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Suveica L, Sima OC, Ciobica ML, Nistor C, Cucu AP, Costachescu M, Ciuche A, Nistor TVI, Carsote M. Redo Thyroidectomy: Updated Insights. J Clin Med 2024; 13:5347. [PMID: 39336834 PMCID: PMC11432308 DOI: 10.3390/jcm13185347] [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: 08/01/2024] [Revised: 08/28/2024] [Accepted: 09/07/2024] [Indexed: 09/30/2024] Open
Abstract
The risk of post-operatory hypothyroidism and hypocalcaemia, along with recurrent laryngeal nerve injury, is lower following a less-than-total thyroidectomy; however, a previously unsuspected carcinoma or a disease progression might be detected after initial surgery, hence indicating re-intervention as mandatory (so-called "redo" surgery) with completion. This decision takes into consideration a multidisciplinary approach, but the surgical technique and the actual approach is entirely based on the skills and availability of the surgical team according to the standard protocols regarding a personalised decision. We aimed to introduce a review of the most recently published data, with respect to redo thyroid surgery. For the basis of the discussion, a novel vignette on point was introduced. This was a narrative review. We searched English-language papers according to the key search terms in different combinations such as "redo" and "thyroid", alternatively "thyroidectomy" and "thyroid surgery", across the PubMed database. Inclusion criteria were original articles. The timeframe of publication was between 1 January 2020 and 20 July 2024. Exclusion criteria were non-English papers, reviews, non-human studies, case reports or case series, exclusive data on parathyroid surgery, and cell line experiments. We identified ten studies across the five-year most recent window of PubMed searches that showed a heterogeneous spectrum of complications and applications of different surgeries with respect to redo interventions during thyroid removal (e.g., recurrent laryngeal nerve monitoring during surgery, other types of incision than cervicotomy, the use of parathyroid fluorescence, bleeding risk, etc.). Most studies addressing novel surgical perspectives focused on robotic-assisted re-intervention, and an expansion of this kind of studies is expected. Further studies and multifactorial models of assessment and risk prediction are necessary to decide, assess, and recommend redo interventions and the most adequate surgical techniques.
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Affiliation(s)
- Luminita Suveica
- Department of Family Medicine, "Nicolae Testemiţanu" State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Oana-Claudia Sima
- PhD Doctoral School of "Carol Davila", University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine I and Rheumatology, "Dr. Carol Davila" Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Thoracic Surgery Department, "Dr. Carol Davila" Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Anca-Pati Cucu
- PhD Doctoral School of "Carol Davila", University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Thoracic Surgery Department, "Dr. Carol Davila" Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Mihai Costachescu
- PhD Doctoral School of "Carol Davila", University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adrian Ciuche
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Thoracic Surgery Department, "Dr. Carol Davila" Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Tiberiu Vasile Ioan Nistor
- Medical Biochemistry Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Mara Carsote
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
- Department of Endocrinology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Cappellacci F, Canu GL, Noli E, Argiolas A, Peis G, Lai ML, Calò PG, Medas F. Changes in Clinical Practice in Adherence to the 2014 American Thyroid Association Guidelines on Thyroid Cancer: A Retrospective Study from a Tertiary Referral Center. J Pers Med 2024; 14:727. [PMID: 39063981 PMCID: PMC11277973 DOI: 10.3390/jpm14070727] [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: 06/14/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Thyroidectomy, a pivotal treatment for various thyroid disorders, has seen its indications evolve, particularly with the 2014 American Thyroid Association (ATA) Guidelines advocating for conservative surgical approaches like lobectomy. This retrospective study analyzes thyroidectomy practices at a high-volume center from January 2014 to December 2023, focusing on patients potentially eligible for lobectomy per ATA guidelines. The inclusion criteria were tumors < 4 cm, indeterminate thyroid nodules, or differentiated thyroid carcinoma with clinically uninvolved lymph nodes (cN0). This study analyzed the proportion of patients undergoing lobectomy versus total thyroidectomy (TT) and the oncological outcomes. Of 357 patients, 243 underwent TT and 114 underwent lobectomy. The prevalence of lobectomies rose markedly, comprising 73.9% of surgeries in 2023. TT patients were predominantly female (83.5%) and had higher rates of autoimmune thyroiditis (67.5%) and malignancy (89.7%). Lobectomy patients had larger nodules and more indeterminate cytology. Among 301 malignant cases, TT was associated with higher lymph node metastasis, but similar recurrence rates, compared to lobectomy. This study underscores a shift towards lobectomy, reflecting adherence to ATA guidelines and suggesting conservative surgery is feasible without compromising outcomes. Further research on long-term outcomes and refined patient selection criteria is needed to optimize surgical approaches.
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Affiliation(s)
- Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Eleonora Noli
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Alessandro Argiolas
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Giulia Peis
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Maria Letizia Lai
- Department of Cytomorphology, University of Cagliari, 09124 Cagliari, Italy;
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
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Zeng Q, Zhong H, Rao H, Wang Y. Diagnostic value of circulating tumor cells in patients with thyroid cancer: a retrospective study of 1478 patients. Discov Oncol 2024; 15:114. [PMID: 38607590 PMCID: PMC11014821 DOI: 10.1007/s12672-024-00976-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/09/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Circulating tumor cell (CTC) detection is one form of liquid biopsy. It is a novel technique that is beginning to be applied in the field of thyroid cancer. The present study was designed to evaluate the diagnostic value of CTCs in patients with thyroid cancer. METHODS A total of 1478 patients were retrospectively analyzed and divided into malignant group (n = 747) and benign group (n = 731). Peripheral blood was collected, and CTCs were enriched and quantified before surgery. The baseline data of the two groups were matched by Propensity Score Matching (PSM). Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficiency of different indicators for thyroid cancer. The malignant group before PSM was further divided into subgroups according to the BRAF V600E mutation and lymphatic metastasis (N stage), and the number of CTCs in different subgroups was compared. RESULTS After 1:1 PSM, baseline characteristics of the malignant group and benign group were matched and assigned 315 cases in each group. The number of CTCs and the TPOAb values were comparable in the two groups (p > 0.05). The TgAb values [1.890 (1.110 - 16.010) vs 1.645 (1.030 - 7.073) IU/mL, p = 0.049] were significantly higher in the malignant group than in the benign group. After PSM, ROC analyses showed that the areas under the curve (AUCs) of CTC, TgAb and ultrasound were 0.537 (sensitivity 65.6%, specificity 45.8%), 0.546 (sensitivity 40.0%, specificity 70.8%) and 0.705 (sensitivity 77.1%, specificity 63.2%), respectively. The AUCs of the combined detection of 'CTC + ultrasound' (combine 1) and the combined detection of 'CTC + TgAb + ultrasound' (combine 2) were 0.718 (sensitivity 79.3%, specificity 61.7%) and 0.724 (sensitivity 78.0%, specificity 63.3%), respectively. The AUC of ultrasound was significantly higher than CTC (p < 0.001). There was no statistically significant difference in AUC between combination 1 and ultrasound, and between combination 2 and ultrasound (p > 0.05). The number of CTCs between the N0 and N1 subgroups, and between the BRAF mutant and BRAF wild subgroups was comparable (p > 0.05). CONCLUSIONS As an emerging and noninvasive testing tool, the efficacy of CTCs in diagnosing thyroid cancer is limited.
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Affiliation(s)
- Qingxin Zeng
- Department of Thyroid Surgery, Meizhou People's Hospital (Huangtang Hospital)/Meizhou Academy of Medical Sciences, No. 63, Huangtang Road, Meijiang District, Meizhou, 514031, China
| | - Haifeng Zhong
- Department of Thyroid Surgery, Meizhou People's Hospital (Huangtang Hospital)/Meizhou Academy of Medical Sciences, No. 63, Huangtang Road, Meijiang District, Meizhou, 514031, China
| | - Hui Rao
- Department of Laboratory Medicine, Meizhou People's Hospital (Huangtang Hospital)/Meizhou Academy of Medical Sciences, Meizhou, China
| | - Yuedong Wang
- Department of Thyroid Surgery, Meizhou People's Hospital (Huangtang Hospital)/Meizhou Academy of Medical Sciences, No. 63, Huangtang Road, Meijiang District, Meizhou, 514031, China.
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