The outcomes and prognostic factors of patients who underwent reoperation for persistent/recurrent papillary thyroid carcinoma

Safety and feasibility of robotic reoperation via a bilateral axillo-breast approach for patients with locally recurrent thyroid cancer: a single-center retrospective study

Background

For patients with recurrent thyroid cancer, traditional open re-operative surgeries often leave conspicuous cervical scars, significantly impacting patients' long-term quality of life. The potential for robotic surgery to enhance the aesthetic outcomes of re-operative surgery and improve the quality of life for these patients has rarely been studied. This study aimed to assess the feasibility and effectiveness of robotic reoperation for recurrent thyroid cancer following initial surgery, offering a viable surgical alternative tailored to patients with heightened aesthetic concerns.

Methods

We conducted a retrospective analysis of patients with recurrent thyroid cancer who underwent robotic reoperation via the bilateral axillo-breast approach (BABA) at the 960th Hospital of People's Liberation Army between September 2018 and March 2024. The study design involved a comprehensive review of clinical data, including patient demographics, surgical outcomes, and postoperative complications.

Results

A cohort of 24 patients (18 females, 6 males) with a mean age of 34.13±10.06 years successfully underwent robotic BABA reoperation without conversion to open surgery. Two patients underwent completion total thyroidectomy (CTT) with central neck node dissection (CND), four underwent CTT with lateral neck dissection (LND), and the remaining 18 patients received LND alone. Histopathological examination revealed papillary thyroid carcinoma (PTC) in 23 patients and medullary thyroid carcinoma (MTC) in one patient. The mean number of lymph nodes retrieved from LND was 14.21±12.30, with 2.74±2.64 nodes harboring metastases. Postoperative complications were transient, including hypoparathyroidism in four patients and temporary vocal cord palsy in one patient, with no permanent complications reported. During an average follow-up period of 29.71±19.29 months, no recurrences were detected. Cosmetic satisfaction was assessed and yielded a median satisfaction score of 9.2.

Conclusions

Robotic BABA reoperation emerges as a feasible and safe surgical modality for managing recurrent thyroid cancer, offering effective treatment while catering to patients' high aesthetic demands.

Lymph node or lymphoid aggregate? Impact on cancer resection quality, clinical prognosis, and tumor staging

The clinical outcome of most cancer patients depends on the stage of the primary tumor, the lymph node status, and if distant metastases are present. According to the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), the Tumor Node Metastasis (TNM) classification of malignant tumors requires the examination of a minimum number of regional lymph nodes for each type of cancer to fulfill the criteria of high-quality surgical oncology. Due to the daily challenge of collecting an appropriate number of lymph nodes and time constraints when processing and assessing tissue samples, pathologists may be tempted to identify every histological lymphoid structure mimicking a lymph node as a "true" lymph node. Faced with this issue, we propose to resolve it by specifying histological characteristics to differentiate lymphoid aggregates from "true" lymph nodes. To find a minimum consensus, we suggest defining as lymph nodes only those lymphoid structures composed of lymphoid cells encapsulated by a complete or incomplete fibrous capsule.

Is second 131I treatment necessary for differentiated thyroid cancer patients and who could not benefit from it? A real-world retrospective study in China

BACKGROUND

The efficacy of a second radioactive iodine-131 (131I) treatment in patients with differentiated thyroid cancer (DTC) who did not achieve an excellent response (ER) following initial 131I therapy remains controversy and the population that would derive limited benefit from it is currently unclear.

OBJECTIVES

The aim of this retrospective study was to assess the efficacy of the second 131I treatment in DTC patients with non-ER after the initial 131I therapy, and to identify potential risk factors associated with non-benefit of the second 131I treatment.

METHODS

127 DTC patients who underwent two 131I treatments following thyroidectomy were included in this study, and the therapeutic response was evaluated after each 131I treatment. Beneficial treatment was defined as an improvement in therapy response grade (e.g. from indeterminate response to ER) after the second 131I treatment, while unbeneficial treatment was defined as no change or a downgrade in therapy response grade. The potential risk factors associated with the non-benefit of the second 131I treatment were identified using univariate and multivariate logistic regression models.

RESULTS

Following the second 131I treatment, therapy responses of 55.12% (70/127) of patients were reclassified to a better grade indicating treatment benefit, while 44.88% (57/127) showed no change or were reclassified to a worse grade suggesting no benefit from treatment. The non-benefit of the second 131I treatment was significantly associated with potential risk factors including stimulated thyroglobulin (sTg) level ≥ 11.46 ng/mL before the second 131I treatment, primary tumor size > 2 cm, status T2 or higher, N1b status and ATA high risk.

CONCLUSIONS

The study results demonstrated that more than half of DTC patients could potentially benefit from a second 131I therapy. However, over 40% of patients exhibited no benefit in response to the second 131I treatment, suggesting potential overtreatment for this subgroup. Therefore, clinicians should exercise meticulous and precise decision-making based on identified risk factors when considering the necessity of a second 131I treatment.

Sex differences and racial/ethnic disparities in the presentation and treatment of medullary thyroid cancer

BACKGROUND

This study assessed for disparities in the presentation and management of medullary thyroid cancer (MTC).

METHODS

Patients with MTC (2010-2020) were identified from the National Cancer Database. Differences in disease presentation and likelihood of guideline-concordant surgical management (total thyroidectomy and resection of ≥1 lymph node) were assessed by sex and race/ethnicity.

RESULTS

Of 6154 patients, 68.2% underwent guideline-concordant surgery. Tumors >4 ​cm were more likely in men (vs. women: OR 2.47, p ​< ​0.001) and Hispanic patients (vs. White patients: OR 1.52, p ​= ​0.001). Non-White patients were more likely to have distant metastases (Black: OR 1.63, p ​= ​0.002; Hispanic: OR 1.44, p ​= ​0.038) and experienced longer time to surgery (Black: HR 0.66, p ​< ​0.001; Hispanic: HR 0.71, p ​< ​0.001). Black patients were less likely to undergo guideline-concordant surgery (OR 0.70, p ​= ​0.022).

CONCLUSIONS

Male and non-White patients with MTC more frequently present with advanced disease, and Black patients are less likely to undergo guideline-concordant surgery.

Ultrasound-guided radiofrequency ablation for the treatment of papillary thyroid carcinoma: a review of the current state and future perspectives

Papillary thyroid carcinoma (PTC) is a highly prevalent cancer that typically exhibits indolent behavior and is associated with a favorable prognosis. The treatment of choice is surgical intervention; however, this approach carries the risk of complications, including scarring and loss of thyroid function. Although active surveillance can mitigate the risk of PTC overtreatment, the possibility of tumor growth and metastasis can elicit anxiety among patients. Ultrasoundguided thermal ablation has emerged as a safe and effective alternative for individuals who are ineligible for or decline surgery. This article provides a review of the clinical research on radiofrequency ablation as a treatment for PTC, offering a thorough examination of its efficacy, safety, and future perspectives.