo Boza
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Raul Rosenthal
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Kelvin Higa
- Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California
| | - Matthias Lannoo
- Department of General Surgery, University Hospital Leuven, Leuven, Belgium
| | - Eric J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dimitri A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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35
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Sessa L, De Crea C, Zotta F, Pia Cerviere M, Gallucci P, Pennestri' F, Princi P, Revelli L, Arcuri G, Bellantone R, Raffaelli M. Post-thyroidectomy hypocalcemia: Is a routine preferable over a selective supplementation? Am J Surg 2021; 223:1126-1131. [PMID: 34711410 DOI: 10.1016/j.amjsurg.2021.10.015] [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] [Received: 05/30/2021] [Revised: 09/09/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comparative studies among protocols for the management of post-total thyroidectomy (TT) hypocalcemia are lacking. We compared the effectiveness of PTH-driven selective supplementation (PD-SS) and routine calcium and calcitriol supplementation with preoperative calcitriol administration in preventing symptomatic hypocalcemia (SH) and readmission. METHODS Three-hundred consecutive patients undergoing TT were assigned to 3 groups: the PD-SS group, the high-dose routine supplementation (HD-RS) group and the low-dose routine supplementation (LD-RS) group. RESULTS Mean post-operative stay was shorter in HD-RS patients when compared to PD-SS and LD-RS (p < 0.001). Significantly more patients in the PD-SS group experienced SH (p = 0.042). The rate of post-operative hypocalcemia was not significantly different among the groups (p = 0.063). No readmission for SH or hypercalcemia occurred. CONCLUSIONS HD-RS emerged as the most effective treatment to prevent SH, without increasing the risk of readmission for calcitriol-related hypercalcemia. Basing on the present results, HD-RS should be recommended as the preferable protocol.
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Affiliation(s)
- Luca Sessa
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmela De Crea
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale - Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Francesca Zotta
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Milena Pia Cerviere
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pierpaolo Gallucci
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Pennestri'
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pietro Princi
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Revelli
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Arcuri
- UOC Tecnologie Sanitarie, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco Bellantone
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale - Università Cattolica del Sacro Cuore, Rome, Italy
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Perigli G, Cianchi F, Giudici F, Russo E, Fiorenza G, Petrone L, Sparano C, Staderini F, Badii B, Morandi A. Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing. J Clin Med 2021; 10:4323. [PMID: 34640352 PMCID: PMC8509338 DOI: 10.3390/jcm10194323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The diagnosis of thyroid cancer is continuously increasing and consequently the amount of thyroidectomy. Notwithstanding the actual surgical skill, postoperative hypoparathyroidism still represents its most frequent complication. The aims of the present study are to analyze the rate of postoperative hypoparathyroidism after thyroidectomy, performed for cancer by a single first operator, without any technological aid, and to compare the data to those obtained adopting the most recent technological adjuncts developed to reduce the postoperative hypoparathyroidism. METHODS During the period 1997-2020 at the Endocrine Surgery Unit of the Department of Clinical and Experimental Medicine of the University of Florence, 1648 consecutive extracapsular thyroidectomies for cancer (401 with central compartment node dissection) were performed. The percentage of hypoparathyroidism, temporary or permanent, was recorded both in the first period (Group A) and in the second, most recent period (Group B). Total thyroidectomies were compared either with those with central compartment dissection and lobectomies. Minimally invasive procedures (MIT, MIVAT, some transoral) were also compared with conventional. Fisher's exact and Chi-square tests were used for comparison of categorical variables. p < 0.01 was considered statistically significant. Furthermore, a literature research from PubMed® has been performed, considering the most available tools to better identify parathyroid glands during thyroidectomy, in order to reduce the postoperative hypoparathyroidism. We grouped and analyzed them by technological affinity. RESULTS On the 1648 thyroidectomies enrolled for the study, the histotype was differentiated in 93.93 % of cases, medullary in 4% and poorly differentiated in the remaining 2.06%. Total extracapsular thyroidectomy and lobectomy were performed respectively in 95.45% and 4.55%. We recorded a total of 318 (19.29%) cases of hypocalcemia, with permanent hypoparathyroidism in 11 (0.66%). In regard to the literature, four categories of tools to facilitate the identification of the parathyroids were identified: (a) vital dye; (b) optical devices; (c) autofluorescence of parathyroids; and (d) autofluorescence enhanced by contrast media. Postoperative hypoparathyroidism had a variable range in the different groups. CONCLUSIONS Our data confirm that the incidence of post-surgical hypoparathyroidism is extremely low in the high volume centers. Its potential reduction adopting technological adjuncts is difficult to estimate, and their cost, together with complexity of application, do not allow immediate routine use. The trend towards increasingly unilateral surgery in thyroid carcinoma, as confirmed by our results in case of lobectomy, is expected to really contribute to a further reduction of postsurgical hypoparathyroidism.
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Affiliation(s)
- Giuliano Perigli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Fabio Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Giulia Fiorenza
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Luisa Petrone
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (L.P.); (C.S.)
| | - Clotilde Sparano
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (L.P.); (C.S.)
| | - Fabio Staderini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Benedetta Badii
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Alessio Morandi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
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Graceffa G, Orlando G, Cocorullo G, Mazzola S, Vitale I, Proclamà MP, Amato C, Saputo F, Rollo EM, Corigliano A, Melfa G, Cipolla C, Scerrino G. Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes According to Clinical and/or Ultrasound Evaluation. J Clin Med 2021; 10:jcm10153407. [PMID: 34362189 PMCID: PMC8347254 DOI: 10.3390/jcm10153407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/21/2022] Open
Abstract
Lymph node neck metastases are frequent in papillary thyroid carcinoma (PTC). Current guidelines state, on a weak level of evidence, that level VI dissection is mandatory in the presence of latero-cervical metastases. The aim of our study is to evaluate predictive factors for the absence of level VI involvement despite the presence of metastases to the lateral cervical stations in PTC. Eighty-eight patients operated for PTC with level II–V metastases were retrospectively enrolled in the study. Demographics, thyroid function, autoimmunity, nodule size and site, cancer variant, multifocality, Bethesda and EU-TIRADS, number of central and lateral lymph nodes removed, number of positive lymph nodes and outcome were recorded. At univariate analysis, PTC location and number of positive lateral lymph nodes were risk criteria for failure to cure. ROC curves demonstrated the association of the number of positive lateral lymph nodes and failure to cure. On multivariate analysis, the protective factors were PTC located in lobe center and number of positive lateral lymph nodes < 4. Kaplan–Meier curves confirmed the absence of central lymph nodes as a positive prognostic factor. In the selected cases, Central Neck Dissection (CND) could be avoided even in the presence of positive Lateralcervical Lymph Nodes (LLN+).
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Affiliation(s)
- Giuseppa Graceffa
- Unit of Oncological Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (G.G.); (F.S.); (E.M.R.); (C.C.)
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
- Correspondence:
| | - Gianfranco Cocorullo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Sergio Mazzola
- Unit of Clinical Epidemiology & Tumor Registry, Department of Laboratory Diagnostics, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy;
| | - Irene Vitale
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Maria Pia Proclamà
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Calogera Amato
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Federica Saputo
- Unit of Oncological Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (G.G.); (F.S.); (E.M.R.); (C.C.)
| | - Enza Maria Rollo
- Unit of Oncological Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (G.G.); (F.S.); (E.M.R.); (C.C.)
| | - Alessandro Corigliano
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (A.C.); (G.S.)
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (G.C.); (I.V.); (M.P.P.); (C.A.); (G.M.)
| | - Calogero Cipolla
- Unit of Oncological Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy; (G.G.); (F.S.); (E.M.R.); (C.C.)
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via L Giuffré, 5, 90127 Palermo, Italy; (A.C.); (G.S.)
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de la Fuente Bartolomé M, Sánchez de Molina Rampérez ML, García Vasquez C, Vieiro Medina MV, Jiménez de Los Galanes Marchan SF. Management of thyroid and parathyroid surgery in major ambulatory surgery. Cir Esp 2021; 100:S0009-739X(21)00211-6. [PMID: 34158163 DOI: 10.1016/j.ciresp.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
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Gray WK, Aspinall S, Tolley N, Day J, Lansdown M. The volume and outcome relationship for thyroidectomy in England. Langenbecks Arch Surg 2021; 406:1999-2010. [PMID: 34106320 PMCID: PMC8188540 DOI: 10.1007/s00423-021-02223-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
Purpose The delivery of surgical care in England has seen a momentum towards centralisation within larger volume hospitals and surgical teams. The aim of this study was to investigate outcomes in England in relationship to hospital and surgeon annual volumes for total thyroidectomy. Methods Data were extracted from the Hospital Episodes Statistics (HES) database for England. A 6-year period (April 2012–March 2018 inclusive) for all adult admissions for thyroidectomy was used in the analysis. The primary outcome measure used was a length of hospital stay greater than 2 days or an emergency readmission within 30 days following surgery. This was used as a proxy for surgical complications. A multilevel modelling strategy was used to adjust for hierarchy and potentially confounding. Results Data for 22,823 total thyroidectomies across 144 hospital trusts were used for analysis. For total thyroidectomy, larger volume surgeons had reduced levels of post-surgical complications; length of stay > 2 and > 4 days; emergency readmission at 30 days; and hypoparathyroidism, vocal cord palsy, stridor, and tracheostomy at 1-year post-surgery. Larger hospital volume was associated with lower levels of emergency readmission at 30 days and hypoparathyroidism at 1 year. Conclusions There is significant correlation between surgeon volume and clinical outcome for total thyroidectomy. The relationship was approximately linear, and a low-volume threshold could not be defined. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02223-8.
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Affiliation(s)
- William K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, 1 Lower Marsh, London, SE1 7NT, UK.
| | - Sebastian Aspinall
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.,Audit Lead, British Association of Endocrine and Thyroid Surgeons, London, UK
| | - Neil Tolley
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jamie Day
- Getting It Right First Time Programme, NHS England and NHS Improvement, 1 Lower Marsh, London, SE1 7NT, UK
| | - Mark Lansdown
- Getting It Right First Time Programme, NHS England and NHS Improvement, 1 Lower Marsh, London, SE1 7NT, UK.,St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Dionigi G, Raffaelli M, Bellantone R, De Crea C, Ambrosini CE, Miccoli P, Materazzi G, Ieni A, Caruso E, Zhang D, Dralle H. Analysis and outcomes of wrong site thyroid surgery. BMC Surg 2021; 21:281. [PMID: 34088279 PMCID: PMC8176686 DOI: 10.1186/s12893-021-01247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background In thyroid surgery, wrong-site surgery (WSS) is considered a rare event and seldom reported in the literature.
Case presentation This report presents 5 WSS cases following thyroid surgery in a 20-year period. We stratified the subtypes of WSS in wrong target, wrong side, wrong procedure and wrong patient. Only planned and elective thyroid surgeries present WSS cases. The interventions were performed in low-volume hospitals, and subsequently, the patients were referred to our centres. Four cases of wrong-target procedures (thymectomies [n = 3] and lymph node excision [n = 1] performed instead of thyroidectomies) and one case of wrong-side procedure were observed in this study. Two wrong target cases resulting additionally in wrong procedure were noted. Wrong patient cases were not detected in the review. Patients experienced benign, malignant, or suspicious pathology and underwent traditional surgery (no endoscopic or robotic surgery). 40% of WSS led to legal action against the surgeon or a monetary settlement. Conclusion WSS is also observed in thyroid surgery. Considering that reports regarding the serious complications of WSS are not yet available, these complications should be discussed with the surgical community. Etiologic causes, outcomes, preventive strategies of WSS and expert opinion are presented. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01247-7.
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Affiliation(s)
- Gianlorenzo Dionigi
- Division of Endocrine and Minimally Invasive Surgery, University of Messina, Messina, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Rocco Bellantone
- U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carmela De Crea
- U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Paolo Miccoli
- Department of Surgery, University of Pisa, Pisa, Italy
| | | | - Antonio Ieni
- Division of Pathology, University of Messina, Messina, Italy
| | - Ettore Caruso
- Division of Endocrine and Minimally Invasive Surgery, University of Messina, Messina, Italy.
| | - Daqi Zhang
- Division of Endocrine and Minimally Invasive Surgery, University of Messina, Messina, Italy.,Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun, 130000, China
| | - Henning Dralle
- Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Van Den Heede K, Tolley NS, Di Marco AN, Palazzo FF. Differentiated Thyroid Cancer: A Health Economic Review. Cancers (Basel) 2021; 13:cancers13092253. [PMID: 34067214 PMCID: PMC8125846 DOI: 10.3390/cancers13092253] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary This review reflects on health economic considerations associated with the increasing diagnosis and treatment of differentiated thyroid cancer. Analysis of different relevant health economic topics, such as overdiagnosis, overtreatment, surgical costs, and costs of follow-up are being addressed. Several unanswered research questions such as optimising molecular markers for diagnosis, active surveillance of primary tumours, and improved risk stratification and survivorship care all influence future healthcare expenditures. Abstract The incidence of differentiated thyroid cancer (DTC) is rising, mainly because of an increased detection of asymptomatic thyroid nodularity revealed by the liberal use of thyroid ultrasound. This review aims to reflect on the health economic considerations associated with the increasing diagnosis and treatment of DTC. Overdiagnosis and the resulting overtreatment have led to more surgical procedures, increasing health care and patients’ costs, and a large pool of community-dwelling thyroid cancer follow-up patients. Additionally, the cost of thyroid surgery seems to increase year on year even when inflation is taken into account. The increased healthcare costs and spending have placed significant pressure to identify potential factors associated with these increased costs. Some truly ground-breaking work in health economics has been undertaken, but more cost-effectiveness studies and micro-cost analyses are required to evaluate expenses and guide future solutions.
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Affiliation(s)
- Klaas Van Den Heede
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of General and Endocrine Surgery, OLV Hospital, 9300 Aalst, Belgium
- Correspondence:
| | - Neil S. Tolley
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
| | - Aimee N. Di Marco
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
| | - Fausto F. Palazzo
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
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Mihai R, Thakker RV. MANAGEMENT OF ENDOCRINE DISEASE: Postsurgical hypoparathyroidism: current treatments and future prospects for parathyroid allotransplantation. Eur J Endocrinol 2021; 184:R165-R175. [PMID: 33599211 PMCID: PMC8052514 DOI: 10.1530/eje-20-1367] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Permanent postsurgical hypoparathyroidism (POSH) is a major complication of anterior neck surgery in general and of thyroid surgery in particular. Depending on diagnostic criteria, up to 10% of patients undergoing bilateral thyroid surgery develop POSH. This leads to a multitude of symptoms that decrease the quality of life and burden the healthcare provision through complex needs for medication and treatment of specific complications, such as seizures and laryngospasm. METHODS Narrative review of current medical treatments for POSH and of the experience accumulated with parathyroid allotransplantation. RESULTS In most patients, POSH is controlled with regular use of calcium supplements and active vitamin D analogues but a significant proportion of patients continue to experience severe symptoms requiring repeated emergency admissions. Replacement therapy with synthetic PTH compounds (PTH1-34, Natpara® and PTH1-84, teriparatide, Forsteo®) has been assessed in multicentre trials, but the use of this medication is restricted by costs and concerns related to the risk of development of osteosarcoma. Based on recent case reports of successful allotransplantation of parathyroid tissue between siblings, there is renewed interest in this technique. Data on selection of donors, parathyroid cell preparation before allotransplantation, site and timing of transplantation, need for immunosuppression and long-term outcomes are reviewed. CONCLUSION A prospective trial to assess the efficacy of parathyroid allotransplantation in patients with severely symptomatic protracted post-surgical hypoparathyroidism is warranted.
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Affiliation(s)
- Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
- Correspondence should be addressed to R Mihai;
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Bedi HK, Jedrzejko N, Nguyen A, Aspinall SR, Wiseman SM. Thyroid and parathyroid surgeon case volume influences patient outcomes: A systematic review. Surg Oncol 2021; 38:101550. [PMID: 33915486 DOI: 10.1016/j.suronc.2021.101550] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The study aim was to systematically review literature evaluating surgeon volume-outcome relationships for thyroid and parathyroid operations in order to inform surgical quality improvement initiatives. Current literature suggests surgeons who perform a high volume of thyroid and/or parathyroid operations have better outcomes than low volume surgeons, though specific volume definition are not standardized. METHODS Eligible studies were selected through a literature search focused on the effect of surgeon volume on thyroid and parathyroid surgery patient outcomes. The literature search was conducted in accordance with the PRISMA guidelines. Publication dates extended from January 1998 to February 2021, and were limited to articles published in English. RESULTS A total of 33 studies were included: 25 studies evaluating thyroid surgery outcomes, 4 studies evaluating parathyroid surgery outcomes, and 4 studies evaluating both thyroid and parathyroid (mixed) surgery outcomes. Higher volume thyroid and parathyroid surgeons were found to be associated with fewer surgical and medical complications, shorter length of hospital stay, and reduced total cost when compared to lower volume surgeons. This volume-outcome relationship was also found to specifically affect the complication and recurrence rates for thyroid cancer patients undergoing surgery, especially for individuals with advanced stage disease. CONCLUSION The heterogeneity in cut-offs used for characterizing surgeons as high versus low volume, and also in subsequent patient outcome measures, limited direct study comparisons. The trend of improved patient outcomes with higher surgeon volume for both thyroid and parathyroid surgeries was consistently present in all studies reviewed.
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Affiliation(s)
- Harjot K Bedi
- St.Paul's Hospital & University of British Columbia, Department of Surgery, Vancouver, British Columbia, Canada.
| | - Nicole Jedrzejko
- St.Paul's Hospital & University of British Columbia, Department of Surgery, Vancouver, British Columbia, Canada.
| | - Anne Nguyen
- St.Paul's Hospital & University of British Columbia, Department of Surgery, Vancouver, British Columbia, Canada.
| | | | - Sam M Wiseman
- St.Paul's Hospital & University of British Columbia, Department of Surgery, Vancouver, British Columbia, Canada.
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Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) for primary hyperparathyroidism: Turkey's experience. Surg Endosc 2021; 36:1037-1043. [PMID: 33660120 DOI: 10.1007/s00464-021-08368-3] [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: 06/11/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
AIM Parathyroid surgery has witnessed a significant evolution with the introduction of more efficacious preoperative localization imaging techniques and the use of rapid intraoperative parathormone assays. Parathyroid surgery can now be performed with the minimum of invasion. Through the adaptation of the transoral endoscopic thyroidectomy vestibular approach (TOETVA), the technique has now been adopted for parathyroid surgery, known as the transoral endoscopic parathyroidectomy vestibular approach (TOEPVA). We present here the initial experiences of 11 centers carrying out TOEPVA surgery in Turkey. MATERIALS AND METHODS Participating in the study were 11 centers, all of which were tertiary care institutions carrying out endocrine surgery. A retrospective review was made of 35 primary hyperparathyroidism patients who underwent the TOEPVA procedure between July 2017 and January 2020. RESULTS Of the total 35 patients, 32 patients underwent the TOEPVA procedure successfully. All patients but one were female, and the mean age was 47.2 (20-73) years. According to localization studies, 18 of the lesions were lower left, 12 were lower right, 3 were upper right and 2 were upper left. The mean operative time was 116 (30-225) min, and three cases were converted to an open procedure. Simultaneous thyroidectomy was performed in seven cases. The average PTH level dropped to normal within 20 min. after the resection in all cases. The complication rate was 19% (ecchymosis, subcutaneous emphysema, nasal bleeding, surgical site infection and seroma). There were neither recurrent nerve palsies, nor mental nerve root or branch injuries. The average hospital stay was 1 day. No persistence was documented on follow up. CONCLUSION TOEPVA is a "hidden scar" parathyroidectomy procedure that can be safely performed on parathyroid adenomas, in cases that have scar-related concerns. Having its own procedure-related complications, the procedure provides satisfactory objective results, particularly in centers experienced in endoscopic and endocrine surgery.
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Barczyński M. Current approach to surgical management of hyperthyroidism. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:124-131. [PMID: 33494587 DOI: 10.23736/s1824-4785.21.03330-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hyperthyroidism is a set of disorders that involve excess synthesis and secretion of thyroid hormones by the thyroid gland, which leads to thyrotoxicosis. The most common forms of hyperthyroidism include diffuse toxic goiter (Graves' disease), toxic multinodular goiter (Plummer disease), and a solitary toxic adenoma. The most reliable screening measure of thyroid function is the thyroid-stimulating hormone (TSH) level. Options for treatment of hyperthyroidism include: antithyroid drugs, radioactive iodine therapy (the preferred treatment of hyperthyroidism among US thyroid specialists), or thyroidectomy. Massive thyroid enlargement with compressive symptoms, a suspicious nodule, Graves' orbitopathy, and patient preference are indications for surgical treatment of thyrotoxicosis. This paper reviews the current literature and controversies on the surgical approach to the management of hyperthyroidism.
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Affiliation(s)
- Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University, Medical College, Kraków, Poland -
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Barrios L, Shafqat I, Alam U, Ali N, Patio C, Filarski CF, Bankston H, Mallen-St Clair J, Luu M, Zumsteg ZS, Adashek K, Chen Y, Jain M, Braunstein GD, Sacks WL, Ho AS. Incidental parathyroidectomy in thyroidectomy and central neck dissection. Surgery 2021; 169:1145-1151. [PMID: 33446359 DOI: 10.1016/j.surg.2020.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/26/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although higher thyroidectomy volume has been linked with lower complication rates, its association with incidental parathyroidectomy remains less studied. The volume relationship is even less clear for central neck dissection, where individual parathyroid glands are at greater risk. METHODS Patients undergoing thyroidectomy with or without central neck dissection were evaluated for incidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Univariate and multivariable analyses were performed using binary logistic regression. RESULTS Overall, 1,114 thyroidectomies and 396 concurrent central neck dissections were performed across 7 surgeons. Incidental parathyroidectomy occurred in 22.4% of surgeries (range, 16.9%-43.6%), affecting 7.1% of parathyroids at risk (range, 5.8%-14.5%). When stratified by surgeon, lower incidental parathyroidectomy rates were associated with higher thyroidectomy volumes (R2 = 0.77, P = .008) and higher central neck dissection volumes (R2 = 0.93, P < .001). On multivariable analysis, low-volume surgeon (odds ratio 2.94, 95% confidence interval 2.06-4.19, P < .001), extrathyroidal extension (odds ratio 3.13, 95% confidence interval 1.24-7.87, P = .016), prophylactic central neck dissection (odds ratio 2.68, 95% confidence interval 1.65-4.35, P <.001), and therapeutic central neck dissection (odds ratio 4.44, 95% confidence interval 1.98-9.96, P < .001) were the most significant factors associated with incidental parathyroidectomy. In addition, incidental parathyroidectomy was associated with a higher likelihood of temporary hypoparathyroidism (odds ratio 2.79, 95% confidence interval 1.45-5.38, P = .002) and permanent hypoparathyroidism (odds ratio 4.62, 95% confidence interval 1.41-5.96, P = .025), but not permanent hypocalcemia (odds ratio 1.27, 95% confidence interval 0.48-3.35, P = .63). Higher lymph node yield in central neck dissection was not associated with higher incidental parathyroidectomy rates (odds ratio 1.13, 95% confidence interval 0.85-8.81, P = .82). CONCLUSION Higher surgical volume conferred a lower rate of incidental parathyroidectomy. Nonetheless, greater lymph node yield in central neck dissections did not result in greater parathyroid-related morbidity. Such findings support the value of leveraging surgical volume to both optimize oncologic resection and minimize complication rates.
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Affiliation(s)
- Laurel Barrios
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Iram Shafqat
- University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Usman Alam
- University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Nabilah Ali
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Chrysanta Patio
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carolyn F Filarski
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hakimah Bankston
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kenneth Adashek
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Yufei Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Monica Jain
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Glenn D Braunstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Wendy L Sacks
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
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Wu CW, Randolph GW, Barczyński M, Schneider R, Chiang FY, Huang TY, Karcioglu AS, Konturek A, Frattini F, Weber F, Liu CH, Dralle H, Dionigi G. Training Courses in Laryngeal Nerve Monitoring in Thyroid and Parathyroid Surgery- The INMSG Consensus Statement. Front Endocrinol (Lausanne) 2021; 12:705346. [PMID: 34220726 PMCID: PMC8253252 DOI: 10.3389/fendo.2021.705346] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 01/04/2023] Open
Abstract
Intraoperative neural monitoring (IONM) is now an integral aspect of thyroid surgery in many centers. Interest in IONM and the number of institutions that perform monitored thyroidectomies have increased throughout the world in recent years. For surgeons considering the introduction of IONM in their practice, specific training in IONM devices and procedures can substantially shorten the learning curve. The International Neural Monitoring Study Group (INMSG) has been at the forefront of IONM technology and procedural adoption since the introduction of neural monitoring in thyroid and parathyroid surgery. The purpose of this document is to define the INMSG consensus on essential elements of IONM training courses. Specifically, this document describes the minimum training required for teaching practical application of IONM and consensus views on key issues that must be addressed for the safe and reliable introduction of IONM in surgical practice. The intent of this publication is to provide societies, course directors, teaching institutions, and national organizations with a practical reference for developing IONM training programs. With these guidelines, IONM will be implemented optimally, to the ultimate benefit of the thyroid and parathyroid surgical patients.
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Affiliation(s)
- Che-Wei Wu
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, and Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gregory W. Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Rick Schneider
- Department of Surgery, University Hospital Halle, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Feng-Yu Chiang
- Department of Otolaryngology, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tzu-Yen Huang
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, and Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Amanda Silver Karcioglu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States
| | - Aleksander Konturek
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Francesco Frattini
- Department of Surgery, Ospedale di Circolo, ASST Settelaghi, Varese, Italy
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, University of Duisburg-Essen, Essen, Germany
| | - Cheng-Hsin Liu
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, University of Duisburg-Essen, Essen, Germany
| | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital G. Martino, University of Messina, Messina, Italy
- *Correspondence: Gianlorenzo Dionigi,
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Mirghani H, Altedlawi Albalawi IA. The Ongoing Debate Regarding Completion Thyroidectomy Versus Primary Thyroid Surgery for Low and Intermediate Differentiated Thyroid Carcinoma: A Meta-Analysis. Cureus 2020; 12:e12033. [PMID: 33329985 PMCID: PMC7734888 DOI: 10.7759/cureus.12033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lobectomy is increasingly performed for low-risk differentiated thyroid cancer (DTC) and papillary thyroid microcarcinoma (PTMC). However, there is a continuous controversy about completion thyroidectomy (CT) following lobectomy. The current meta-analysis aimed to assess the outcomes of the initial surgical procedure versus CT performed for low/intermediate-risk thyroid carcinoma. Six hundred and sixty-one articles were retrieved, and only 15 full texts fulfilled the inclusion and exclusion criteria. There were 15 studies, including 17,143 patients; twelve were retrospective, two prospective studies, and a controlled trial. Seven articles were from Asia, four from the USA, two from Europe, while two were published in Canada. The studies showed no difference between lobectomy and primary thyroid surgery regarding post-surgery complications. CT was not different from the initial surgical procedure in terms of complications for DTC. The study was limited by the retrospective studies included, the outcomes assessed were not uniform, and significant heterogeneity was observed. Further, well-controlled, more specific trials are needed.
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Public expectations, consenting rules and professional probity require a change in the current provision of surgical care for endocrine tumours. Langenbecks Arch Surg 2020; 405:397-399. [DOI: 10.1007/s00423-020-01905-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
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