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Di Filippo G, Canu GL, Lazzari G, Serbusca D, Morelli E, Brazzarola P, Rossi L, Gjeloshi B, Caradonna M, Kotsovolis G, Pliakos I, Poulios E, Papavramidis T, Cappellacci F, Nocini PF, Calò PG, Materazzi G, Medas F. Exploring the Link between BMI and Aggressive Histopathological Subtypes in Differentiated Thyroid Carcinoma-Insights from a Multicentre Retrospective Study. Cancers (Basel) 2024; 16:1429. [PMID: 38611106 PMCID: PMC11011018 DOI: 10.3390/cancers16071429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Obesity's role in thyroid cancer development is still debated, as well as its association with aggressive histopathological subtypes (AHSs). To clarify the link between Body Mass Index (BMI) and AHS of differentiated thyroid carcinoma (DTC), we evaluated patients who underwent thyroidectomy for DTC from 2020 to 2022 at four European referral centres for endocrine surgery. Based on BMI, patients were classified as normal-underweight, overweight, or obese. AHSs were defined according to 2022 WHO guidelines. Among 3868 patients included, 34.5% were overweight and 19.6% obese. Histological diagnoses were: 93.6% papillary (PTC), 4.8% follicular (FTC), and 1.6% Hürthle cell (HCC) thyroid carcinoma. Obese and overweight patients with PTC had a higher rate of AHSs (p = 0.03), bilateral, multifocal tumours (p = 0.014, 0.049), and larger nodal metastases (p = 0.017). In a multivariate analysis, BMI was an independent predictor of AHS of PTC, irrespective of gender (p = 0.028). In younger patients (<55 years old) with PTC > 1 cm, BMI predicted a higher ATA risk class (p = 0.036). Overweight and obese patients with FTC had larger tumours (p = 0.036). No difference was found in terms of AHS of FTC and HCC based on BMI category. Overweight and obese patients with PTC appear to be at an increased risk for AHS and aggressive clinico-pathological characteristics.
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Affiliation(s)
- Giacomo Di Filippo
- Endocrine Surgery Unit, Department of Surgery and Oncology, Verona University Hospital, 37134 Verona, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, SS554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Giovanni Lazzari
- Endocrine Surgery Unit, Department of Surgery and Oncology, Verona University Hospital, 37134 Verona, Italy
| | - Dorin Serbusca
- Endocrine Surgery Unit, Department of Surgery and Oncology, Verona University Hospital, 37134 Verona, Italy
| | - Eleonora Morelli
- Endocrine Surgery Unit, Department of Surgery and Oncology, Verona University Hospital, 37134 Verona, Italy
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, Verona University Hospital, 37134 Verona, Italy
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy
| | - Benard Gjeloshi
- Endocrine Surgery Unit, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy
| | - Mariangela Caradonna
- Endocrine Surgery Unit, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy
| | - George Kotsovolis
- First Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 85 Karakasi Str., 54453 Thessaloniki, Greece
| | - Ioannis Pliakos
- First Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 85 Karakasi Str., 54453 Thessaloniki, Greece
| | - Efthymios Poulios
- First Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 85 Karakasi Str., 54453 Thessaloniki, Greece
| | - Theodosios Papavramidis
- First Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 85 Karakasi Str., 54453 Thessaloniki, Greece
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, SS554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Pier Francesco Nocini
- Endocrine Surgery Unit, Department of Surgery and Oncology, Verona University Hospital, 37134 Verona, Italy
- Department of Oral and Maxillofacial Surgery, University of Verona, 37134 Verona, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, SS554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Gabriele Materazzi
- Endocrine Surgery Unit, University Hospital of Pisa, Via Paradisa 2, 56100 Pisa, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, SS554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mura C, Rodia R, Corrias S, Cappai A, Lai ML, Canu GL, Medas F, Calò PG, Mariotti S, Boi F. Diffuse C-Cells Hyperplasia Is the Source of False Positive Calcitonin Measurement in FNA Washout Fluids of Thyroid Nodules: A Rational Clinical Approach to Avoiding Unnecessary Surgery. Cancers (Basel) 2024; 16:210. [PMID: 38201637 PMCID: PMC10777925 DOI: 10.3390/cancers16010210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/23/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE The FNA-CT is useful for the diagnosis of MTC. The aim of this study was to evaluate the performance of FNA-CT in TNs coexisting with CCH. METHODS This study retrospectively reviewed the records of 11 patients with TNs submitted to thyroidectomy on the basis of elevated basal and/or stimulated serum CT values, which at histology were not confirmed to be MTC. The results obtained in this group were compared with those of a previously reported group of histologically proven MTC patients submitted to an identical presurgical evaluation. All patients, negative for known mutations in the RET proto-oncogene, were preoperatively submitted to neck ultrasound, FNA-cytology, and FNA-CT. RESULTS Approximately 6 of 11 patients showed increased (>36 ng/mL, as established in previous studies not involving patients with CCH) FNA-CT. All these patients showed diffuse CCH at histology in the thyroid lobe submitted to FNA; 5 of them were benign at histology, while only one was malignant (papillary thyroid carcinoma, PTC). The remaining 5 of 11 patients had low FNA-CT (<36 ng/mL), and all of them showed only focal CCH in the lobe submitted to FNA; three of them were malignant (2 PTC, 1 follicular carcinoma), while two were benign. CONCLUSIONS Employing the currently proposed cut-off values, false-positive FNA-CT results may be observed in benign/malignant TNs with coexisting diffuse CCH. FNA-CT must therefore be cautiously used in the diagnostic approach for patients with TNs and a slightly increased basal or stimulated serum CT concentration in order to avoid unnecessary surgery.
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Affiliation(s)
- Chiara Mura
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (C.M.); (R.R.); (S.C.); (A.C.); (S.M.)
| | - Rossella Rodia
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (C.M.); (R.R.); (S.C.); (A.C.); (S.M.)
| | - Silvia Corrias
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (C.M.); (R.R.); (S.C.); (A.C.); (S.M.)
| | - Antonello Cappai
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (C.M.); (R.R.); (S.C.); (A.C.); (S.M.)
| | - Maria Letizia Lai
- Pathology Unit, San Giovanni di Dio Hospital, 09100 Cagliari, Italy;
| | - Gian Luigi Canu
- Surgery Unit, Department of Surgical Sciences, University of Cagliari, 09100 Cagliari, Italy; (G.L.C.); (F.M.); (P.G.C.)
| | - Fabio Medas
- Surgery Unit, Department of Surgical Sciences, University of Cagliari, 09100 Cagliari, Italy; (G.L.C.); (F.M.); (P.G.C.)
| | - Pietro Giorgio Calò
- Surgery Unit, Department of Surgical Sciences, University of Cagliari, 09100 Cagliari, Italy; (G.L.C.); (F.M.); (P.G.C.)
| | - Stefano Mariotti
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (C.M.); (R.R.); (S.C.); (A.C.); (S.M.)
| | - Francesco Boi
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (C.M.); (R.R.); (S.C.); (A.C.); (S.M.)
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Canu GL, Medas F, Cappellacci F, Rossi L, Gjeloshi B, Sessa L, Pennestrì F, Djafarrian R, Mavromati M, Kotsovolis G, Pliakos I, Di Filippo G, Lazzari G, Vaccaro C, Izzo M, Boi F, Brazzarola P, Feroci F, Demarchi MS, Papavramidis T, Materazzi G, Raffaelli M, Calò PG. Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study). Front Surg 2023; 10:1278696. [PMID: 37850042 PMCID: PMC10577166 DOI: 10.3389/fsurg.2023.1278696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Background Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence. Methods Patients undergoing thyroidectomy in seven high-volume thyroid surgery centers in Europe, between January 2020 and December 2022, were retrospectively analysed. Based on the onset of cervical haematoma, two groups were identified: Cervical Haematoma (CH) Group and No Cervical Haematoma (NoCH) Group. Univariate analysis was performed to compare these two groups. Moreover, employing multivariate analysis, all potential independent risk factors for the development of this complication were assessed. Results Eight thousand eight hundred and thirty-nine patients were enrolled: 8,561 were included in NoCH Group and 278 in CH Group. Surgical revision of haemostasis was performed in 70 (25.18%) patients. The overall incidence of postoperative cervical haematoma was 3.15% (0.79% for cervical haematomas requiring surgical revision of haemostasis, and 2.35% for those managed conservatively). The timing of onset of cervical haematomas requiring surgical revision of haemostasis was within six hours after the end of the operation in 52 (74.28%) patients. Readmission was necessary in 3 (1.08%) cases. At multivariate analysis, male sex (P < 0.001), older age (P < 0.001), higher BMI (P = 0.021), unilateral lateral neck dissection (P < 0.001), drain placement (P = 0.007), and shorter operative times (P < 0.001) were found to be independent risk factors for cervical haematoma. Conclusions Based on our findings, we believe that patients with the identified risk factors should be closely monitored in the postoperative period, particularly during the first six hours after the operation, and excluded from outpatient surgery.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | | | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Benard Gjeloshi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Luca Sessa
- UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Delle Ghiandole Endocrine e Dell’Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pennestrì
- UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Delle Ghiandole Endocrine e Dell’Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Reza Djafarrian
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Maria Mavromati
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Center, Geneva University Hospital, Geneva University, Geneva, Switzerland
| | - George Kotsovolis
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- Unit of Minimally Invasive Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - Ioannis Pliakos
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- Unit of Minimally Invasive Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - Giacomo Di Filippo
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Lazzari
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Carla Vaccaro
- SOC Chirurgia Generale, Ospedale SS Cosma e Damiano, Pescia, Italy
| | - Martina Izzo
- SOC Chirurgia Generale, Ospedale SS Cosma e Damiano, Pescia, Italy
| | - Francesco Boi
- Department of Medical Sciences, University of Cagliari, Monserrato, Italy
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Francesco Feroci
- SOC Chirurgia Generale, Ospedale SS Cosma e Damiano, Pescia, Italy
- Department of General and Oncologic Surgery, Santo Stefano Hospital, Prato, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Theodossios Papavramidis
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- Unit of Minimally Invasive Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | | | - Marco Raffaelli
- UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Delle Ghiandole Endocrine e Dell’Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Medas F, Dobrinja C, Al-Suhaimi EA, Altmeier J, Anajar S, Arikan AE, Azaryan I, Bains L, Basili G, Bolukbasi H, Bononi M, Borumandi F, Bozan MB, Brenta G, Brunaud L, Brunner M, Buemi A, Canu GL, Cappellacci F, Cartwright SB, Castells Fusté I, Cavalheiro B, Cavallaro G, Chala A, Chan SYB, Chaplin J, Cheema MS, Chiapponi C, Chiofalo MG, Chrysos E, D'Amore A, de Cillia M, De Crea C, de Manzini N, de Matos LL, De Pasquale L, Del Rio P, Demarchi MS, Dhiwakar M, Donatini G, Dora JM, D'Orazi V, Doulatram Gamgaram VK, Eismontas V, Kabiri EH, El Malki HO, Elzahaby I, Enciu O, Eskander A, Feroci F, Figueroa-Bohorquez D, Filis D, François G, Frías-Fernández P, Gamboa-Dominguez A, Genc V, Giordano D, Gómez-Pedraza A, Graceffa G, Griffin J, Guerreiro SC, Gupta K, Gupta KK, Gurrado A, Hajiioannou J, Hakala T, Harahap WA, Hargitai L, Hartl D, Hellmann A, Hlozek J, Hoang VT, Iacobone M, Innaro N, Ioannidis O, Jang JHI, Xavier-Junior JC, Jovanovic M, Kaderli RM, Kakamad F, Kaliszewski K, Karamanliev M, Katoh H, Košec A, Kovacevic B, Kowalski LP, Králik R, Yadav SK, Kumorová A, Lampridis S, Lasithiotakis K, Leclere JC, Leong EKF, Leow MKS, Lim JY, Lino-Silva LS, Liu SYW, Llorach NP, Lombardi CP, López-Gómez J, Lori E, Quintanilla-Dieck L, Lucchini R, Madani A, Manatakis D, Markovic I, Materazzi G, Mazeh H, Mercante G, Meyer-Rochow GY, Mihaljevic O, Miller JA, Minuto M, Monacelli M, Mulita F, Mullineris B, Muñoz-de-Nova JL, Muradás Girardi F, Nader S, Napadon T, Nastos C, Offi C, Ronen O, Oragano L, Orois A, Pan Y, Panagiotidis E, Panchangam RB, Papavramidis T, Parida PK, Paspala A, Pérez ÒV, Petrovic S, Raffaelli M, Ramacciotti CF, Ratia Gimenez T, Rivo Vázquez Á, Roh JL, Rossi L, Sanabria A, Santeerapharp A, Semenov A, Seneviratne S, Serdar A, Sheahan P, Sheppard SC, Slotcavage RL, Smaxwil C, Kim SY, Sorrenti S, Spartalis E, Sriphrapradang C, Testini M, Turk Y, Tzikos G, Vabalayte K, Vargas-Osorio K, Vázquez Rentería RS, Velázquez-Fernández D, Vithana SMP, Yücel L, Yulian ED, Zahradnikova P, Zarogoulidis P, Ziablitskaia E, Zolotoukho A, Calò PG. Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study. Lancet Diabetes Endocrinol 2023; 11:402-413. [PMID: 37127041 PMCID: PMC10147315 DOI: 10.1016/s2213-8587(23)00094-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING None.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Chiara Dobrinja
- Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Ebtesam Abdullah Al-Suhaimi
- Biology Department, College of Science, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Julia Altmeier
- Endocrine Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - Said Anajar
- Department of Otolaryngology-Head and Neck Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Akif Enes Arikan
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Türkiye
| | - Irina Azaryan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Giancarlo Basili
- Azienda USL Toscana Nord-Ovest, UOSD Chirurgia della Tiroide, Toscana, Italy
| | - Hakan Bolukbasi
- General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye
| | - Marco Bononi
- Dipartimento di Chirurgia Pietro Valdoni, Policlinico Umberto I Sapienza, Rome, Italy
| | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St Richard's Hospital, Chichester and Worthing Hospital, Worthing, UK
| | - Mehmet Buğra Bozan
- General Surgery, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Türkiye
| | - Gabriela Brenta
- Endocrinology Department, Unidad Asistencial Dr César Milstein, Buenos Aires, Argentina
| | - Laurent Brunaud
- Department of Surgery CVMC, CHU Nancy-Brabois, Université de Lorraine, Nancy, France
| | - Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Antoine Buemi
- Department of Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | | | | | - Beatriz Cavalheiro
- Departamento de Cirurgia de Cabeça e Pescoço, Hospital São Camilo Oncologia-Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | | | - Andres Chala
- Head and Neck Department Oncologos del Occidente, Universidad de Caldas, Manizales, Colombia
| | - Shun Yan Bryant Chan
- Department of Surgery, Tseung Kwan O Hospital, Hong Kong Special Administrative Region, China
| | - John Chaplin
- Department of Otolaryngology Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Costanza Chiapponi
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany; Department of Endocrine Surgery, Evangelisches Klinikum Cologne Weyertal, Cologne, Germany
| | - Maria Grazia Chiofalo
- Head and Neck Cancer Medical Oncology Department, Istituto Nazionale Tumori, IRCCS Fondazione G Pascale, Napoli, Italy
| | - Emmanuel Chrysos
- Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | - Annamaria D'Amore
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michael de Cillia
- Department of Surgery, Saint John of God Hospital, Salzburg, Austria
| | - Carmela De Crea
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Nicolò de Manzini
- Department of Medical and Surgical Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Leandro Luongo de Matos
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Unit-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Del Rio
- General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Muthuswamy Dhiwakar
- Department of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Coimbatore, India
| | | | - Jose Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Valerio D'Orazi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy; Division of General Surgery-Section of Endocrine and Diabetic Foot Surgery, "Fabia Mater" Hospital, Rome, Italy
| | | | - Vitalijus Eismontas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania; Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Hadj Omar El Malki
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University, Rabat, Morocco
| | | | - Octavian Enciu
- Elias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Francesco Feroci
- Department of Surgery, General Surgery Unit, S Stefano Hospital, Prato, Italy
| | | | - Dimitrios Filis
- Department of Surgery, Saint Andrew Hospital of Patras, Patras, Greece
| | - Gorostidi François
- Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Armando Gamboa-Dominguez
- Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Volkan Genc
- Department of Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Davide Giordano
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppa Graceffa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - James Griffin
- Otolaryngology, Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - Sofia Cuco Guerreiro
- Endocrine Surgery, University Hospital Center of Central Lisbon, Hospital Curry Cabral, Lisboa, Portugal
| | - Karan Gupta
- Department of Head and Neck Surgery, Medanta, Gurugram, India
| | - Keshav Kumar Gupta
- Department of ENT, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | | | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Wirsma Arif Harahap
- Department of Surgery, Faculty of Medicine, Universitas Andalas, Padang City, Indonesia
| | - Lindsay Hargitai
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Dana Hartl
- Department of Surgery, Anesthesia and Interventional Radiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy, Villejuif, France
| | - Andrzej Hellmann
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jiri Hlozek
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Nadia Innaro
- Unit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "Georgios Papanikolaou", Thessaloniki, Greece
| | - J H Isabelle Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | | | - Milan Jovanovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade, Serbia
| | - Reto Martin Kaderli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fahmi Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Iraq
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Martin Karamanliev
- Department of Surgical Oncology, University Hospital "Georgi Stranski", Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Japan
| | - Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Bozidar Kovacevic
- Institute of Pathology and Forensic Medicine, Medical Military Academy, Belgrade, Serbia
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgry and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Robert Králik
- Department of Surgical Oncology, St Elisabeth Cancer Institute, Medical Faculty of Comenius University, Bratislava, Slovakia
| | | | - Adriána Kumorová
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital Ružomberok, Ružomberok, Slovakia
| | - Savvas Lampridis
- Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece
| | - Konstantinos Lasithiotakis
- Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | | | | | | | - James Y Lim
- Department of Surgery and Otolaryngology, Oregon Health and Science University, Portland, OR, USA
| | | | - Shirley Yuk Wah Liu
- Department of Surgery, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Núria Perucho Llorach
- Unit of Endocrine Surgery Head and Neck Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Javier López-Gómez
- Head and Neck Department, Hospital de Oncología Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Eleonora Lori
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Lourdes Quintanilla-Dieck
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Roberta Lucchini
- Endocrine Surgery Unit, University of Perugia, Santa Maria Hospital, Terni, Italy
| | - Amin Madani
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Dimitrios Manatakis
- Second Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ivan Markovic
- Clinic for Surgical Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | - Haggi Mazeh
- Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Julie A Miller
- The Royal Melbourne Hospital and Epworth Hospital, Melbourne, VIC, Australia
| | - Michele Minuto
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Barbara Mullineris
- Department of General, Emergency and New Technologies, University Hospital of Modena, Baggiovara Civil Hospital, Modena, Italy
| | - José Luis Muñoz-de-Nova
- Department of General and Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Saki Nader
- Otolaryngology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Chiara Offi
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, ASl Napoli 1 Centro, Naples, Italy
| | - Ohad Ronen
- Galilee Medical Center, Azrieli Faculty of Medicine Bar Ilan University, Safed, Israel
| | | | - Aida Orois
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Yongqin Pan
- Department of Thyroid Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Emmanouil Panagiotidis
- Department of Nuclear Medicine/PET CT, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Theodosios Papavramidis
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Pradipta Kumar Parida
- Department of ENT-Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anna Paspala
- Department of Surgery, Eugenideio Hospital, Athens, Greece
| | - Òscar Vidal Pérez
- General Surgery Department, Universitat de Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Tomas Ratia Gimenez
- General Surgery, Hospital Universitario Principe de Asturias, Alcala de Henares, Spain
| | - Ángel Rivo Vázquez
- Department of General and Digestive Surgery, Division of Endocrine Surgery, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alena Santeerapharp
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Arseny Semenov
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | | - Altinay Serdar
- Department of Endocrin Pathology Unit, University of Health Sciences, Faculty of Medicine, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Sean C Sheppard
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Rachel L Slotcavage
- Department of Surgery and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Soo Young Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Yigit Turk
- Division of Endocrine Surgery, General Surgery Department, Ege University Hospital, Izmir, Turkey
| | - George Tzikos
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Kristina Vabalayte
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Kelly Vargas-Osorio
- Clinical University Hospital Santiago de Compostela University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - David Velázquez-Fernández
- Endocrine Surgery Unit, Department of Surgery, National Institute for Medical Sciences and Nutrition, Mexico City, Mexico
| | | | - Levent Yücel
- Department of Otorhinolaryngology, University of Health Sciences, Gülhane Research and Training Hospital, Ankara, Turkey
| | - Erwin Danil Yulian
- Division of Surgical Oncology, Department of Surgery, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Petra Zahradnikova
- Department of Paediatric Surgery, Medical Faculty of Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Paul Zarogoulidis
- Third Surgery Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evgeniia Ziablitskaia
- Central Research Laboratory, Clinical Medical Multidisciplinary Center of St Luke VI Vernadsky Crimean Federal University, Simferopol, Russia
| | - Anna Zolotoukho
- Endocrine Surgery Department, Saint Petersburg State University Hospital, Saint Petersburg, Russia
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Dolcetti V, Lori E, Fresilli D, Del Gaudio G, Di Bella C, Pacini P, D'Andrea V, Frattaroli FM, Vallone GG, Liberatore P, Pironi D, Canu GL, Calò PG, Cantisani V, Sorrenti S. US Evaluation of Topical Hemostatic Agents in Post-Thyroidectomy. Cancers (Basel) 2023; 15:cancers15092644. [PMID: 37174110 PMCID: PMC10177612 DOI: 10.3390/cancers15092644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND the aim of this study was to describe the ultrasound appearance of topical hemostatics after thyroidectomy. METHODS we enrolled 84 patients who were undergoing thyroid surgery and were treated with two types of topical hemostats, 49 with an absorbable hemostat of oxidized regenerated cellulose (Oxitamp®) and 35 with a fibrin glue-based hemostat (Tisseel®). All patients were examined using B-mode ultrasound. RESULTS In 39 patients of the first group (approximately 80%), a hemostatic residue was detected and in some cases confused with a native gland residue, or with cancer recurrence in oncological patients. No residue was detected in patients in the second group. The main ultrasound characteristics of the tampon were analyzed and arranged according to predefined patterns, and suggestions to recognize it and avoid wrong diagnoses were provided. A part of the group of patients with tampon residue was re-evaluated after 6-12 months, ensuring that the swab remained for months after the maximum resorption time declared by the manufacturer. CONCLUSIONS with equal hemostatic effectiveness, the fibrin glue pad is more favorable in the ultrasound follow-up because it creates reduced surgical outcomes. It is also important to know and recognize the ultrasound characteristics of oxidized cellulose-based hemostats in order to reduce the number of diagnostic errors and inappropriate diagnostic investigations.
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Affiliation(s)
- Vincenzo Dolcetti
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Eleonora Lori
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Daniele Fresilli
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Chiara Di Bella
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Patrizia Pacini
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Vito D'Andrea
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Fabrizio Maria Frattaroli
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Giulia Giordana Vallone
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Piero Liberatore
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Daniele Pironi
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato (Cagliari), Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato (Cagliari), Italy
| | - Vito Cantisani
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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8
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Medas F, Moroni E, Deidda S, Zorcolo L, Restivo A, Canu GL, Cappellacci F, Calò PG, Pintus S, Fantola G. The paradox of Zeno in bariatric surgery weight loss: Superobese patients run faster than morbidly obese patients, but can't overtake them. Front Surg 2023; 10:1100483. [PMID: 36816006 PMCID: PMC9932266 DOI: 10.3389/fsurg.2023.1100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Superobesity (SO) is defined as a BMI > 50 Kg/m2, and represents the extreme severity of the disease, resulting in a challenge for the surgeons. Methods In this retrospective study we aimed to compare the outcomes of SO patients compared to morbidly obese (MO) patients. Results We included in this study 154 MO patients, with a median preoperative BMI of 40.8 kg/m2, and 19 SO patients with median preoperative BMI of 54.9 kg/m2. The MO patients underwent sleeve gastrectomy (SG) in 62 (40.3%) cases, laparoscopic Roux-and-Y gastric bypass (LRYGBP) in 85 (55.2%) cases and One-Anastomosis Gastric Bypass (OAGB) in 7 (4.5%) cases. underwent OAGB. The patients in the SO group were submitted to SG in 11 (57.9%) cases, LRYGBP in 5 (26.3%) cases, and OAGB in 3 (15.8%). At 24-month follow-up, an excess weight loss (EWL) >50% was achieved in 129 (83.8%) patients in the MO group and in 15 (78.9%) in the SO group (p = 0.53). A BMI < 35 kg/m2 was achieved in 137 (89%) patients in the MO group and from 8 (42.2%) patients in the SO group (p < 0.001). The total weight loss was significantly directly related to the initial BMI. Superobesity was identified as independent risk factor for surgical failure when considering the outcome of BMI < 35 kg/m2. Discussion Our study confirms that, although SO patients tend to gain a greater weight loss than MO patients, they less frequently achieve the desired BMI target. In this setting, it should be necessary to re-consider malabsorptive procedures as first choice.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy,Correspondence: Fabio Medas
| | - Enrico Moroni
- Obesity Surgery Unit, Surgical Department, “ARNAS G. Brotzu” Hospital, Cagliari, Italy
| | - Simona Deidda
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Luigi Zorcolo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Angelo Restivo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | | | - Stefano Pintus
- Obesity Surgery Unit, Surgical Department, “ARNAS G. Brotzu” Hospital, Cagliari, Italy
| | - Giovanni Fantola
- Obesity Surgery Unit, Surgical Department, “ARNAS G. Brotzu” Hospital, Cagliari, Italy
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9
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Anedda G, Cappellacci F, Canu GL, Farris S, Calò PG, Dessena M, Medas F. Axillary Treatment Management in Breast Cancer during COVID-19 Pandemic (Association between ACOSOG Z0011 Criteria and OSNA Test). J Pers Med 2023; 13:jpm13020241. [PMID: 36836475 PMCID: PMC9960710 DOI: 10.3390/jpm13020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The outbreak of the SARS-COVID-2 pandemic (COVID-19) had a significant effect on the organisation of healthcare systems. Surgical units saw a significant reduction in the volume of surgical procedures performed, with lengthening waiting lists as a consequence. We assessed the surgical activity in relation to breast cancer that took place at the University Hospital of Cagliari, Italy, from February 2018 to March 2022. Two phases were identified based on the epidemiological circumstances: Phase 1-February 2018 to February 2020; Phase 2-March 2020 to March 2022. The surgery performed in the two phases was then compared. All the patients in our sample underwent a breast surgical procedure involving a lymph node biopsy using OSNA associated with the ACOSOG Z0011 criteria. In the study period overall at our facility, there were 4214 procedures, 417 of which involved breast surgery. In Phase 2, 91 procedures were performed using the OSNA method and ACOSOG Z0011 criteria, enabling the intraoperative staging of axillary nodes. Axillary treatment in breast cancer using this approach resulted in a significant reduction in the number of reoperations for the radicalisation of metastatic sentinel lymph nodes.
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Affiliation(s)
- Giacomo Anedda
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-3335351390
| | | | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Stefania Farris
- Polispecialistyc Surgery Unit, Policlinico Universitario “Duilio Casula”, 09042 Cagliari, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Massimo Dessena
- Polispecialistyc Surgery Unit, Policlinico Universitario “Duilio Casula”, 09042 Cagliari, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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10
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De Simone B, Abu-Zidan FM, Chouillard E, Di Saverio S, Sartelli M, Podda M, Gomes CA, Moore EE, Moug SJ, Ansaloni L, Kluger Y, Coccolini F, Landaluce-Olavarria A, Estraviz-Mateos B, Uriguen-Etxeberria A, Giordano A, Luna AP, Amín LAH, Hernández AMP, Shabana A, Dzulkarnaen ZA, Othman MA, Sani MI, Balla A, Scaramuzzo R, Lepiane P, Bottari A, Staderini F, Cianchi F, Cavallaro A, Zanghì A, Cappellani A, Campagnacci R, Maurizi A, Martinotti M, Ruggieri A, Jusoh AC, Rahman KA, Zulkifli ASM, Petronio B, Matías-García B, Quiroga-Valcárcel A, Mendoza-Moreno F, Atanasov B, Campanile FC, Vecchioni I, Cardinali L, Travaglini G, Sebastiani E, Chooklin S, Chuklin S, Cianci P, Restini E, Capuzzolo S, Currò G, Filippo R, Rispoli M, Aparicio-Sánchez D, Muñóz-Cruzado VD, Barbeito SD, Delibegovic S, Kesetovic A, Sasia D, Borghi F, Giraudo G, Visconti D, Doria E, Santarelli M, Luppi D, Bonilauri S, Grossi U, Zanus G, Sartori A, Piatto G, De Luca M, Vita D, Conti L, Capelli P, Cattaneo GM, Marinis A, Vederaki SA, Bayrak M, Altıntas Y, Uzunoglu MY, Demirbas IE, Altinel Y, Meric S, Aktimur YE, Uymaz DS, Omarov N, Azamat I, Lostoridis E, Nagorni EA, Pujante A, Anania G, Bombardini C, Bagolini F, Gonullu E, Mantoglu B, Capoglu R, Cappato S, Muzio E, Colak E, Polat S, Koylu ZA, Altintoprak F, Bayhan Z, Akin E, Andolfi E, Rezart S, Kim JI, Jung SW, Shin YC, Enciu O, Toma EA, Medas F, Canu GL, Cappellacci F, D’Acapito F, Ercolani G, Solaini L, Roscio F, Clerici F, Gelmini R, Serra F, Rossi EG, Fleres F, Clarizia G, Spolini A, Ferrara F, Nita G, Sarnari J, Gachabayov M, Abdullaev A, Poillucci G, Palini GM, Veneroni S, Garulli G, Piccoli M, Pattacini GC, Pecchini F, Argenio G, Armellino MF, Brisinda G, Tedesco S, Fransvea P, Ietto G, Franchi C, Carcano G, Martines G, Trigiante G, Negro G, Vega GM, González AR, Ojeda L, Piccolo G, Bondurri A, Maffioli A, Guerci C, Sin BH, Zuhdi Z, Azman A, Mousa H, al Bahri S, Augustin G, Romic I, Moric T, Nikolopoulos I, Andreuccetti J, Pignata G, D’Alessio R, Kenig J, Skorus U, Fraga GP, Hirano ES, de Lima Bertuol JV, Isik A, Kurnaz E, Asghar MS, Afzal A, Akbar A, Nikolouzakis TK, Lasithiotakis K, Chrysos E, Das K, Özer N, Seker A, Ibrahim M, Hamid HKS, Babiker A, Bouliaris K, Koukoulis G, Kolla CC, Lucchi A, Agostinelli L, Taddei A, Fortuna L, Agostini C, Licari L, Viola S, Callari C, Laface L, Abate E, Casati M, Anastasi A, Canonico G, Gabellini L, Tosi L, Guariniello A, Zanzi F, Bains L, Sydorchuk L, Iftoda O, Sydorchuk A, Malerba M, Costanzo F, Galleano R, Monteleone M, Costanzi A, Riva C, Walędziak M, Kwiatkowski A, Czyżykowski Ł, Major P, Strzałka M, Matyja M, Natkaniec M, Valenti MR, Di Vita MDP, Sotiropoulou M, Kapiris S, Massalou D, Veroux M, Volpicelli A, Gioco R, Uccelli M, Bonaldi M, Olmi S, Nardi M, Livadoti G, Mesina C, Dumitrescu TV, Ciorbagiu MC, Ammendola M, Ammerata G, Romano R, Slavchev M, Misiakos EP, Pikoulis E, Papaconstantinou D, Elbahnasawy M, Abdel-elsalam S, Felsenreich DM, Jedamzik J, Michalopoulos NV, Sidiropoulos TA, Papadoliopoulou M, Cillara N, Deserra A, Cannavera A, Negoi I, Schizas D, Syllaios A, Vagios I, Gourgiotis S, Dai N, Gurung R, Norrey M, Pesce A, Feo CV, Fabbri N, Machairas N, Dorovinis P, Keramida MD, Mulita F, Verras GI, Vailas M, Yalkin O, Iflazoglu N, Yigit D, Baraket O, Ayed K, Ghalloussi MH, Patias P, Ntokos G, Rahim R, Bala M, Kedar A, Sawyer RG, Trinh A, Miller K, Sydorchuk R, Knut R, Plehutsa O, Liman RK, Ozkan Z, Kader SA, Gupta S, Gureh M, Saeidi S, Aliakbarian M, Dalili A, Shoko T, Kojima M, Nakamoto R, Atici SD, Tuncer GK, Kaya T, Delis SG, Rossi S, Picardi B, del Monte SR, Triantafyllou T, Theodorou D, Pintar T, Salobir J, Manatakis DK, Tasis N, Acheimastos V, Ioannidis O, Loutzidou L, Symeonidis S, de Sá TC, Rocha M, Guagni T, Pantalone D, Maltinti G, Khokha V, Abdel-elsalam W, Ghoneim B, López-Ruiz JA, Kara Y, Zainudin S, Hayati F, Azizan N, Khei VTP, Yi RCX, Sellappan H, Demetrashvili Z, Lekiashvili N, Tvaladze A, Froiio C, Bernardi D, Bonavina L, Gil-Olarte A, Grassia S, Romero-Vargas E, Bianco F, Gumbs AA, Dogjani A, Agresta F, Litvin A, Balogh ZJ, Gendrikson G, Martino C, Damaskos D, Pararas N, Kirkpatrick A, Kurtenkov M, Gomes FC, Pisanu A, Nardello O, Gambarini F, Aref H, Angelis ND, Agnoletti V, Biondi A, Vacante M, Griggio G, Tutino R, Massani M, Bisetto G, Occhionorelli S, Andreotti D, Lacavalla D, Biffl WL, Catena F. The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis? World J Emerg Surg 2022; 17:61. [PMID: 36527038 PMCID: PMC9755784 DOI: 10.1186/s13017-022-00466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. METHODS Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. RESULTS A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. CONCLUSIONS The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Fikri M. Abu-Zidan
- grid.43519.3a0000 0001 2193 6666The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates., United Arab Emirates University, Al-Ain, UAE
| | - Elie Chouillard
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Salomone Di Saverio
- Department of General Surgery, Santa Maria del Soccorso Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Mauro Podda
- grid.7763.50000 0004 1755 3242Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Carlos Augusto Gomes
- Faculdade de Ciência Médicas e da Saúde de Juiz de Fora, Hospital Universitario Terezinha de Jesus (SUPREMA), Juiz de Fora, Brazil
| | - Ernest E. Moore
- grid.239638.50000 0001 0369 638XErnest E. Moore Shock Trauma Center at Denver Health, Denver, CO USA
| | - Susan J. Moug
- grid.8756.c0000 0001 2193 314XDepartment of Surgery, Royal Alexandra Hospital, Paisley and Golden Jubilee National Hospital, University of Glasgow, Glasgow, Scotland
| | - Luca Ansaloni
- grid.18887.3e0000000417581884Department of General Surgery, University Hospital of Pavia, Pavia, Italy
| | - Yoram Kluger
- Department of General Surgery, The Rambam Academic Hospital, Haifa, Israel
| | - Federico Coccolini
- grid.144189.10000 0004 1756 8209Department of General and Emergency Surgery, University Hospital of Pisa, Pisa, Italy
| | | | | | | | - Alessio Giordano
- General Surgery Unit ASL Toscana Centro, Santo Stefano Hospital, Prato, Italy
| | | | | | | | - Amanda Shabana
- grid.8348.70000 0001 2306 7492Emergency Surgery Department, John Radcliffe Hospital, Oxford, UK
| | - Zakaria Andee Dzulkarnaen
- grid.11875.3a0000 0001 2294 3534Department of Surgery, School of Medical Sciences and Hospital USM, Universiti Sains Malaysia, Kubang Kerian, Kelantan Malaysia
| | - Muhammad Asyraf Othman
- grid.11875.3a0000 0001 2294 3534Department of Surgery, School of Medical Sciences and Hospital USM, Universiti Sains Malaysia, Kubang Kerian, Kelantan Malaysia
| | - Mohamad Ikhwan Sani
- grid.11875.3a0000 0001 2294 3534Department of Surgery, School of Medical Sciences and Hospital USM, Universiti Sains Malaysia, Kubang Kerian, Kelantan Malaysia
| | - Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital “San Paolo”, Largo Donatori del Sangue 1, 00053 Civitavecchia, Rome, Italy
| | - Rosa Scaramuzzo
- UOC of General and Minimally Invasive Surgery, Hospital “San Paolo”, Largo Donatori del Sangue 1, 00053 Civitavecchia, Rome, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital “San Paolo”, Largo Donatori del Sangue 1, 00053 Civitavecchia, Rome, Italy
| | - Andrea Bottari
- grid.24704.350000 0004 1759 9494SOD Chirurgia dell’Apparato Digerente, AOU Careggi, Florence, Italy
| | - Fabio Staderini
- grid.24704.350000 0004 1759 9494SOD Chirurgia dell’Apparato Digerente, AOU Careggi, Florence, Italy
| | - Fabio Cianchi
- grid.24704.350000 0004 1759 9494SOD Chirurgia dell’Apparato Digerente, AOU Careggi, Florence, Italy
| | - Andrea Cavallaro
- grid.8158.40000 0004 1757 1969Department of Surgery, University of Catania, Policlinico “G. Rodolico - San Marco” Hospital, Catania, Italy
| | - Antonio Zanghì
- grid.8158.40000 0004 1757 1969Department of Surgery, University of Catania, Policlinico “G. Rodolico - San Marco” Hospital, Catania, Italy
| | - Alessandro Cappellani
- grid.8158.40000 0004 1757 1969Department of Surgery, University of Catania, Policlinico “G. Rodolico - San Marco” Hospital, Catania, Italy
| | | | - Angela Maurizi
- U.O.C. of General Surgery, “Carlo Urbani” Hospital, Jesi, AN Italy
| | | | | | - Asri Che Jusoh
- Department of General Surgery, Hospital Sultan Ismail Petra, 18000 Kuala Krai, Kelantan Malaysia
| | - Karim Abdul Rahman
- Department of General Surgery, Hospital Sultan Ismail Petra, 18000 Kuala Krai, Kelantan Malaysia
| | - Anis Suraya M. Zulkifli
- Department of General Surgery, Hospital Sultan Ismail Petra, 18000 Kuala Krai, Kelantan Malaysia
| | - Barbara Petronio
- Chirurgia Generale e Mininvasiva, San Polo Monfalcone, Monfalcone, GO Italy
| | - Belén Matías-García
- grid.411336.20000 0004 1765 5855Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Ana Quiroga-Valcárcel
- grid.411336.20000 0004 1765 5855Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Fernando Mendoza-Moreno
- grid.411336.20000 0004 1765 5855Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Boyko Atanasov
- grid.35371.330000 0001 0726 0380RIMU, Medical University of Plovdiv, UMHAT Eurohospital, Plovdiv, Bulgaria
| | | | - Ilaria Vecchioni
- Ospedale San Giovanni Decollato Andosilla – ASL, Civita Castellana, Viterbo, VT Italy
| | - Luca Cardinali
- UOC Chirurgia Generale, Ospedale “Madonna del Soccorso”, San Benedetto del Tronto, AP Italy
| | - Grazia Travaglini
- UOC Chirurgia Generale, Ospedale “Madonna del Soccorso”, San Benedetto del Tronto, AP Italy
| | - Elisa Sebastiani
- UOC Chirurgia Generale, Ospedale “Madonna del Soccorso”, San Benedetto del Tronto, AP Italy
| | | | | | - Pasquale Cianci
- grid.416083.80000 0004 1768 5712Lorenzo Bonomo Hospital, ASL BAT, Andria, Puglia Italy
| | - Enrico Restini
- grid.416083.80000 0004 1768 5712Lorenzo Bonomo Hospital, ASL BAT, Andria, Puglia Italy
| | - Sabino Capuzzolo
- grid.416083.80000 0004 1768 5712Lorenzo Bonomo Hospital, ASL BAT, Andria, Puglia Italy
| | - Giuseppe Currò
- grid.411489.10000 0001 2168 2547Generall Surgery Unit, Science of Health Department, “Mater Domini” Hospital, University “Magna Graecia” Medical School, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Rosalinda Filippo
- grid.411489.10000 0001 2168 2547Generall Surgery Unit, Science of Health Department, “Mater Domini” Hospital, University “Magna Graecia” Medical School, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Michele Rispoli
- grid.411489.10000 0001 2168 2547Generall Surgery Unit, Science of Health Department, “Mater Domini” Hospital, University “Magna Graecia” Medical School, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Daniel Aparicio-Sánchez
- grid.411109.c0000 0000 9542 1158Emergency Surgery Unit, Hospital Virgen del Rocío, Seville, Spain
| | | | - Sandra Dios Barbeito
- grid.411109.c0000 0000 9542 1158Emergency Surgery Unit, Hospital Virgen del Rocío, Seville, Spain
| | - Samir Delibegovic
- grid.412410.20000 0001 0682 9061Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amar Kesetovic
- grid.412410.20000 0001 0682 9061Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Diego Sasia
- grid.413179.90000 0004 0486 1959Santa Croce and Carle Hospital, Cuneo, Italy
| | - Felice Borghi
- grid.413179.90000 0004 0486 1959Santa Croce and Carle Hospital, Cuneo, Italy
| | - Giorgio Giraudo
- grid.413179.90000 0004 0486 1959Santa Croce and Carle Hospital, Cuneo, Italy
| | - Diego Visconti
- Chirurgia Generale d’Urgenza e PS - AOU Cittá della Salute e della Scienza, Turin, Italy
| | - Emanuele Doria
- Chirurgia Generale d’Urgenza e PS - AOU Cittá della Salute e della Scienza, Turin, Italy
| | - Mauro Santarelli
- Chirurgia Generale d’Urgenza e PS - AOU Cittá della Salute e della Scienza, Turin, Italy
| | - Davide Luppi
- General and Emergency Surgery, ASMN IRCCS REGGIO EMILIA, Reggio Emilia, Italy
| | - Stefano Bonilauri
- General and Emergency Surgery, ASMN IRCCS REGGIO EMILIA, Reggio Emilia, Italy
| | - Ugo Grossi
- grid.5608.b0000 0004 1757 3470Surgery Unit 2, Regional Hospital Treviso, DISCOG, University of Padua, Treviso, Italy
| | - Giacomo Zanus
- grid.5608.b0000 0004 1757 3470Surgery Unit 2, Regional Hospital Treviso, DISCOG, University of Padua, Treviso, Italy
| | - Alberto Sartori
- U.O. Chirurgia Generale e d’Urgenza Ospedale San Valentino, Montebelluna, Treviso, Italy
| | - Giacomo Piatto
- U.O. Chirurgia Generale e d’Urgenza Ospedale San Valentino, Montebelluna, Treviso, Italy
| | - Maurizio De Luca
- U.O. Chirurgia Generale e d’Urgenza Ospedale San Valentino, Montebelluna, Treviso, Italy
| | - Domenico Vita
- grid.5608.b0000 0004 1757 3470Surgery Unit 2, Regional Hospital Treviso, DISCOG, University of Padua, Treviso, Italy
| | - Luigi Conti
- grid.476050.0Department of Surgery, G. Da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy
| | - Patrizio Capelli
- grid.476050.0Department of Surgery, G. Da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy
| | - Gaetano Maria Cattaneo
- grid.476050.0Department of Surgery, G. Da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy
| | - Athanasios Marinis
- grid.414012.20000 0004 0622 6596Styliani-Aikaterini Vederaki, Third Department of Surgery, “Tzaneio” General Hospital, Piraeus, Greece
| | - Styliani-Aikaterini Vederaki
- grid.414012.20000 0004 0622 6596Styliani-Aikaterini Vederaki, Third Department of Surgery, “Tzaneio” General Hospital, Piraeus, Greece
| | - Mehmet Bayrak
- Mehmet Bayrak, Clinic for Surgery, Private Ortadogu Hospital, Adana, Turkey
| | | | | | | | - Yuksel Altinel
- grid.488643.50000 0004 5894 3909Department of General Surgery, Bagcilar Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Serhat Meric
- grid.488643.50000 0004 5894 3909Department of General Surgery, Bagcilar Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Yunus Emre Aktimur
- grid.488643.50000 0004 5894 3909Department of General Surgery, Bagcilar Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Derya Salim Uymaz
- grid.15876.3d0000000106887552General Surgery Department, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Nail Omarov
- grid.15876.3d0000000106887552General Surgery Department, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Ibrahim Azamat
- grid.15876.3d0000000106887552General Surgery Department, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Eftychios Lostoridis
- grid.513828.50000 0004 0623 027X1St Department of Surgery, Kavala General Hospital, Kavala, Greece
| | - Eleni-Aikaterini Nagorni
- grid.513828.50000 0004 0623 027X1St Department of Surgery, Kavala General Hospital, Kavala, Greece
| | - Antonio Pujante
- grid.513828.50000 0004 0623 027X1St Department of Surgery, Kavala General Hospital, Kavala, Greece
| | - Gabriele Anania
- grid.416315.4UO Chirurgia 1, Dipartimento Chirurgico, Arcispedale Sant’Anna, Azienda Ospedaliero-Universitaria’di Ferrara, Ferrara, Italy
| | - Cristina Bombardini
- grid.416315.4UO Chirurgia 1, Dipartimento Chirurgico, Arcispedale Sant’Anna, Azienda Ospedaliero-Universitaria’di Ferrara, Ferrara, Italy
| | - Francesco Bagolini
- grid.416315.4UO Chirurgia 1, Dipartimento Chirurgico, Arcispedale Sant’Anna, Azienda Ospedaliero-Universitaria’di Ferrara, Ferrara, Italy
| | - Emre Gonullu
- grid.459902.30000 0004 0386 5536Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Baris Mantoglu
- grid.459902.30000 0004 0386 5536Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Recayi Capoglu
- grid.459902.30000 0004 0386 5536Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Stefano Cappato
- Department of General Surgery ASL 4, Lavagna Hospital, Genoa, Italy
| | - Elena Muzio
- Department of General Surgery ASL 4, Lavagna Hospital, Genoa, Italy
| | - Elif Colak
- grid.510471.60000 0004 7684 9991Samsun Training and Research Hospital, University of Samsun, Samsun, Turkey
| | - Suleyman Polat
- grid.510471.60000 0004 7684 9991Samsun Training and Research Hospital, University of Samsun, Samsun, Turkey
| | - Zehra Alan Koylu
- grid.510471.60000 0004 7684 9991Samsun Training and Research Hospital, University of Samsun, Samsun, Turkey
| | - Fatih Altintoprak
- grid.49746.380000 0001 0682 3030Department of General Surgery, Faculty of Medicine, Sakarya University, Serdivan, Turkey
| | - Zülfü Bayhan
- grid.49746.380000 0001 0682 3030Department of General Surgery, Faculty of Medicine, Sakarya University, Serdivan, Turkey
| | - Emrah Akin
- grid.49746.380000 0001 0682 3030Department of General Surgery, Faculty of Medicine, Sakarya University, Serdivan, Turkey
| | - Enrico Andolfi
- grid.416351.40000 0004 1789 6237General and Emergency Surgery Unit, San Donato Hospital, Arezzo, Italy
| | - Sulce Rezart
- grid.416351.40000 0004 1789 6237General and Emergency Surgery Unit, San Donato Hospital, Arezzo, Italy
| | - Jae Il Kim
- grid.411633.20000 0004 0371 8173Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Sung Won Jung
- grid.411633.20000 0004 0371 8173Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Yong Chan Shin
- grid.411633.20000 0004 0371 8173Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Octavian Enciu
- grid.8194.40000 0000 9828 7548Elias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Adelina Toma
- grid.8194.40000 0000 9828 7548Elias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Fabio Medas
- grid.7763.50000 0004 1755 3242Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gian Luigi Canu
- grid.7763.50000 0004 1755 3242Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Federico Cappellacci
- grid.7763.50000 0004 1755 3242Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Fabrizio D’Acapito
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via C. Forlanini 34, 47121 Forlì, Italy
| | - Giorgio Ercolani
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via C. Forlanini 34, 47121 Forlì, Italy
| | - Leonardo Solaini
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via C. Forlanini 34, 47121 Forlì, Italy
| | | | | | - Roberta Gelmini
- grid.7548.e0000000121697570Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine AOU Policlinico Di Modena, Modena, Italy
| | - Francesco Serra
- grid.7548.e0000000121697570Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine AOU Policlinico Di Modena, Modena, Italy
| | - Elena Giulia Rossi
- grid.7548.e0000000121697570Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine AOU Policlinico Di Modena, Modena, Italy
| | - Francesco Fleres
- UOC General Surgery, Hospital Civil of Sondrio, ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Guglielmo Clarizia
- UOC General Surgery, Hospital Civil of Sondrio, ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Alessandro Spolini
- UOC General Surgery, Hospital Civil of Sondrio, ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Francesco Ferrara
- grid.414126.40000 0004 1760 1507Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gabriela Nita
- grid.458453.b0000 0004 1756 7652AUSL Reggio Emilia, Ospedale Sant’Anna, Castelnuovo ne Monti, Reggio Emilia, Italy
| | - Jlenia Sarnari
- grid.458453.b0000 0004 1756 7652AUSL Reggio Emilia, Ospedale Sant’Anna, Castelnuovo ne Monti, Reggio Emilia, Italy
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Abakar Abdullaev
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | | | - Gian Marco Palini
- grid.414614.2Chirurgia generale e d’urgenza, Ospedale Infermi di Rimini, AUSL Romagna, Rimini, Italy
| | - Simone Veneroni
- grid.414614.2Chirurgia generale e d’urgenza, Ospedale Infermi di Rimini, AUSL Romagna, Rimini, Italy
| | - Gianluca Garulli
- grid.414614.2Chirurgia generale e d’urgenza, Ospedale Infermi di Rimini, AUSL Romagna, Rimini, Italy
| | - Micaela Piccoli
- Department of General Surgery, Emergencies and New Technologies, Baggiovara Civil Hospital, Modena, Italy
| | - Gianmaria Casoni Pattacini
- Department of General Surgery, Emergencies and New Technologies, Baggiovara Civil Hospital, Modena, Italy
| | - Francesca Pecchini
- Department of General Surgery, Emergencies and New Technologies, Baggiovara Civil Hospital, Modena, Italy
| | - Giulio Argenio
- UOC Chirurgia d’Urgenza, AOU San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | - Giuseppe Brisinda
- grid.414603.4Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Silvia Tedesco
- grid.414603.4Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Pietro Fransvea
- grid.414603.4Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giuseppe Ietto
- grid.18147.3b0000000121724807General, Emergency and Transplant Surgery Department, ASST-Settelaghi and University of Insubria, Varese, Italy
| | - Caterina Franchi
- grid.18147.3b0000000121724807General, Emergency and Transplant Surgery Department, ASST-Settelaghi and University of Insubria, Varese, Italy
| | - Giulio Carcano
- grid.18147.3b0000000121724807General, Emergency and Transplant Surgery Department, ASST-Settelaghi and University of Insubria, Varese, Italy
| | - Gennaro Martines
- General Surgery Unit, Azienda Ospedaliero Universitaria Policlinico Bari - Italy, Bari, Italy
| | - Giuseppe Trigiante
- General Surgery Unit, Azienda Ospedaliero Universitaria Policlinico Bari - Italy, Bari, Italy
| | - Giulia Negro
- General Surgery Unit, Azienda Ospedaliero Universitaria Policlinico Bari - Italy, Bari, Italy
| | - Gustavo Machain Vega
- grid.412213.70000 0001 2289 5077Department of Surgery, Hospital de Clinicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Agustín Rodríguez González
- grid.412213.70000 0001 2289 5077Department of Surgery, Hospital de Clinicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Leonardo Ojeda
- grid.412213.70000 0001 2289 5077Department of Surgery, Hospital de Clinicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Gaetano Piccolo
- grid.4708.b0000 0004 1757 2822Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Via Di Rudinì 8, 20142 Milan, Italy
| | - Andrea Bondurri
- grid.4708.b0000 0004 1757 2822Department of General Surgery, Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Anna Maffioli
- grid.4708.b0000 0004 1757 2822Department of General Surgery, Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Claudio Guerci
- grid.4708.b0000 0004 1757 2822Department of General Surgery, Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Boo Han Sin
- HPB Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Zamri Zuhdi
- HPB Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Azlanudin Azman
- HPB Unit, Department of Surgery, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Hussam Mousa
- grid.43519.3a0000 0001 2193 6666College of Medicine, Tawam Hospital, UAE University, Al-Ain, UAE
| | - Shadi al Bahri
- grid.43519.3a0000 0001 2193 6666College of Medicine, Tawam Hospital, UAE University, Al-Ain, UAE
| | - Goran Augustin
- grid.412688.10000 0004 0397 9648Department of Surgery, University Hospital Centre, Zagreb, Croatia
| | - Ivan Romic
- grid.412688.10000 0004 0397 9648Department of Surgery, University Hospital Centre, Zagreb, Croatia
| | - Trpimir Moric
- grid.412688.10000 0004 0397 9648Department of Surgery, University Hospital Centre, Zagreb, Croatia
| | | | - Jacopo Andreuccetti
- grid.412725.72nd Department of General Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giusto Pignata
- grid.412725.72nd Department of General Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Rossella D’Alessio
- grid.412725.72nd Department of General Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Jakub Kenig
- grid.5522.00000 0001 2162 9631Department of General, Gastrointestinal, Oncologic Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Urszula Skorus
- grid.5522.00000 0001 2162 9631Department of General, Gastrointestinal, Oncologic Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Gustavo Pereira Fraga
- grid.411087.b0000 0001 0723 2494Division of Trauma Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Elcio Shiyoiti Hirano
- grid.411087.b0000 0001 0723 2494Division of Trauma Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | | | - Arda Isik
- grid.412176.70000 0001 1498 7262School of Medicine, Erzincan University, Erzincan, Turkey
| | - Eray Kurnaz
- grid.412176.70000 0001 1498 7262School of Medicine, Erzincan University, Erzincan, Turkey
| | | | - Ameer Afzal
- grid.412129.d0000 0004 0608 7688King Edward Medical University, Lahore, Pakistan
| | - Ali Akbar
- grid.412129.d0000 0004 0608 7688King Edward Medical University, Lahore, Pakistan
| | | | - Konstantinos Lasithiotakis
- grid.412481.a0000 0004 0576 5678Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Emmanuel Chrysos
- grid.412481.a0000 0004 0576 5678Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Koray Das
- Department of General Surgery, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Nazmi Özer
- Department of General Surgery, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Ahmet Seker
- Department of General Surgery, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey
| | | | | | | | - Konstantinos Bouliaris
- Surgical Department, Koutlimbaneio and Triantafylleio General Hospital of Larissa, Larisa, Greece
| | - George Koukoulis
- Surgical Department, Koutlimbaneio and Triantafylleio General Hospital of Larissa, Larisa, Greece
| | | | - Andrea Lucchi
- U.O. Chirurgia Generale Ospedale “Ceccarini” Riccione, Riccione, Italy
| | - Laura Agostinelli
- U.O. Chirurgia Generale Ospedale “Ceccarini” Riccione, Riccione, Italy
| | - Antonio Taddei
- grid.24704.350000 0004 1759 9494Hepatobiliary Surgery, Department of Clinical and Experimental Medicine, University of Florence, AOU Careggi, Florence, Italy
| | - Laura Fortuna
- grid.24704.350000 0004 1759 9494Hepatobiliary Surgery, Department of Clinical and Experimental Medicine, University of Florence, AOU Careggi, Florence, Italy
| | - Carlotta Agostini
- grid.24704.350000 0004 1759 9494Hepatobiliary Surgery, Department of Clinical and Experimental Medicine, University of Florence, AOU Careggi, Florence, Italy
| | - Leo Licari
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences (DICHIRONS), Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Simona Viola
- grid.10776.370000 0004 1762 5517University of Palermo, Palermo, Italy
| | - Cosimo Callari
- Department of Surgery, Buccheri La Ferla Hospital, Via Messina Marine, 197, 90123 Palermo, Italy
| | - Letizia Laface
- Department of General Surgery, Vittorio Emanuele III Hospital, Carate Brianza - ASST Brianza, Carate Brianza, Italy
| | - Emmanuele Abate
- Department of General Surgery, Vittorio Emanuele III Hospital, Carate Brianza - ASST Brianza, Carate Brianza, Italy
| | - Massimiliano Casati
- Department of General Surgery, Vittorio Emanuele III Hospital, Carate Brianza - ASST Brianza, Carate Brianza, Italy
| | | | | | - Linda Gabellini
- Chirurgia Generale, Ospedale San Giovanni Di Dio, Florence, Italy
| | - Lorenzo Tosi
- grid.6292.f0000 0004 1757 1758Residency Program in General Surgery, University of Bologna, Bologna, Italy
| | - Anna Guariniello
- grid.415207.50000 0004 1760 3756Section of Emergency Surgery, Department of Surgery, S.Maria delle Croci Hospital Ravenna, Ravenna, Italy
| | - Federico Zanzi
- grid.415207.50000 0004 1760 3756Section of Emergency Surgery, Department of Surgery, S.Maria delle Croci Hospital Ravenna, Ravenna, Italy
| | - Lovenish Bains
- grid.414698.60000 0004 1767 743XDepartment of Surgery, Maulana Azad Medical College and Nayak Hospital, New Delhi, 110002 India
| | - Larysa Sydorchuk
- grid.445372.30000 0004 4906 2392Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Oksana Iftoda
- grid.445372.30000 0004 4906 2392Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Andrii Sydorchuk
- grid.445372.30000 0004 4906 2392Bukovinian State Medical University, Chernivtsi, Ukraine
| | | | | | | | - Michela Monteleone
- Andrea Costanzi, Carlo Riva, O.U. of General Surgery, San Leopoldo Mandic Hospital, Merate, ASST, Lecco, Italy
| | - Andrea Costanzi
- Andrea Costanzi, Carlo Riva, O.U. of General Surgery, San Leopoldo Mandic Hospital, Merate, ASST, Lecco, Italy
| | - Carlo Riva
- Andrea Costanzi, Carlo Riva, O.U. of General Surgery, San Leopoldo Mandic Hospital, Merate, ASST, Lecco, Italy
| | - Maciej Walędziak
- grid.415641.30000 0004 0620 0839Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Kwiatkowski
- grid.415641.30000 0004 0620 0839Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Łukasz Czyżykowski
- grid.415641.30000 0004 0620 0839Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Major
- grid.5522.00000 0001 2162 9631Department of General and Emergency Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Strzałka
- grid.5522.00000 0001 2162 9631Department of General and Emergency Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Matyja
- grid.5522.00000 0001 2162 9631Department of General and Emergency Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Michal Natkaniec
- grid.5522.00000 0001 2162 9631Department of General and Emergency Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Maria Rosaria Valenti
- U.O. General Surgery, Azienda Ospedaliera Universitaria “Policlinico - San Marco”, Catania, Italy
| | | | - Maria Sotiropoulou
- grid.414655.70000 0004 4670 43293Rd Surgical Department, Evangelismos General Hospital, Athens, Greece
| | - Stylianos Kapiris
- grid.414655.70000 0004 4670 43293Rd Surgical Department, Evangelismos General Hospital, Athens, Greece
| | - Damien Massalou
- grid.410528.a0000 0001 2322 4179Department of Emergency Surgery, Centre Hospitalier Universitaire de Nice (CHU de Nice), Université Côte d’Azur, Nice, France
| | | | | | - Rossella Gioco
- General Surgery, Azienda Policlinico San Marco, Catania, Italy
| | - Matteo Uccelli
- General and Oncological Surgery Department, San Marco Hospital GSD, Zingonia, BG Italy
| | - Marta Bonaldi
- General and Oncological Surgery Department, San Marco Hospital GSD, Zingonia, BG Italy
| | - Stefano Olmi
- General and Oncological Surgery Department, San Marco Hospital GSD, Zingonia, BG Italy
| | - Matteo Nardi
- San Giovanni Calibita Hospital- Fondazione Fatebenefratelli, Rome, Italy
| | - Giada Livadoti
- San Giovanni Calibita Hospital- Fondazione Fatebenefratelli, Rome, Italy
| | - Cristian Mesina
- grid.452359.c0000 0004 4690 999XDepartment of Surgery, Emergency County Hospital of Craiova, Craiova, Romania
| | - Theodor Viorel Dumitrescu
- grid.452359.c0000 0004 4690 999XDepartment of Surgery, Emergency County Hospital of Craiova, Craiova, Romania
| | - Mihai Calin Ciorbagiu
- grid.452359.c0000 0004 4690 999XDepartment of Surgery, Emergency County Hospital of Craiova, Craiova, Romania
| | - Michele Ammendola
- grid.411489.10000 0001 2168 2547Science of Health Department, Digestive Surgery Unit, “Mater Domini” Hospital, University “Magna Graecia” Medical School, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Giorgio Ammerata
- grid.411489.10000 0001 2168 2547Science of Health Department, Digestive Surgery Unit, “Mater Domini” Hospital, University “Magna Graecia” Medical School, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Roberto Romano
- grid.411489.10000 0001 2168 2547Science of Health Department, Digestive Surgery Unit, “Mater Domini” Hospital, University “Magna Graecia” Medical School, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Mihail Slavchev
- Department of General Surgery, University Hospital Eurohospital, Plovdiv, Bulgaria
| | - Evangelos P. Misiakos
- grid.5216.00000 0001 2155 08003Rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Pikoulis
- grid.5216.00000 0001 2155 08003Rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papaconstantinou
- grid.5216.00000 0001 2155 08003Rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamed Elbahnasawy
- grid.412258.80000 0000 9477 7793Emergency Medicine and Traumatology Department, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Sherief Abdel-elsalam
- grid.412258.80000 0000 9477 7793Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Daniel M. Felsenreich
- grid.22937.3d0000 0000 9259 8492Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- grid.22937.3d0000 0000 9259 8492Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Nikolaos V. Michalopoulos
- grid.5216.00000 0001 2155 08004Rd Department of Surgery Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros A. Sidiropoulos
- grid.5216.00000 0001 2155 08004Rd Department of Surgery Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Papadoliopoulou
- grid.5216.00000 0001 2155 08004Rd Department of Surgery Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicola Cillara
- grid.459832.1Surgery Department, Santissima Trinità Hospital, Cagliari, Italy
| | - Antonello Deserra
- grid.459832.1Surgery Department, Santissima Trinità Hospital, Cagliari, Italy
| | | | - Ionuţ Negoi
- grid.8194.40000 0000 9828 7548General Surgery Department, Carol Davila University of Medicine and Pharmacy, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Dimitrios Schizas
- grid.411565.20000 0004 0621 2848First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Athanasios Syllaios
- grid.411565.20000 0004 0621 2848First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Ilias Vagios
- grid.411565.20000 0004 0621 2848First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Stavros Gourgiotis
- grid.5335.00000000121885934Addenbrooke’s Hospital, Cambridge University, Cambridge, UK
| | - Nick Dai
- grid.5335.00000000121885934Addenbrooke’s Hospital, Cambridge University, Cambridge, UK
| | - Rekha Gurung
- grid.5335.00000000121885934Addenbrooke’s Hospital, Cambridge University, Cambridge, UK
| | - Marcus Norrey
- grid.5335.00000000121885934Addenbrooke’s Hospital, Cambridge University, Cambridge, UK
| | - Antonio Pesce
- grid.8484.00000 0004 1757 2064Department of Surgery, Delta Hospital, Azienda USL of Ferrara, University of Ferrara, Ferrara, Italy
| | - Carlo Vittorio Feo
- grid.8484.00000 0004 1757 2064Department of Surgery, Delta Hospital, Azienda USL of Ferrara, University of Ferrara, Ferrara, Italy
| | - Nicolo’ Fabbri
- grid.8484.00000 0004 1757 2064Department of Surgery, Delta Hospital, Azienda USL of Ferrara, University of Ferrara, Ferrara, Italy
| | - Nikolaos Machairas
- grid.5216.00000 0001 2155 08002Nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, General Hospital Laiko, Athens, Greece
| | - Panagiotis Dorovinis
- grid.5216.00000 0001 2155 08002Nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, General Hospital Laiko, Athens, Greece
| | - Myrto D. Keramida
- grid.5216.00000 0001 2155 08002Nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, General Hospital Laiko, Athens, Greece
| | - Francesk Mulita
- grid.412458.eDepartment of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Michail Vailas
- grid.412458.eDepartment of Surgery, General University Hospital of Patras, Patras, Greece
| | - Omer Yalkin
- Department of Surgical Oncology and Gastroenterological Surgery, Bursa City Hospital, Bursa, Turkey
| | - Nidal Iflazoglu
- Department of Surgical Oncology and Gastroenterological Surgery, Bursa City Hospital, Bursa, Turkey
| | - Direnc Yigit
- Department of Surgical Oncology and Gastroenterological Surgery, Bursa City Hospital, Bursa, Turkey
| | - Oussama Baraket
- grid.265234.40000 0001 2177 9066Department of General Surgery, Habib Bougatfa Hospital, University Tunis El Manar, Bizerte, Tunisia
| | - Karim Ayed
- grid.265234.40000 0001 2177 9066Department of General Surgery, Habib Bougatfa Hospital, University Tunis El Manar, Bizerte, Tunisia
| | - Mohamed hedi Ghalloussi
- grid.265234.40000 0001 2177 9066Department of General Surgery, Habib Bougatfa Hospital, University Tunis El Manar, Bizerte, Tunisia
| | - Parmenion Patias
- grid.414012.20000 0004 0622 65962nd Department of Surgery, General Hospital of Athens “G.Gennimatas”, Athens, Greece
| | - Georgios Ntokos
- grid.414012.20000 0004 0622 65962nd Department of Surgery, General Hospital of Athens “G.Gennimatas”, Athens, Greece
| | - Razrim Rahim
- grid.462995.50000 0001 2218 9236Department of Surgery, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Miklosh Bala
- grid.9619.70000 0004 1937 0538Department of General Surgery and Trauma, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asaf Kedar
- grid.9619.70000 0004 1937 0538Department of General Surgery and Trauma, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Robert G. Sawyer
- grid.268187.20000 0001 0672 1122Western Michigan University School of Medicine, Kalamazoo, USA
| | - Anna Trinh
- grid.268187.20000 0001 0672 1122Western Michigan University School of Medicine, Kalamazoo, USA
| | - Kelsey Miller
- grid.268187.20000 0001 0672 1122Western Michigan University School of Medicine, Kalamazoo, USA
| | | | - Ruslan Knut
- Regional Emergency Hospital, Chernivtsi, Ukraine
| | | | | | - Zeynep Ozkan
- General Surgery Clinic, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | - Saleh Abdel Kader
- Egypt and NMC Specialty Hospital Al Ain, Ain Shams University, Al-Ain, UAE
| | - Sanjay Gupta
- grid.413220.60000 0004 1767 2831Government Medical College and Hospital, Chandigarh, India
| | - Monika Gureh
- grid.413220.60000 0004 1767 2831Government Medical College and Hospital, Chandigarh, India
| | - Sara Saeidi
- grid.411583.a0000 0001 2198 6209Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Aliakbarian
- grid.411583.a0000 0001 2198 6209Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- grid.411583.a0000 0001 2198 6209Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tomohisa Shoko
- grid.410818.40000 0001 0720 6587Department of Emergency and Critical Care Medicine, Department of Acute Care Surgery Center, Adachi Medical Center, Tokyo Women’s Medical University, Tokyo, Japan
| | - Mitsuaki Kojima
- grid.410818.40000 0001 0720 6587Department of Emergency and Critical Care Medicine, Department of Acute Care Surgery Center, Adachi Medical Center, Tokyo Women’s Medical University, Tokyo, Japan
| | - Raira Nakamoto
- grid.410818.40000 0001 0720 6587Department of Emergency and Critical Care Medicine, Department of Acute Care Surgery Center, Adachi Medical Center, Tokyo Women’s Medical University, Tokyo, Japan
| | - Semra Demirli Atici
- grid.414882.30000 0004 0643 0132Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Gizem Kilinc Tuncer
- grid.414882.30000 0004 0643 0132Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tayfun Kaya
- grid.414882.30000 0004 0643 0132Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | | | - Stefano Rossi
- grid.416357.2Department of General and Emergency Surgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Biagio Picardi
- grid.416357.2Department of General and Emergency Surgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Simone Rossi del Monte
- grid.416357.2Department of General and Emergency Surgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Tania Triantafyllou
- grid.5216.00000 0001 2155 0800Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Dimitrios Theodorou
- grid.5216.00000 0001 2155 0800Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Tadeja Pintar
- grid.29524.380000 0004 0571 7705Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jure Salobir
- grid.29524.380000 0004 0571 7705Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Dimitrios K. Manatakis
- grid.414025.60000 0004 0638 8093Vasileios Acheimastos, Athens Naval and Veterans Hospital, Athens, Greece
| | - Nikolaos Tasis
- grid.414025.60000 0004 0638 8093Vasileios Acheimastos, Athens Naval and Veterans Hospital, Athens, Greece
| | - Vasileios Acheimastos
- grid.414025.60000 0004 0638 8093Vasileios Acheimastos, Athens Naval and Veterans Hospital, Athens, Greece
| | - Orestis Ioannidis
- grid.414012.20000 0004 0622 65964Th Department of Surgery, Medical School Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, Thessaloniki, Greece
| | - Lydia Loutzidou
- grid.414012.20000 0004 0622 65964Th Department of Surgery, Medical School Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, Thessaloniki, Greece
| | - Savvas Symeonidis
- grid.414012.20000 0004 0622 65964Th Department of Surgery, Medical School Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, Thessaloniki, Greece
| | - Tiago Correia de Sá
- grid.466592.aGeneral Surgery Department, Centro Hospitalar Do Tâmega e Sousa Penafiel, Penafiel, Portugal
| | - Mónica Rocha
- grid.466592.aGeneral Surgery Department, Centro Hospitalar Do Tâmega e Sousa Penafiel, Penafiel, Portugal
| | - Tommaso Guagni
- grid.24704.350000 0004 1759 9494Department of general surgery, Careggi University Hospital, Florence, Italy
| | - Desiré Pantalone
- grid.24704.350000 0004 1759 9494Department of general surgery, Careggi University Hospital, Florence, Italy
| | - Gherardo Maltinti
- grid.24704.350000 0004 1759 9494Department of general surgery, Careggi University Hospital, Florence, Italy
| | | | - Wafaa Abdel-elsalam
- grid.411978.20000 0004 0578 3577Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Basma Ghoneim
- grid.411978.20000 0004 0578 3577Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - José Antonio López-Ruiz
- grid.411375.50000 0004 1768 164XAngeles Gil-Olarte, Estela Romero-Vargas, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Yasin Kara
- grid.414850.c0000 0004 0642 8921General Surgery Clinic Health Sciences University Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Syaza Zainudin
- grid.265727.30000 0001 0417 0814Faculty of Medicine and Health Sciences, Queen Elisabeth Hospital, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Firdaus Hayati
- grid.265727.30000 0001 0417 0814Faculty of Medicine and Health Sciences, Queen Elisabeth Hospital, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Nornazirah Azizan
- grid.265727.30000 0001 0417 0814Faculty of Medicine and Health Sciences, Queen Elisabeth Hospital, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Victoria Tan Phooi Khei
- grid.265727.30000 0001 0417 0814Department of Surgery, Queen Elizabeth Hospital, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Rebecca Choy Xin Yi
- grid.265727.30000 0001 0417 0814Department of Surgery, Queen Elizabeth Hospital, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Harivinthan Sellappan
- grid.265727.30000 0001 0417 0814Department of Surgery, Queen Elizabeth Hospital, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | | | | | - Ana Tvaladze
- N.Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Caterina Froiio
- grid.4708.b0000 0004 1757 2822IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Daniele Bernardi
- grid.4708.b0000 0004 1757 2822IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- grid.4708.b0000 0004 1757 2822IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Angeles Gil-Olarte
- grid.411375.50000 0004 1768 164XAngeles Gil-Olarte, Estela Romero-Vargas, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Sebastiano Grassia
- General Surgery Unit, S. Leonardo Hospital, Castellammare Di Stabia, Naples, Italy
| | - Estela Romero-Vargas
- grid.411375.50000 0004 1768 164XAngeles Gil-Olarte, Estela Romero-Vargas, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Francesco Bianco
- General Surgery Unit, S. Leonardo Hospital, Castellammare Di Stabia, Naples, Italy
| | - Andrew A. Gumbs
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Agron Dogjani
- Department of General Surgery, University Hospital of Tirana, Tirana, Albania
| | - Ferdinando Agresta
- Department of General Surgery, AULSS2 Trevigiana del Veneto, Ospedale di Vittorio Veneto, Vittorio Veneto, TV Italy
| | - Andrey Litvin
- grid.410686.d0000 0001 1018 9204Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kalingrad, Russia
| | - Zsolt J. Balogh
- grid.414724.00000 0004 0577 6676Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - George Gendrikson
- grid.410686.d0000 0001 1018 9204Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kalingrad, Russia
| | - Costanza Martino
- Anesthesia and Intensive Care Unit, Umberto I Hospital, AUSL Romagna, Lugo, Italy
| | - Dimitrios Damaskos
- grid.4305.20000 0004 1936 7988Department of General and Emergency Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Nikolaos Pararas
- grid.411335.10000 0004 1758 7207Department of General Surgery, Dr. Sulaiman Al Habib Hospital, Alfaisal University, Riyadh, Saudi Arabia
| | - Andrew Kirkpatrick
- grid.414959.40000 0004 0469 2139General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Mikhail Kurtenkov
- grid.410686.d0000 0001 1018 9204Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kalingrad, Russia
| | - Felipe Couto Gomes
- Faculdade de Ciência Médicas e da Saúde de Juiz de Fora, Hospital Universitario Terezinha de Jesus (SUPREMA), Juiz de Fora, Brazil
| | - Adolfo Pisanu
- grid.7763.50000 0004 1755 3242Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Oreste Nardello
- grid.7763.50000 0004 1755 3242Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Hager Aref
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Nicola de’ Angelis
- grid.412116.10000 0004 1799 3934Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital and University Paris-Est, Creteil, France
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Department of General and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Antonio Biondi
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Marco Vacante
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Giulia Griggio
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Roberta Tutino
- grid.10776.370000 0004 1762 5517Chirurgia 1; Dipartimento di Discipline Chirurgiche , Oncologiche e Stomatologiche (DI.CHIR.ON.S), Ospedale “Ca’Foncell”; Univerità degli studi di Palermo, Treviso; Palermo, Italy
| | - Marco Massani
- grid.10776.370000 0004 1762 5517Chirurgia 1; Dipartimento di Discipline Chirurgiche , Oncologiche e Stomatologiche (DI.CHIR.ON.S), Ospedale “Ca’Foncell”; Univerità degli studi di Palermo, Treviso; Palermo, Italy
| | - Giovanni Bisetto
- grid.5608.b0000 0004 1757 3470Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologica (DI.SC.O.G.), Chirurgia 1-Ospedale “Ca Foncello”- Treviso, Università degli Studi di Padova, Padua, Italy
| | - Savino Occhionorelli
- grid.8484.00000 0004 1757 2064Department of General Surgery, Arcispedale Sant’Anna-University of Ferrara, Ferrara, Italy
| | - Dario Andreotti
- grid.8484.00000 0004 1757 2064Department of General Surgery, Arcispedale Sant’Anna-University of Ferrara, Ferrara, Italy
| | - Domenico Lacavalla
- grid.8484.00000 0004 1757 2064Department of General Surgery, Arcispedale Sant’Anna-University of Ferrara, Ferrara, Italy
| | - Walter L. Biffl
- grid.415401.5Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA USA
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Department of General and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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11
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Canu GL, Medas F, Cappellacci F, Giordano ABF, Casti F, Grifoni L, Feroci F, Calò PG. Does the continuation of low-dose acetylsalicylic acid during the perioperative period of thyroidectomy increase the risk of cervical haematoma? A 1-year experience of two Italian centers. Front Surg 2022; 9:1046561. [DOI: 10.3389/fsurg.2022.1046561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundA growing number of patients taking antiplatelet drugs, mainly low-dose acetylsalicylic acid (ASA) (75–150 mg/day), for primary or secondary prevention of thrombotic events, are encountered in every field of surgery. While the bleeding risk due to the continuation of these medications during the perioperative period has been adequately investigated in several surgical specialties, in thyroid surgery it still needs to be clarified. The main aim of this study was to assess the occurrence of cervical haematoma in patients receiving low-dose acetylsalicylic acid, specifically ASA 100 mg/day, during the perioperative period of thyroidectomy.MethodsPatients undergoing thyroidectomy in two high-volume thyroid surgery centers in Italy, between January 2021 and December 2021, were retrospectively analysed. Enrolled patients were divided into two groups: those not taking ASA were included in Group A, while those receiving this drug in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analysis was employed to evaluate the use of low-dose ASA as independent risk factor for cervical haematoma.ResultsA total of 412 patients underwent thyroidectomy during the study period. Among them, 29 (7.04%) were taking ASA. Based on the inclusion criteria, 351 patients were enrolled: 322 were included in Group A and 29 in Group B. In Group A, there were 4 (1.24%) cervical haematomas not requiring surgical revision of haemostasis and 4 (1.24%) cervical haematomas requiring surgical revision of haemostasis. In Group B, there was 1 (3.45%) cervical haematoma requiring surgical revision of haemostasis. At univariate analysis, no statistically significant difference was found between the two groups in terms of occurrence of cervical haematoma, nor of the other early complications of thyroidectomy. At multivariate analysis, the use of low-dose ASA did not prove to be an independent risk factor for cervical haematoma.ConclusionsBased on our findings, we believe that in patients receiving this drug, either for primary or secondary prevention of thrombotic events, its discontinuation during the perioperative period of thyroidectomy is not necessary.
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12
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Cappellacci F, Canu GL, Lai ML, Lori E, Biancu M, Boi F, Medas F. Association between hashimoto thyroiditis and differentiated thyroid cancer: A single-center experience. Front Oncol 2022; 12:959595. [PMID: 35965566 PMCID: PMC9366466 DOI: 10.3389/fonc.2022.959595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/30/2022] [Indexed: 12/29/2022] Open
Abstract
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the iodine-sufficient areas of the world. Differentiated thyroid cancer is the most common thyroid cancer subtype, accounting for more than 95% of cases, and it is considered a tumor with a good prognosis, although a certain number of patients experience a poor clinical outcome. Hashimoto’s thyroiditis has been found to coexist with differentiated thyroid cancer in surgical specimens, but the relationship between these two entities has not yet been clarified. Our study aims to analyze the relationship between these two diseases, highlighting the incidence of histological diagnosis of Hashimoto thyroiditis in differentiated thyroid cancer patients, and assess how this autoimmune disorder influences the risk of structural disease recurrence and recurrence rate.
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Affiliation(s)
- Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
- *Correspondence: Federico Cappellacci,
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Maria Letizia Lai
- Department of Cytomorphology, University of Cagliari, Cagliari, Italy
| | - Eleonora Lori
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
| | - Miriam Biancu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Francesco Boi
- Endocrinology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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13
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Canu GL, Medas F, Cappellacci F, Casti F, Bura R, Erdas E, Calò PG. The Use of Harmonic Focus and Thunderbeat Open Fine Jaw in Thyroid Surgery: Experience of a High-Volume Center. J Clin Med 2022; 11:jcm11113062. [PMID: 35683450 PMCID: PMC9181533 DOI: 10.3390/jcm11113062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/05/2023] Open
Abstract
Background: In thyroid surgery, achieving accurate haemostasis is fundamental in order to avoid the occurrence of complications. Energy-based devices are currently extensively utilized in this field of surgery. This study aims to compare Harmonic Focus and Thunderbeat Open Fine Jaw with regard to surgical outcomes and complications. Methods: Patients submitted to total thyroidectomy in our center, between January 2017 and June 2020, were retrospectively analysed. Based on the energy-based device utilized, two groups were identified: Group A (Harmonic Focus) and Group B (Thunderbeat Open Fine Jaw). Results: A total of 527 patients were included: 409 in Group A and 118 in Group B. About surgical outcomes, the mean operative time was significantly shorter in Group B than in Group A (p < 0.001), while as regards complications, the occurrence of transient recurrent laryngeal nerve injury was significantly greater in Group B than in Group A (p = 0.019). Conclusions. Both Harmonic Focus and Thunderbeat Open Fine Jaw have proven to be effective devices. Operative times were significantly shorter in thyroidectomies performed with Thunderbeat Open Fine Jaw; however, the occurrence of transient recurrent laryngeal nerve injury was significantly greater in patients operated on with this device.
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14
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Canu GL, Medas F, Cappellacci F, Giordano ABF, Gurrado A, Gambardella C, Docimo G, Feroci F, Conzo G, Testini M, Calò PG. Risk of Complications in Patients Undergoing Completion Thyroidectomy after Hemithyroidectomy for Thyroid Nodule with Indeterminate Cytology: An Italian Multicentre Retrospective Study. Cancers (Basel) 2022; 14:cancers14102472. [PMID: 35626075 PMCID: PMC9139447 DOI: 10.3390/cancers14102472] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary The increasing use of high-quality imaging techniques together with improved access to healthcare has led to an increase in the detection of thyroid nodules. Fine-needle aspiration cytology (FNAC) is currently considered the most accurate examination for the assessment of thyroid nodular disease. However, in about 25% of cases, FNAC leads to the diagnosis of an indeterminate thyroid nodule, which represents a problem because malignancy, although relatively low (up to 30%), cannot be excluded with certainty. According to the 2015 American Thyroid Association guidelines, patients with thyroid nodular disease with an indeterminate cytology can undergo, based on established factors, a total thyroidectomy or a hemithyroidectomy. However, if an intermediate or high-risk differentiated thyroid carcinoma is detected after the hemithyroidectomy, through histological examination, the above-mentioned guidelines recommend performing a completion thyroidectomy. The main aim of this study was to assess the rate of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology. Abstract There is still controversy as to whether patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery. The main aim of this study was to investigate this topic. Patients undergoing a thyroidectomy for thyroid nodular disease with an indeterminate cytology in four high-volume thyroid surgery centres in Italy, between January 2017 and December 2020, were retrospectively analysed. Based on the surgical procedure performed, four groups were identified: the TT Group (total thyroidectomy), HT Group (hemithyroidectomy), CT Group (completion thyroidectomy) and HT + CT Group (hemithyroidectomy with subsequent completion thyroidectomy). A total of 751 patients were included. As for the initial surgery, 506 (67.38%) patients underwent a total thyroidectomy and 245 (32.62%) a hemithyroidectomy. Among all patients submitted to a hemithyroidectomy, 66 (26.94%) were subsequently submitted to a completion thyroidectomy. No statistically significant difference was found in terms of complications comparing both the TT Group with the HT + CT Group and the HT Group with the CT Group. The risk of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology was comparable to that of patients submitted to primary thyroid surgery (both a total thyroidectomy and hemithyroidectomy).
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, CA, Italy; (F.M.); (F.C.); (P.G.C.)
- Correspondence:
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, CA, Italy; (F.M.); (F.C.); (P.G.C.)
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, CA, Italy; (F.M.); (F.C.); (P.G.C.)
| | | | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, BA, Italy; (A.G.); (M.T.)
| | - Claudio Gambardella
- Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, NA, Italy; (C.G.); (G.D.)
| | - Giovanni Docimo
- Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, NA, Italy; (C.G.); (G.D.)
| | - Francesco Feroci
- Department of General and Oncologic Surgery, Santo Stefano Hospital, 59100 Prato, PO, Italy; (A.B.F.G.); (F.F.)
| | - Giovanni Conzo
- Department of Traslational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, NA, Italy;
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, BA, Italy; (A.G.); (M.T.)
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, CA, Italy; (F.M.); (F.C.); (P.G.C.)
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15
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Canu GL, Medas F, Cappellacci F, Soddu C, Romano G, Erdas E, Calò PG. Intact parathyroid hormone value on the first postoperative day following total thyroidectomy as a predictor of permanent hypoparathyroidism: a retrospective analysis on 426 consecutive patients. Endokrynol Pol 2022; 73:48-55. [PMID: 35156703 DOI: 10.5603/ep.a2022.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hypoparathyroidism represents a common complication following total thyroidectomy. To date, there is still no reliable and immediate postoperative parameter to establish which patients with postsurgical hypoparathyroidism will develop permanent hypoparathyroidism. The main purpose of the present study was to assess whether the intact parathyroid hormone (iPTH) value on the first postoperative day is a good predictor of permanent hypoparathyroidism. MATERIAL AND METHODS Patients undergoing thyroidectomy in our unit between March 2018 and January 2020 were analysed. According to the iPTH value on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into two groups: Group A (iPTH ≥ 4.6 pg/mL) and Group B (iPTH < 4.6 pg/mL, undetectable). RESULTS In total 426 patients were included: 364 in Group A and 62 in Group B. Permanent hypoparathyroidism occurred in 3 (0.82%) patients from Group A and in 26 (41.94%) from Group B (p < 0.001). When iPTH levels were < 4.6 pg/mL on the first postoperative day the sensitivity for the prediction of permanent hypoparathyroidism was 89.66%, the specificity was 90.93%, the positive predictive value (PPV) was 41.94%, the negative predicitive value (NPV) was 99.18% and the accuracy was 90.85%. CONCLUSIONS An iPTH value < 4.6 pg/mL on the first postoperative day following total thyroidectomy has proven to be a good parameter for early identification of patients at high risk for permanent hypoparathyroidism. Moreover, we want to underline that in our experience no patient with an iPTH level > 6.5 pg/mL developed this complication.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy.
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Cristina Soddu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Palermo, Italy, Palermo, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
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16
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Canu GL, Cappellacci F, Noordzij JP, Piras S, Erdas E, Calò PG, Medas F. A mini-invasive approach is feasible in patients with primary hyperparathyroidism and discordant or negative localisation studies. Updates Surg 2022; 74:747-755. [PMID: 34988915 DOI: 10.1007/s13304-021-01213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
Preoperative localisation of pathological glands in patients with primary hyperparathyroidism (PHP) is the mainstay for mini-invasive parathyroidectomy. Nevertheless, a not negligible number of patients presents discordant or negative neck ultrasound (US) and 99mTc-Sestamibi (MIBI) scan. The aim of this study was to assess if a mini-invasive approach is feasible in this kind of patients. In this retrospective study were included patients that underwent parathyroidectomy for PHP. Patients were divided into two groups according to concordance of US and MIBI scan results. 242 patients were included: 183 had concordant preoperative studies, and 59 had discordant or negative studies. A mini-invasive approach was possible in 42 (72.9%) patients with unclear preoperative studies, whereas 12 (20.3%) additional patients required conversion to BNE. The incidence of persistent PHP was higher in patients with unclear preoperative studies (8.5% vs 2.7%), but this difference did not reach a statistical significance (p = 0.121). In patients with unclear preoperative studies, a negative result of intraoperative PTH allowed to avoid a persistent disease in 12 patients, while in 3 cases led to an unnecessary additional exploration. In patients with discordant preoperative studies a mini-invasive approach is feasible; in this setting, the use of intraoperative PTH is mandatory to reduce the incidence of persistent PHP.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, "Policlinico Universitario Duilio Casula", University of Cagliari, 09042, Monserrato, CA, Italy.
| | - Federico Cappellacci
- Department of Surgical Sciences, "Policlinico Universitario Duilio Casula", University of Cagliari, 09042, Monserrato, CA, Italy
| | - Jacob Pieter Noordzij
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, 02118, USA
| | - Stefano Piras
- Department of Surgical Sciences, "Policlinico Universitario Duilio Casula", University of Cagliari, 09042, Monserrato, CA, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, "Policlinico Universitario Duilio Casula", University of Cagliari, 09042, Monserrato, CA, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, "Policlinico Universitario Duilio Casula", University of Cagliari, 09042, Monserrato, CA, Italy
| | - Fabio Medas
- Department of Surgical Sciences, "Policlinico Universitario Duilio Casula", University of Cagliari, 09042, Monserrato, CA, Italy
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Cappellacci F, Anedda G, Del Giacco S, Coghe F, Cappai R, Canu GL, Erdas E, Calò PG, Medas F, Firinu D. Seroprevalence of SARS-CoV-2 in unselected surgical patients: An update from an unicentric regional study. Ann Med Surg (Lond) 2021. [PMID: 33968401 DOI: 10.1016/j.amsu.2021.102375.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Giacomo Anedda
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Ferdinando Coghe
- Laboratory Clinical Chemical Analysis and Microbiology, University Hospital of Cagliari, Italy
| | - Riccardo Cappai
- Laboratory Clinical Chemical Analysis and Microbiology, University Hospital of Cagliari, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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Cappellacci F, Anedda G, Del Giacco S, Coghe F, Cappai R, Canu GL, Erdas E, Calò PG, Medas F, Firinu D. Seroprevalence of SARS-CoV-2 in unselected surgical patients: An update from an unicentric regional study. Ann Med Surg (Lond) 2021; 66:102375. [PMID: 33968401 PMCID: PMC8095072 DOI: 10.1016/j.amsu.2021.102375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/28/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042, Monserrato, CA, Italy
- Corresponding author.
| | - Giacomo Anedda
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042, Monserrato, CA, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Ferdinando Coghe
- Laboratory Clinical Chemical Analysis and Microbiology, University Hospital of Cagliari, Italy
| | - Riccardo Cappai
- Laboratory Clinical Chemical Analysis and Microbiology, University Hospital of Cagliari, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042, Monserrato, CA, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042, Monserrato, CA, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042, Monserrato, CA, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042, Monserrato, CA, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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Canu GL, Medas F, Cappellacci F, Piras S, Sorrenti S, Erdas E, Calò PG. Is extensive surgery really necessary in patients with parathyroid carcinoma? Single-centre experience and a brief review of the literature. Ann Ital Chir 2021; 92:227-233. [PMID: 34312331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM Parathyroid carcinoma (PC) represents a rare cause of primary hyperparathyroidism (PHPT). In this paper, among patients who underwent surgery for PHPT, we compared those with benign parathyroid disease with those affected by PC in terms of demographic and preoperative biochemical features. Moreover, we singularly described all 10 cases of PC treated at our Institution (including a case that occurred in a patient with tertiary hyperparathyroidism) and a brief review of the literature. MATERIAL AND METHODS Patients undergoing surgery for PHPT in our Unit between 2003 and 2018 were retrospectively analysed. They were divided into two groups: Group A (benign parathyroid disease), Group B (PC). The case of PC that occurred in the patient with tertiary hyperparathyroidism was not included into the two groups. RESULTS Three hundred and eight patients were included: 299 in Group A and 9 in Group B. The mean preoperative serum PTH value and mean preoperative serum calcium level were significantly higher in Group B than in Group A (P = 0.018, P = 0.027; respectively). Including the case of PC that occurred in the patient with tertiary hyperparathyroidism, 10 patients with PC were treated at our Institution. Among these, 3 underwent a re-exploration. Disease recurrence occurred in 1 (10%) patient, who developed a local recurrence and distant metastases. CONCLUSIONS In the presence of PHPT characterized by particularly high preoperative levels of serum PTH and calcium this malignancy should be suspected. On the basis of our experience, we believe that extensive surgery is not always necessary. KEY WORDS Hyperparathyroidism, Parathyroid carcinoma, Parathyroid surgery.
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Canu GL, Medas F, Cappellacci F, Noordzij JP, Marcialis J, Erdas E, Calò PG. Risk factors of permanent hypoparathyroidism after total thyroidectomy Retrospective analysis of 285 consecutive patients. Ann Ital Chir 2021; 92:339-345. [PMID: 34524111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy. The aim of the present study was to investigate the risk factors of this complication. MATERIAL AND METHODS Patients undergoing thyroidectomy in our Unit between January 2017 and February 2018 were retrospectively analysed. They were divided into 2 groups: those with normal parathyroid function in the long term were included in Group A, those who developed permanent hypoparathyroidism in Group B. RESULTS Two hundred and eighty-five patients were included in this study: 271 in Group A and 14 in Group B. No statistically significant difference was found in terms of sex, age, extent of surgery, rate of retrosternal goiter, postoperative stay and histopathological findings between the 2 groups. On the contrary, mean operative time, rate of patients with PTH values < 6.3 pg/mL on postoperative day 1 and mean thyroid weight were significantly greater in Group B than in Group A (P = 0.049, P < 0.001, P = 0.014; respectively). CONCLUSIONS Long operative times, PTH levels < 6.3 pg/mL on postoperative day 1 and high thyroid weight have proved to be strong risk factors of permanent hypoparathyroidism after total thyroidectomy. Thus, in these cases a careful follow-up is highly recommended. KEY WORDS Permanent hypoparathyroidism, Risk factors, Total thyroidectomy.
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Longheu A, Canu GL, Cappellacci F, Erdas E, Medas F, Calò PG. Tall Cell Variant versus Conventional Papillary Thyroid Carcinoma: A Retrospective Analysis in 351 Consecutive Patients. J Clin Med 2020; 10:jcm10010070. [PMID: 33379135 PMCID: PMC7794904 DOI: 10.3390/jcm10010070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The aim of this retrospective study was to investigate clinical and pathological characteristics of the tall cell variant of papillary thyroid carcinoma compared to conventional variants. Methods: The clinical records of patients who underwent surgical treatment between 2009 and 2015 were analyzed. The patients were divided into two groups: those with a histopathological diagnosis of tall cell papillary carcinoma were included in Group A, and those with a diagnosis of conventional variants in Group B. Results: A total of 35 patients were included in Group A and 316 in Group B. All patients underwent total thyroidectomy. Central compartment and lateral cervical lymph node dissection were performed more frequently in Group A (42.8% vs. 18%, p = 0.001, and 17.1% vs. 6.9%, p = 0.04). Angiolymphatic invasion, parenchymal invasion, extrathyroidal extension, and lymph node metastases were more frequent in Group A, and the data reached statistical significance. Local recurrence was more frequent in Group A (17.1% vs. 6.3%, p = 0.02), with two patients (5.7%) in Group A showing visceral metastases, whereas no patient in Group B developed metastatic cancer (p = 0.009). Conclusions: Tall cell papillary carcinoma is the most frequent aggressive variant of papillary thyroid cancer. Tall cell histology represents an independent poor prognostic factor compared to conventional variants.
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Medas F, Cappellacci F, Anedda G, Canu GL, Del Giacco S, Calò PG, Firinu D. Seroprevalence of SARS-Cov-2 in the setting of a non-dedicated COVID-19 hospital in a low CoV-2 incidence area: Implications for surgery. Ann Med Surg (Lond) 2020. [PMID: 33163178 DOI: 10.1016/j.amsu.2020.11.006.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the seroprevalence of SARS-Cov-2 in the setting of a non-dedicated COVID-19 hospital in a low CoV-2 incidence area. We analysed the data of the patients admitted at our surgical department during the period 31st March - June 30, 2020. Among 86 patients included in the study, we found 2 (2.3%) patients positive for both SARS-CoV-2 specific IgM and IgG, 2 (2.3%) for only SARS-CoV-2 specific IgM, and 1 for only SARS-CoV-2 specific IgG. Thus, seroprevalence for SARS-CoV-2 was 5.8%; nasopharyngeal swab was negative in all the cases. Considering the current limitations in sensitivity of nasopharyngeal swab, the uncertainty in the natural history of SARS-CoV2, and the reported prevalence of CoV-2, we think that careful preadmission triage and tests, the use of personal protective equipment and safe management of surgical smoke are mandatory also in our context of low CoV-2 incidence area.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Giacomo Anedda
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | | | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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Canu GL, Medas F, Cappellacci F, Podda MG, Romano G, Erdas E, Calò PG. Can thyroidectomy be considered safe in obese patients? A retrospective cohort study. BMC Surg 2020; 20:275. [PMID: 33160350 PMCID: PMC7648980 DOI: 10.1186/s12893-020-00939-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity is a growing public health concern in most western countries. More and more patients with high body mass index (BMI) are undergoing surgical procedures of all kinds and, in this context, obese patients are undergoing thyroid surgery more than ever before. The aim of the present study was to evaluate whether thyroidectomy can be considered safe in obese patients. METHODS Patients undergoing thyroidectomy in our Unit between January 2014 and December 2018 were retrospectively analysed. Patients were divided into two groups: those with BMI < 30 kg/m2 were included in Group A, while those with BMI ≥ 30 kg/m2 in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analyses were performed to evaluate whether the BMI value (considered in this case as a continuous variable) had a significant role in the development of each individual postoperative complication. RESULTS A total of 813 patients were included in this study: 31 (3.81%) were underweight, 361 (44.40%) normal-weight, 286 (35.18%) overweight, 94 (11.57%) obese and 41 (5.04%) morbidly obese. Six hundred and seventy-eight patients were included in Group A and 135 in Group B. At univariate analysis, the comparison between the two groups, in terms of operative time and thyroid weight resulted in statistically significant results (P = 0.001, P = 0.008; respectively). These features were significantly higher in Group B than in Group A. About postoperative stay and complications, no statistically significant difference was found between the two groups. At multivariate analyses, only the development of cervical haematoma was statistically significantly correlated to the BMI value. Patients with high BMI had a lower risk of cervical haematoma (P = 0.045, OR 0.797, 95% CI 0.638-0.995). CONCLUSIONS This study showed that obesity, in the field of thyroid surgery, is not associated with any increase of postoperative complications. Thus, it is possible to conclude that thyroidectomy can be performed safely in obese patients. Our result about operative times had no clinical significance.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy.
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Michele Guido Podda
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, 90127, Palermo, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
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Medas F, Cappellacci F, Anedda G, Canu GL, Del Giacco S, Calò PG, Firinu D. Seroprevalence of SARS-Cov-2 in the setting of a non-dedicated COVID-19 hospital in a low CoV-2 incidence area: Implications for surgery. Ann Med Surg (Lond) 2020; 60:261-262. [PMID: 33163178 PMCID: PMC7607230 DOI: 10.1016/j.amsu.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to assess the seroprevalence of SARS-Cov-2 in the setting of a non-dedicated COVID-19 hospital in a low CoV-2 incidence area. We analysed the data of the patients admitted at our surgical department during the period 31st March - June 30, 2020. Among 86 patients included in the study, we found 2 (2.3%) patients positive for both SARS-CoV-2 specific IgM and IgG, 2 (2.3%) for only SARS-CoV-2 specific IgM, and 1 for only SARS-CoV-2 specific IgG. Thus, seroprevalence for SARS-CoV-2 was 5.8%; nasopharyngeal swab was negative in all the cases. Considering the current limitations in sensitivity of nasopharyngeal swab, the uncertainty in the natural history of SARS-CoV2, and the reported prevalence of CoV-2, we think that careful preadmission triage and tests, the use of personal protective equipment and safe management of surgical smoke are mandatory also in our context of low CoV-2 incidence area.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Giacomo Anedda
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | | | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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Erdas E, Canu GL, Medas F. Intraoperative cholangiography during laparoscopic cholecystectomy. Should we follow the recommendations of the current guidelines? J Hepatobiliary Pancreat Sci 2020; 27:e17-e18. [PMID: 33053251 DOI: 10.1002/jhbp.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/29/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Enrico Erdas
- Chirurgia Generale Polispecialistica, Department of Surgical Science, Policlinico Universitario "Duilio Casula," A.O.U. di Cagliari, Cagliari, Italy
| | - Gian Luigi Canu
- Chirurgia Generale Polispecialistica, Department of Surgical Science, Policlinico Universitario "Duilio Casula," A.O.U. di Cagliari, Cagliari, Italy
| | - Fabio Medas
- Chirurgia Generale Polispecialistica, Department of Surgical Science, Policlinico Universitario "Duilio Casula," A.O.U. di Cagliari, Cagliari, Italy
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Medas F, Canu GL, Cappellacci F, Romano G, Amato G, Erdas E, Calò PG. Antibiotic Prophylaxis for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:482-488. [DOI: 10.1177/0194599820947700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective Although thyroid and parathyroid surgery is considered a clean procedure with a low incidence of surgical site infections (SSIs), a great number of endocrine surgeons use antibiotic prophylaxis (AP). The aim of this study was to assess whether AP is significantly effective in reducing the incidence of SSIs in this kind of surgery. Data Sources A systematic literature search was performed with PubMed, Scopus, and ISI–Web of Science. Studies addressing the efficacy of AP in reducing the incidence of SSIs in thyroid and parathyroid surgery were included in the systematic review and meta-analysis. Review Methods The random effects model was assumed to account for different sources of variation among studies. The overall effect size was computed through the inverse variance method. Heterogeneity across studies, possible outlier studies, and publication bias were evaluated. Results A total of 6 studies with 4428 patients were included in the quantitative analysis. The incidence of SSI was 0.6% in the case group and 0.4% in the control group (odds ratio, 1.07; 95% CI, 0.3-3.81; P = .915). There was no evidence of heterogeneity among the studies ( Q = 8.36, P = .138; I2 = 40.17). The analysis of several continuous moderators, including age, use of drain, and duration of surgery, did not generate any significant result. Conclusion AP is not effective in reducing the incidence of SSI in thyroid and parathyroid surgery and should be avoided, notwithstanding the negative impact on social costs and the risk of development of antibiotic resistance.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Giorgio Romano
- Department of Surgical, Oncological, and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Palermo, Italy
| | - Giuseppe Amato
- Postgraduate School of General Surgery, University of Cagliari, Cagliari, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Medas F, Canu GL, Cappellacci F, Anedda G, Conzo G, Erdas E, Calò PG. Prophylactic Central Lymph Node Dissection Improves Disease-Free Survival in Patients with Intermediate and High Risk Differentiated Thyroid Carcinoma: A Retrospective Analysis on 399 Patients. Cancers (Basel) 2020; 12:E1658. [PMID: 32585797 PMCID: PMC7353019 DOI: 10.3390/cancers12061658] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022] Open
Abstract
The role of prophylactic central lymph node dissection (pCLND) in the treatment of differentiated thyroid cancer (DTC) is controversial and still a matter of debate. The primary outcome of our study was to assess whether pCLND is effective in reducing the incidence of recurrent disease, and the secondary goal was to estimate the incidence of postoperative complications in patients who underwent pCLND and to evaluate the prognostic value of occult node metastases. In this retrospective study, we included patients with preoperative diagnosis of DTC and clinically uninvolved lymph nodes (cN0). The patients were divided into two groups, depending on the surgical approach: total thyroidectomy alone (TT group) or total thyroidectomy and pCLND (pCLND group). Three hundred and ninety-nine patients were included in this study, 320 (80.2%) in the TT group and 79 (19.8%) in the pCLND group. There were no significant differences in morbidity among the two groups. Histopathological evaluation demonstrated a similar distribution of aggressive features, especially regarding multicentricity, extrathyroidal extension, and angioinvasivity between the two groups. Occult lymph node metastases were found in 20 (25.3%) patients in the pCLND group. Prophylactic CLND was effective in improving disease-free survival in patients with intermediate and high risk of disease recurrence (p = 0.0392); occult lymph node metastases resulted as a significant negative prognostic factor (p < 0.001).
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Giacomo Anedda
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Cardiothoracic Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.L.C.); (F.C.); (G.A.); (E.E.); (P.G.C.)
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Canu GL, Medas F, Podda F, Tatti A, Pisano G, Erdas E, Calò PG. Thyroidectomy with energy-based devices: surgical outcomes and complications-comparison between Harmonic Focus, LigaSure Small Jaw and Thunderbeat Open Fine Jaw. Gland Surg 2020; 9:721-726. [PMID: 32775262 DOI: 10.21037/gs.2020.03.31] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Being the thyroid gland a highly vascularized organ, achieving a meticulous hemostasis is essential to avoid serious complications. Currently, energy-based devices are widely used in thyroid surgery. The aim of this study was to compare Harmonic Focus (HF), LigaSure Small Jaw (LSJ) and Thunderbeat Open Fine Jaw (TB) in terms of surgical outcomes and complications. Methods Patients undergoing thyroidectomy in our Unit between January 2012 and June 2018 were retrospectively analyzed. According to the type of energy-device used, patients were divided into three groups: Group A (HF), Group B (LSJ) and Group C (TB). Results A total of 1,165 patients were included in this study: 1,012 in Group A, 96 in Group B and 57 in Group C. Demographic data and histopathological findings were comparable between the three groups. About the postoperative stay and complications, no statistically significant difference was found. The mean operative time was 89.41±20.60 minutes in Group A, 85.57±15.91 minutes in Group B and 78.07±17.67 minutes in Group C (P<0.01). However, the post-hoc test for all pairwise comparisons showed a statistically significant difference only between Group A and Group C. Conclusions HF, LSJ and TB have proved to be safe and effective. The postoperative stay and complications were comparable between the three groups. Considering the limits of our investigation, further studies are needed to investigate the effect of TB on operative times.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Francesco Podda
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Alberto Tatti
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", Monserrato, Italy
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Medas F, Canu GL, Cappellacci F, Boi F, Lai ML, Erdas E, Calò PG. Predictive Factors of Lymph Node Metastasis in Patients With Papillary Microcarcinoma of the Thyroid: Retrospective Analysis on 293 Cases. Front Endocrinol (Lausanne) 2020; 11:551. [PMID: 32982963 PMCID: PMC7477034 DOI: 10.3389/fendo.2020.00551] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction: Papillary thyroid microcarcinoma (PTMC) is defined as a tumor with a larger diameter ≤ 1 cm and is considered having an indolent course and an excellent prognosis. Nevertheless, the incidence of lymph node metastasis in PTMC is not negligible, reaching up to 65% in some series. The aim of this study was to assess the incidence of lymph node metastasis in patients with PTMC and to evaluate predictive factors for lymph node metastasis. Methods: We included in this retrospective observational study patients who underwent thyroidectomy with pathological diagnosis of PTMC at our department from January 2003 to June 2019. Results: Two hundred ninety-three patients were included in the study. The incidence of lymph node metastasis was 13.7%. Multivariate analysis revealed as independent risk factors for lymph node metastasis age <45 years, nodule size ≥6 mm, tall cell variant of PTC, extrathyroidal extension, and angioinvasion. Conversely, autoimmune thyroiditis was found as a protective factor for lymph node metastasis. A subgroup of patients, with nodule size ≤ 5 mm, presented non-aggressive features. Conclusion: The incidence of lymph node metastasis in PTMC is considerable; the size of the tumor appears to be the most significant predictive factor for lymph node metastasis. The traditional cut-off value used for definition of microcarcinoma could be reconsidered to identify patients with an indolent course of the tumor, where active surveillance could be the appropriate treatment, and on the other hand, patients with potentially aggressive tumors requiring an adequate surgical intervention. Clinical Trial Registration: The trial was registered at ClinicalTrials.gov (ID: NCT04274829).
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
- *Correspondence: Fabio Medas
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Francesco Boi
- Endocrinology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Letizia Lai
- Division of Anatomy and Pathological Histology, University of Cagliari, Cagliari, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Canu GL, Medas F, Conzo G, Boi F, Amato G, Erdas E, Calò PG. Is prophylactic central neck dissection justified in patients with cN0 differentiated thyroid carcinoma? An overview of the most recent literature and latest guidelines. Ann Ital Chir 2020; 91:451-457. [PMID: 33295306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To date, in patients with differentiated thyroid cancer, central neck dissection is recommended in the presence of central compartment lymph node metastases. Differently, the efficacy of prophylactic central neck dissection in case of clinically node-negative differentiated thyroid carcinoma remains still uncertain. There are many arguments in favor and many against the execution of this surgical procedure. The most recent literature and latest guidelines have been reviewed and illustrated, paying particular attention to currently hottest and most discussed points. Prophylactic central neck dissection is associated with higher rates of postoperative complications, such as recurrent laryngeal nerve injury and hypoparathyroidism, with unclear oncological benefits. Thus, in the absence of lymph node involvement, this procedure should be avoided, reserving it for high-risk patients with advanced primary tumors. Moreover, to avoid serious complications, prophylactic central neck dissection should be performed by high-volume surgeons. KEY WORDS: Clinically node-negative differentiated thyroid cancer, Differentiated thyroid carcinoma, Prophylactic central neck dissection.
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Canu GL, Bulla JS, Lai ML, Medas F, Baghino G, Erdas E, Mariotti S, Calò PG. Primary thyroid leiomyosarcoma: a case report and review of the literature. G Chir 2019; 39:51-56. [PMID: 29549682 DOI: 10.11138/gchir/2018.39.1.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary thyroid leiomyosarcoma (LMS) is an extremely rare tumor. We report a case of a 47-year-old male with a rapidly growing neck mass and disfagia. Preoperative investigations were diagnostic of anaplastic carcinoma. Total thyroidectomy with partial esophagectomy and dissection of right infrahyoid muscles was performed. Through histolological and immunohistochemical evaluations a primary thyroid high-grade LMS was diagnosed. At 2 months of follow-up a local recurrence was detected and consequently the patient was submitted to chemotherapy with partial response. He is still alive 9 months after surgery. Diagnosis of primary thyroid LMS is difficult due to its similarity to other more common thyroid tumors. To date, there is no standard therapy and prognosis is poor.
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Affiliation(s)
- Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Monserrato, CA, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Monserrato, CA, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Monserrato, CA, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Monserrato, CA, Italy
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Canu GL, Medas F, Longheu A, Boi F, Docimo G, Erdas E, Calò PG. Correlation between iPTH Levels on the First Postoperative Day After Total Thyroidectomy and Permanent Hypoparathyroidism: Our Experience. Open Med (Wars) 2019; 14:437-442. [PMID: 31231683 PMCID: PMC6572408 DOI: 10.1515/med-2019-0047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
Permanent hypoparathyroidism is the most common long-term complication after thyroidectomy. We evaluated whether iPTH concentrations on the first postoperative day may be a good predictor of this complication. Patients undergoing thyroidectomy in our Unit between January 2017 and February 2018 who developed postsurgical hypoparathyroidism were analysed. According to iPTH values on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into 2 groups: Group A (iPTH < 6.3 pg/mL, undetectable), Group B (iPTH ≥ 6.3 pg/mL). Seventy-five patients were included in this study: 64 in Group A and 11 in Group B. Permanent hypoparathyroidism occurred in 14 (21.88%) patients in Group A, while none developed this complication in Group B. When iPTH was < 6.3 pg/mL, the sensitivity for the prediction of permanent hypoparathyroidism was 100%, the specificity was 18.03%, the positive predictive value was 21.88% and the negative predictive value was 100%. No patient with iPTH ≥ 6.3 pg/mL on the first postoperative day developed permanent hypoparathyroidism. On the other hand, iPTH concentrations < 6.3 pg/mL have not proved to be a strong predictor of this condition. However, this cut-off value can be useful to identify patients at risk of developing this complication.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Alessandro Longheu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Francesco Boi
- Department of Medical Sciences, University of Cagliari, Endocrinology Unit, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Giovanni Docimo
- Department of General Surgery, General and Endocrine Surgical Unit, Second University of Naples, 80131, Naples, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
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Erdas E, Medas F, Sanna S, Gordini L, Pisano G, Canu GL, Calò PG. Does antithrombotic prophylaxis worsen early outcomes of total thyroidectomy? - a retrospective cohort study. BMC Surg 2019; 18:82. [PMID: 31074394 PMCID: PMC7402577 DOI: 10.1186/s12893-018-0407-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 09/09/2018] [Indexed: 11/25/2022] Open
Abstract
Background Currently, there is no strong evidence on the effectiveness and safety of pharmacological antithrombotic prophylaxis in thyroid surgery. The aim of this study was to establish whether the prophylactic use of low-molecular-weight heparin (LMWH) could negatively affect the early outcomes of patients undergoing total thyroidectomy. Methods Data from patients submitted to total thyroidectomy between February 2013 and October 2017 were retrospectively collected and analysed. Only patients with indication to antithrombotic prophylaxis according to current guidelines were included in the study. Eligible cases were divided into two groups, which corresponded to two distinct periods of our surgical practice: Group A, which included 178 consecutive patients who were submitted to antithrombotic prophylaxis with LMWH, and Group B, which included 348 consecutive patients who did not receive prophylaxis. Primary endpoints were the incidence of post-operative cervical haematomas (POCH) and thromboembolic events. Secondary endpoint was the length of postoperative hospital stay. Statistical analysis was performed by using Student’s t test for continuous variables and Chi-square test for categorical variables. A P value of less than 0.05 was considered statistically significant. Results The two groups of patients were comparable in terms of age, gender, thyroid disease, duration of surgery, and weight of the thyroid gland. Overall, no thromboembolic events were registered. The comparative analysis of the other outcome measures, showed no significant differences between the two groups (POCH: 2 cases (1.12%) in Group A vs 8 cases (2.30%) in Group B - p 0.349; Postoperative hospital stay: 2.90 ± 0.86 days in Group A vs 2.89 ± 0.99 days in Group B - p 0.908). Conclusions Data from this study do not support or contraindicate the use of antithrombotic prophylaxis in thyroid surgery. However, since thyroidectomy is a closed-space procedure, and even modest bleeding may quickly result in airway compression and death by asphyxia, mechanical prophylaxis should be preferred to LMWH whenever possible. Trial registration ISRCTN ISRCTN12029395. Registered 05/02/2018 retrospectively registered.
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Affiliation(s)
- E Erdas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - F Medas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - S Sanna
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - L Gordini
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - G Pisano
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - G L Canu
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
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Amato G, Romano G, Agrusa A, Canu GL, Gulotta E, Erdas E, Calò PG. Tentacle-shaped mesh for fixation-free repair of umbilical hernias. Hernia 2019; 23:801-807. [PMID: 30980199 PMCID: PMC6661022 DOI: 10.1007/s10029-019-01950-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/07/2019] [Indexed: 12/01/2022]
Abstract
Purpose Mesh fixation and broad overlap represent an open issue in umbilical hernia repair. A proprietary-designed implant with tentacle straps at its boundary has been developed to ensure a suture-free repair and a broader coverage of the abdominal wall. The study describes the results of umbilical hernia procedures carried out with the tentacle-shaped implant and the related surgical technique. Methods A proprietary tentacle-shaped flat mesh having a central body with integrated radiating arms at its edge was used to repair large umbilical hernias in 62 patients. The implant was placed in preperitoneal sublay. The friction of the straps, crossing the abdominal wall thanks to a special needle passer, was intended to assure adequate grip to hold the implant in place assuring a fixation-free procedure and broad overlap of the hernia defect. Results In a mean follow-up of 48 months (range 10–62 months), 4 seromas and 2 ischemia of the navel skin occurred. No infections, hematomas, chronic pain, mesh dislocation, or recurrence has been reported. Conclusions The tentacle strap system of the prosthesis effectively ensured an easier implant placement avoiding the need for suturing the mesh. The arms of the implant ensured a proper orientation and stabilization of the mesh in association with a broad defect overlap. The specifically developed surgical procedure showed a quick postoperative recovery, a very low complication rate, and no recurrences even in the long term.
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Affiliation(s)
- G Amato
- Postgraduate School of General Surgery, University of Cagliari, Cittadella Universitaria di Monserrato, 09042, Monserrato - Cagliari, Italy.
| | - G Romano
- Department of General Surgery and Urgency, University of Palermo, Palermo, Italy
| | - A Agrusa
- Department of General Surgery and Urgency, University of Palermo, Palermo, Italy
| | - G L Canu
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - E Gulotta
- Department of General Surgery and Urgency, University of Palermo, Palermo, Italy
| | - E Erdas
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - P G Calò
- Department of General Surgery, University of Cagliari, Cagliari, Italy
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Medas F, Tuveri M, Canu GL, Erdas E, Calò PG. Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases. Updates Surg 2019; 71:705-710. [PMID: 30937820 DOI: 10.1007/s13304-019-00647-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
Abstract
Reoperative thyroid surgery is an uncommon procedure that is indicated in recurrent benign or malignant disease. It is associated with a high complication rate, especially of hypoparathyroidism and recurrent nerve palsy. We retrospectively reviewed our series of patients on whom reoperative thyroid surgery was performed and we compared this group with patients who underwent primary thyroidectomies. From 2002 to 2015, 4572 thyroidectomies were performed at our institution; among these, 152 (3.3%) were for benign or malignant recurrent disease. We observed a higher rate of transient hypoparathyroidism in secondary vs primary surgery (56.6% vs 25.9%; p < 0.0001), of permanent hypoparathyroidism (10% vs 2.0%; p < 0.0001) and of transient recurrent nerve injury (4.6% vs 1.4%; p < 0.05). Reoperative thyroid surgery is a technical challenge with a high incidence of complications. Scarring, edema, and friability of the tissues together with distortion of the landmarks make reoperative surgery hazardous. Careful assessment of patient's risk factors, physical examination, and if necessary fine needle aspiration cytology are crucial for selecting the patients who should undergo reoperation. Research registry n. 2617 registered 5 June 2017 (retrospectively registered).
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Massimiliano Tuveri
- Istituto Pancreas, Policlinico Borgo Roma, AOUI Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Ernico Erdas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
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Canu GL, Medas F, Ravarino A, Furcas S, Loi G, Cerrone G, Rossi C, Erdas E, Calò PG. Pseudoangiomatous stromal hyperplasia (PASH) presenting as axillary lump: case report and review of the literature. G Chir 2018; 39:378-382. [PMID: 30563602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign mesenchymal breast lesion. There are extremely rare reports of PASH arising in accessory breast tissue. To date, in literature, fewer than 10 cases of PASH occurring in axillary region have been described. We report a case presenting as axillary lump in a young woman. A 20-year-old female presented to our surgical unit for a progressively growing and painful palpable mass of the right axilla for about a year. Before surgery an ultrasound was performed. The patient underwent local excision of the lesion under local anaesthesia. Through histological and immunohistochemical examination a pseudoangiomatous stromal hyperplasia (PASH) was diagnosed. At 6 months of followup the patient is free of disease. It is important to include PASH also in the differential diagnosis of axillary lumps. Histological examination of the surgical specimen and surgery represent, respectively, the mainstay for diagnosis and therapy.
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Medas F, Erdas E, Canu GL, Longheu A, Pisano G, Tuveri M, Calò PG. Does hyperthyroidism worsen prognosis of thyroid carcinoma? A retrospective analysis on 2820 consecutive thyroidectomies. J Otolaryngol Head Neck Surg 2018; 47:6. [PMID: 29357932 PMCID: PMC5778700 DOI: 10.1186/s40463-018-0254-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/08/2018] [Indexed: 12/04/2022] Open
Abstract
Background Hyperthyroidism is associated with high incidence of thyroid carcinoma; furthermore, tumors arisen in hyperthyroid tissue show an aggressive behavior. Thyroid Stimulating Hormone (TSH) and Thyroid-stimulating antibodies, present in Graves’s disease, seem to play a key role in carcinogenesis and tumoral growth. Methods We retrospectively reviewed our series of patients who underwent thyroidectomy for thyroid carcinoma. We compared pathological features and surgical outcomes of hyperthyroid versus euthyroid patients. Results From 2007 to 2015, 909 thyroidectomies were performed at our institution for thyroid cancer: 87 patients were hyperthyroid and 822 euthyroid. We observed, in hyperthyroid patients, a higher rate of transient hypoparathyroidism (28.1% vs 13.2%; p < 0.01) and of node metastases (12.6% vs 6.1%; p = 0.03); also local recurrence rate was higher (5.7% vs 2.5%) even if not statistically significant (p = 0.17). Five-year disease free survival rate was significant lower in the same group (89.1% vs 96.6%; p = 0.03). Conclusion Thyroid cancers in hyperthyroid patients have an aggressive behavior, with high incidence of local invasion and a worse prognosis than euthyroid patients. All hyperthyroid patients should undergo a careful evaluation with ultrasound and scintigraphy; in case of suspicious nodules, an aggressive approach, including thyroidectomy and lymphectomy, is justified. In patients with toxic adenoma, thyroid cancer is uncommon, thus a loboisthmectomy can be safely performed. Trial registration number Research registry n. 2670 registered 19 June 2017 (retrospectively registered).
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
| | - Ernico Erdas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy
| | - Alessandro Longheu
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy
| | - Massimiliano Tuveri
- Istituto Pancreas, Policlinico Borgo Roma, AOUI Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy
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Medas F, Erdas E, Gordini L, Conzo G, Gambardella C, Canu GL, Pisano G, Nicolosi A, Calò PG. Risk of malignancy in thyroid nodules classified as TIR-3A: What therapy? Int J Surg 2018; 41 Suppl 1:S60-S64. [PMID: 28506415 DOI: 10.1016/j.ijsu.2017.03.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/20/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of the present study was to assess the clinical applicability of the TIR3A category in managing thyroid nodules, to examine the malignancy rates of TIR 3A and TIR 3B nodules, and to suggest management guidelines for these nodules. MATERIALS AND METHODS Thyroid cytologies performed in patients referred to our Department between January 2014 and August 2016 were classified according to the guidelines published by the SIAPEC. 102 cases were included in this retrospective study and were divided into two groups: 19 TIR3A were included in group A and 83 TIR3B in group B. RESULTS In group A, malignancy was diagnosed in 4 (21.1%) cases, papillary thyroid cancer was found in 3 patients and follicular thyroid cancer in 1; one case was classified as microcarcinoma, in two cancer was multicentric and bilateral and in one central node metastases were observed. In Group B malignancy was diagnosed in 48 (57.8%) patients, papillary thyroid cancer was found in 36 patients and follicular cancer in 12; microcarcinoma was observed in 25 cases, 12 were unilateral multicentric and 7 bilateral multicentric; in 3 cases central node metastases were present. CONCLUSION Thyroid nodules with TIR3A cytology have a lower risk of malignancy than TIR3B cases, for which the new SIAPEC classification has proved accurate and effective. Malignancy rates in nodules with TIR3A cytology are higher than expected, although the real and accurate definition of the risk is extremely difficult. The recommendation to perform an accurate follow-up and repeat the fine-needle aspiration still appears the best option. For better management of patients with TIR3A cytology a careful assessment of risk factors and ultrasound characteristics is always needed. Further multicenter studies with longer follow-up are needed to better define the efficacy of this classification, the actual cancer risk, and the best management of these lesions.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Luca Gordini
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Giovanni Conzo
- Università degli Studi della Campania "Luigi Vanvitelli" - School of Medicine, Division of General Surgery and Surgical Oncology, Via Gen.G.Orsini 42, 80132 Naples, Italy.
| | - Claudio Gambardella
- Università degli Studi della Campania "Luigi Vanvitelli" - School of Medicine, Division of General Surgery and Surgical Oncology, Via Gen.G.Orsini 42, 80132 Naples, Italy.
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Angelo Nicolosi
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
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Calò PG, Medas F, Conzo G, Podda F, Canu GL, Gambardella C, Pisano G, Erdas E, Nicolosi A. Intraoperative neuromonitoring in thyroid surgery: Is the two-staged thyroidectomy justified? Int J Surg 2018; 41 Suppl 1:S13-S20. [PMID: 28506407 DOI: 10.1016/j.ijsu.2017.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic accuracy of intraoperative neuromonitoring (IONM) in predicting postoperative nerve function during thyroid surgery and its consequent ability to assist the surgeon in intraoperative decision making. MATERIALS AND METHODS A total of 2365 consecutive patients were submitted to thyroidectomy by the same surgical team. Group A included 1356 patients (2712 nerves at risk) in whom IONM was utilized, and Group B included 1009 patients (2018 nerves at risk) in whom IONM was not utilized. RESULTS In Group A, loss of signal (LOS) was observed in 37 patients; there were 29 true positive, 1317 true negative, 8 false positive, and 2 false negative cases. Accuracy was 99.3%, positive predictive value was 78.4%, negative predictive value was 99.8%, sensitivity was 93.6%, and specificity was 99.4%. A total of 29 (2.1%) cases of unilateral paralysis were observed, 23 (1.7%) of which were transient and 6 (0.4%) of which were permanent. Bilateral palsy was observed in two (0.1%) cases requiring a tracheostomy. In Group A, 31 (2.3%) injuries were observed, 25 (1.8%) of which were transient and 6 (0.4%) of which were permanent. In Group B, 26 (2.6%) unilateral paralysis cases were observed, 20 (2%) of which were transient and 6 (0.6%) of which were permanent; bilateral palsy was observed in 2 (0.2%) cases. In Group B, 28 (2.8%) injuries were observed, 21 (2.1%) of which were transient and 7 (0.7%) of which were permanent. Differences between the two groups were not statistically significant. CONCLUSIONS Our results show that IONM has a very high sensitivity and negative predictive value, but also good specificity and positive predictive value. For these reasons, in selected patients with LOS, the surgical strategy should be reconsidered. However, patients need to be informed preoperatively about potential strategy changes during the planned bilateral surgery. Future larger and multicenter studies are needed to confirm the benefits of this therapeutic strategy.
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Affiliation(s)
- Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
| | - Giovanni Conzo
- Università degli Studi della Campania "Luigi Vanvitelli" - School of Medicine, Division of General Surgery and Surgical Oncology, Via Gen.G.Orsini 42, 80132, Naples, Italy.
| | - Francesco Podda
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
| | - Claudio Gambardella
- Università degli Studi della Campania "Luigi Vanvitelli" - School of Medicine, Division of General Surgery and Surgical Oncology, Via Gen.G.Orsini 42, 80132, Naples, Italy.
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
| | - Angelo Nicolosi
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato (CA), Italy.
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