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Russell MD, Shonka DC, Noel J, Karcioglu AS, Ahmed AH, Angelos P, Atkins K, Bischoff L, Buczek E, Caulley L, Freeman J, Kroeker T, Liddy W, McIver B, McMullen C, Nikiforov Y, Orloff L, Scharpf J, Shah J, Shaha A, Singer M, Tolley N, Tuttle RM, Witterick I, Randolph GW. Preoperative Evaluation of Thyroid Cancer: A Review of Current Best Practices. Endocr Pract 2023; 29:811-821. [PMID: 37236353 DOI: 10.1016/j.eprac.2023.05.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The incidence of thyroid cancer has significantly increased in recent decades. Although most thyroid cancers are small and carry an excellent prognosis, a subset of patients present with advanced thyroid cancer, which is associated with increased rates of morbidity and mortality. The management of thyroid cancer requires a thoughtful individualized approach to optimize oncologic outcomes and minimize morbidity associated with treatment. Because endocrinologists usually play a key role in the initial diagnosis and evaluation of thyroid cancers, a thorough understanding of the critical components of the preoperative evaluation facilitates the development of a timely and comprehensive management plan. The following review outlines considerations in the preoperative evaluation of patients with thyroid cancer. METHODS A clinical review based on current literature was generated by a multidisciplinary author panel. RESULTS A review of considerations in the preoperative evaluation of thyroid cancer is provided. The topic areas include initial clinical evaluation, imaging modalities, cytologic evaluation, and the evolving role of mutational testing. Special considerations in the management of advanced thyroid cancer are discussed. CONCLUSION Thorough and thoughtful preoperative evaluation is critical for formulating an appropriate treatment strategy in the management of thyroid cancer.
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Affiliation(s)
- Marika D Russell
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Julia Noel
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Amanda Silver Karcioglu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Amr H Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Kristen Atkins
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Lindsay Bischoff
- Division of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Erin Buczek
- Department of Otolaryngology-Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Yuri Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Orloff
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jatin Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashok Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Neil Tolley
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Robert Michael Tuttle
- Endocrine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Sanghi A, Gruber JJ, Metwally A, Jiang L, Reynolds W, Sunwoo J, Orloff L, Chang HY, Kasowski M, Snyder MP. Chromatin accessibility associates with protein-RNA correlation in human cancer. Nat Commun 2021; 12:5732. [PMID: 34593797 PMCID: PMC8484618 DOI: 10.1038/s41467-021-25872-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
Although alterations in chromatin structure are known to exist in tumors, how these alterations relate to molecular phenotypes in cancer remains to be demonstrated. Multi-omics profiling of human tumors can provide insight into how alterations in chromatin structure are propagated through the pathway of gene expression to result in malignant protein expression. We applied multi-omics profiling of chromatin accessibility, RNA abundance, and protein abundance to 36 human thyroid cancer primary tumors, metastases, and patient-match normal tissue. Through quantification of chromatin accessibility associated with active transcription units and global protein expression, we identify a local chromatin structure that is highly correlated with coordinated RNA and protein expression. In particular, we identify enhancers located within gene-bodies as predictive of correlated RNA and protein expression, that is independent of overall transcriptional activity. To demonstrate the generalizability of these findings we also identify similar results in an independent cohort of human breast cancers. Taken together, these analyses suggest that local enhancers, rather than distal enhancers, are likely most predictive of cancer gene expression phenotypes. This allows for identification of potential targets for cancer therapeutic approaches and reinforces the utility of multi-omics profiling as a methodology to understand human disease.
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Affiliation(s)
- Akshay Sanghi
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Joshua J Gruber
- Department of Genetics, Stanford University, Stanford, CA, USA
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ahmed Metwally
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Lihua Jiang
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Warren Reynolds
- Center for Personal Dynamic Regulomes and HHMI, Stanford University, Stanford, USA
| | - John Sunwoo
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Orloff
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, CA, USA
| | - Howard Y Chang
- Department of Genetics, Stanford University, Stanford, CA, USA
- Center for Personal Dynamic Regulomes and HHMI, Stanford University, Stanford, USA
| | - Maya Kasowski
- Department of Genetics, Stanford University, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
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Scharpf J, Liu JC, Sinclair C, Singer M, Liddy W, Orloff L, Steward D, Bonilla Velez J, Randolph GW. Critical Review and Consensus Statement for Neural Monitoring in Otolaryngologic Head, Neck, and Endocrine Surgery. Otolaryngol Head Neck Surg 2021; 166:233-248. [PMID: 34000898 DOI: 10.1177/01945998211011062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND Enhancing patient outcomes in an array of surgical procedures in the head and neck requires the maintenance of complex regional functions through the protection of cranial nerve integrity. This review and consensus statement cover the scope of cranial nerve monitoring of all cranial nerves that are of practical importance in head, neck, and endocrine surgery except for cranial nerves VII and VIII within the temporal bone. Complete and applied understanding of neurophysiologic principles facilitates the surgeon's ability to monitor the at-risk nerve. METHODS The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) identified the need for a consensus statement on cranial nerve monitoring. An AAO-HNS task force was created through soliciting experts on the subject. Relevant domains were identified, including residency education, neurophysiology, application, and various techniques for monitoring pertinent cranial nerves. A document was generated to incorporate and consolidate these domains. The panel used a modified Delphi method for consensus generation. RESULTS Consensus was achieved in the domains of education needs and anesthesia considerations, as well as setup, troubleshooting, and documentation. Specific cranial nerve monitoring was evaluated and reached consensus for all cranial nerves in statement 4 with the exception of the spinal accessory nerve. Although the spinal accessory nerve's value can never be marginalized, the task force did not feel that the existing literature was as robust to support a recommendation of routine monitoring of this nerve. In contrast, there is robust supporting literature cited and consensus for routine monitoring in certain procedures, such as thyroid surgery, to optimize patient outcomes. CONCLUSIONS The AAO-HNS Cranial Nerve Monitoring Task Force has provided a state-of-the-art review in neural monitoring in otolaryngologic head, neck, and endocrine surgery. The evidence-based review was complemented by consensus statements utilizing a modified Delphi method to prioritize key statements to enhance patient outcomes in an array of surgical procedures in the head and neck. A precise definition of what actually constitutes intraoperative nerve monitoring and its benefits have been provided.
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Affiliation(s)
- Joseph Scharpf
- Cleveland Clinic Foundation Head and Neck Institute, Cleveland, Ohio, USA
| | - Jeffrey C Liu
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | | | | | | | - Lisa Orloff
- Stanford University, Palo Alto, California, USA
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Thatipamala P, Noel JE, Orloff L. Quality of Life After Thyroidectomy for Hashimoto Disease in Patients With Persistent Symptoms. Ear Nose Throat J 2020; 101:NP299-NP304. [PMID: 33090901 DOI: 10.1177/0145561320967332] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine whether thyroidectomy improves quality of life in patients with Hashimoto thyroiditis with persistent symptoms despite biochemical euthyroidism. METHODS A retrospective cohort study was conducted of patients undergoing thyroidectomy for Hashimoto thyroiditis at our institution between 2014 and 2018. The following variables were collected: age, race, body mass index, preoperative symptoms, preoperative thyroid peroxidase antibody titer, thyroglobulin antibody titer, thyroid-stimulating hormone, free thyroxine, specimen weight, and histologic presence of thyroiditis. Outcomes included general health score on the Short Form 36 (SF-36) Health and responses to a questionnaire addressing postoperative disease management. RESULTS A total of 19 patients were included in the study, 18 of whom were female with a mean age of 48 years. The majority of patients were Caucasian. There were no significant differences between the postoperative general health scores of the patients with Hashimoto thyroiditis and scores from a healthy control population (66.9 vs 74.1; 95% CI: -16.9 to +2.5, P = .16). There were also no differences between groups within the 7 SF-36 subscores. Elevation in preoperative thyroperoxidase antibody correlated with lower reported postoperative energy levels (r = -0.63, P = .016) and emotional well-being (r = -.55, P = .041); 87.5% of respondents reported being moderately or extremely happy with their decision to proceed with surgery. CONCLUSIONS Quality of life in patients with Hashimoto thyroiditis who undergo thyroidectomy is equivalent to the general population, and the majority are satisfied with surgery. Thyroidectomy is a consideration for patients with persistent symptoms despite optimization on medical therapy.
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Affiliation(s)
- Priyanka Thatipamala
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Julia E Noel
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Orloff
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Thatipamala P, Noel J, Orloff L. SAT-430 Quality of Life After Thyroidectomy for Patients with Hashimoto’s Disease and Persistent Symptoms. J Endocr Soc 2020. [PMCID: PMC7208397 DOI: 10.1210/jendso/bvaa046.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: To determine whether thyroidectomy improves quality of life in patients with Hashimoto’s thyroiditis with persistent symptoms despite biochemical euthyroidism. Study Design: A retrospective cohort study of patients undergoing thyroidectomy for Hashimoto’s thyroiditis. Setting: Tertiary referral center. Subjects and Methods: Included patients underwent thyroidectomy for Hashimoto’s thyroiditis at our institution between 2014 and 2018. The following variables were collected: age, race, body mass index (BMI), pre-operative symptoms, pre-operative thyroid peroxidase antibody (TPO Ab), thyroglobulin antibody (Tg Ab) thyroid stimulating hormone (TSH), free T4, specimen weight, and presence of thyroiditis or malignancy on the pathology report. The primary outcome was general health score on the Short Form-36 Health Survey (SF-36) ranging from 3–35 months postoperatively. Secondary outcomes included an additional questionnaire specifically addressing disease management after surgery as well as any adverse outcomes. Results: 19 patients were included in the study. 18 of the 19 patients were female with a mean age of 48 years (SD 13.6 years). The majority of patients were Caucasian. There was no significant difference between the general health score of the Hashimoto’s thyroiditis patients post-operatively compared to a healthy control population. (66.9 vs. 74.1; 95% CI [-16.9 + 2.5], p = 0.16). There were also no significant differences between groups within the 7 SF-36 subscores. Elevation in pre-operative TPO Ab correlated with lower reported post-operative energy levels (r = -0.63, p = 0.016) and emotional well-being (r = -.55, p = 0.041). 87.5% (14/16) of respondents reported to be moderately or extremely happy with their decision to proceed with surgery. Conclusions: Quality of life in patients with Hashimoto’s thyroiditis who undergo thyroidectomy is equivalent to the general population, and the majority of patients are satisfied with the decision to have undergone surgery. Thyroidectomy is a consideration for patients with Hashimoto’s disease and persistent symptoms despite optimization on medical therapy.
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Affiliation(s)
| | - Julia Noel
- Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Orloff
- Stanford University School of Medicine, Stanford, CA, USA
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Sanghi A, Orloff L, Snyder M. SAT-LB25 A Multi-Omics Analysis of Advanced Papillary Thyroid Cancer. J Endocr Soc 2020. [PMCID: PMC7208554 DOI: 10.1210/jendso/bvaa046.2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Molecular profiling of papillary thyroid carcinoma has largely been confined to exome sequencing of non-aggressive cancer.1,2 Canonical mutations in BRAF and RAS are significantly represented in thyroid tumors, but these mutations have not resulted in diagnostics and therapeutics for advanced disease. To broadly examine the molecular landscape of advanced disease, we conducted a multi-omic analysis of 34 cases of advanced papillary thyroid carcinoma, including patient-matched lymph node metastases, primary tumor, adjacent-normal thyroid and germline. Our genome-wide multi-omic analysis links the regions of activated chromatin with expressed transcripts and proteins, identifying regulatory elements at primary tumor and nodal metastases stages of thyroid cancer progression. Distal regulatory elements putatively upregulate expression of MAPK-pathway genes in both tumors and metastases (36 genes (p =0.0057) in tumors and 76 genes (p =0.0011) in metastases). Furthermore, tumors and metastases harbor accessible chromatin regions that appear to be bound by MAPK transcription factors, FOS and JUN (p-value <10-150 for tumors and metastases). This study identifies regulatory elements that mediate MAPK activity in tumors and metastases of advanced papillary thyroid carcinoma and may ultimately lead to diagnostics and therapeutics that utilize advanced-thyroid-cancer-specific epigenetic targets. References • Cancer Genome Atlas Research Network. Integrated genomic characterization of papillary thyroid carcinoma. Cell. 2014 • Masoodi T, et al. Whole-Exome Sequencing of Matched Primary and Metastatic Papillary Thyroid Cancer. Thyroid. 2020
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Affiliation(s)
- Akshay Sanghi
- STANFORD UNIVERSITY MEDICAL CENTER, Palo Alto, CA, USA
| | - Lisa Orloff
- STANFORD UNIVERSITY MEDICAL CENTER, Palo Alto, CA, USA
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Zafereo M, McIver B, Vargas-Salas S, Domínguez JM, Steward DL, Holsinger FC, Kandil E, Williams M, Cruz F, Loyola S, Solar A, Roa JC, León A, Droppelman N, Lobos M, Arias T, Kong CS, Busaidy N, Grubbs EG, Graham P, Stewart J, Tang A, Wang J, Orloff L, Henríquez M, Lagos M, Osorio M, Schachter D, Franco C, Medina F, Wohllk N, Diaz RE, Veliz J, Horvath E, Tala H, Pineda P, Arroyo P, Vasquez F, Traipe E, Marín L, Miranda G, Bruce E, Bracamonte M, Mena N, González HE. A Thyroid Genetic Classifier Correctly Predicts Benign Nodules with Indeterminate Cytology: Two Independent, Multicenter, Prospective Validation Trials. Thyroid 2020; 30:704-712. [PMID: 31910118 PMCID: PMC7232660 DOI: 10.1089/thy.2019.0490] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Although most thyroid nodules with indeterminate cytology are benign, in most of the world, surgery remains as the most frequent diagnostic approach. We have previously reported a 10-gene thyroid genetic classifier, which accurately predicts benign thyroid nodules. The assay is a prototype diagnostic kit suitable for reference laboratory testing and could potentially avoid unnecessary diagnostic surgery in patients with indeterminate thyroid cytology. Methods: Classifier performance was tested in two independent, ethnically diverse, prospective multicenter trials (TGCT-1/Chile and TGCT-2/USA). A total of 4061 fine-needle aspirations were collected from 15 institutions, of which 897 (22%) were called indeterminate. The clinical site was blind to the classifier score and the clinical laboratory blind to the pathology report. A matched surgical pathology and valid classifier score was available for 270 samples. Results: Cohorts showed significant differences, including (i) clinical site patient source (academic, 43% and 97% for TGCT-1 and -2, respectively); (ii) ethnic diversity, with a greater proportion of the Hispanic population (40% vs. 3%) for TGCT-1 and a greater proportion of African American (11% vs. 0%) and Asian (10% vs. 1%) populations for TGCT-2; and (iii) tumor size (mean of 1.7 and 2.5 cm for TGCT-1 and -2, respectively). Overall, there were no differences in the histopathological profile between cohorts. Forty-one of 155 and 45 of 115 nodules were malignant (cancer prevalence of 26% and 39% for TGCT-1 and -2, respectively). The classifier predicted 37 of 41 and 41 of 45 malignant nodules, yielding a sensitivity of 90% [95% confidence interval; CI 77-97] and 91% [95% CI 79-98] for TGCT-1 and -2, respectively. One hundred one of 114 and 61 of 70 nodules were correctly predicted as benign, yielding a specificity of 89% [95% CI 82-94] and 87% [95% CI 77-94], respectively. The negative predictive values for TGCT-1 and TGCT-2 were 96% and 94%, respectively, whereas the positive predictive values were 74% and 82%, respectively. The overall accuracy for both cohorts was 89%. Conclusions: Clinical validation of the classifier demonstrates equivalent performance in two independent and ethnically diverse cohorts, accurately predicting benign thyroid nodules that can undergo surveillance as an alternative to diagnostic surgery.
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Affiliation(s)
- Mark Zafereo
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan McIver
- Department of Head and Neck–Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Bryan McIver, MD, PhD, Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612, USA
| | - Sergio Vargas-Salas
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Miguel Domínguez
- Department of Endocrinology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David L. Steward
- Department of Otolaryngology, Head and Neck Surgery; University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | | | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Michelle Williams
- Division of Pathology/Lab Medicine, Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Francisco Cruz
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Soledad Loyola
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Antonieta Solar
- Department of Pathology, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Juan Carlos Roa
- Department of Pathology, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Augusto León
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelman
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maite Lobos
- Centro Diagnostico Plaza Italia, Santiago, Chile
| | | | - Christina S. Kong
- Department of Pathology; Stanford University, Palo Alto, California, USA
| | - Naifa Busaidy
- Department of Endocrine Neoplasia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth G. Grubbs
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul Graham
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Stewart
- Division of Pathology/Lab Medicine, Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alice Tang
- Department of Otolaryngology, Head and Neck Surgery; University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Jiang Wang
- Department of Pathology; University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Lisa Orloff
- Division of Head and Neck Surgery, Department of Otolaryngology; Palo Alto, California, USA
| | - Marcela Henríquez
- Department of Laboratory Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Marcela Lagos
- Department of Laboratory Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Miren Osorio
- Clinica Santa Maria Santiago de Chile; Universidad de Chile, Santiago, Chile
| | - Dina Schachter
- Clinica Santa Maria Santiago de Chile; Universidad de Chile, Santiago, Chile
| | - Carmen Franco
- Clinica Santa Maria Santiago de Chile; Universidad de Chile, Santiago, Chile
| | - Francisco Medina
- Clinica Santa Maria Santiago de Chile; Universidad de Chile, Santiago, Chile
| | - Nelson Wohllk
- Hospital del Salvador; Universidad de Chile, Santiago, Chile
| | - René E. Diaz
- Hospital del Salvador; Universidad de Chile, Santiago, Chile
| | - Jesús Veliz
- Hospital del Salvador; Universidad de Chile, Santiago, Chile
| | - Eleonora Horvath
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Hernán Tala
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Pedro Pineda
- Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | | | - Eufrosina Traipe
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Luis Marín
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Giovanna Miranda
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elsa Bruce
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Milagros Bracamonte
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Mena
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán E. González
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Address correspondence to: Hernán E. González, MD, PhD, Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Surgery Division, 3rd Floor, Santiago, Chile
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Chan JYK, Koh YW, Richmon J, Kim J, Holsinger FC, Orloff L, Anuwong A. Transoral thyroidectomy with a next generation flexible robotic system: A feasibility study in a cadaveric model. Gland Surg 2019; 8:644-647. [PMID: 32042671 DOI: 10.21037/gs.2019.10.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Transoral endoscopic thyroidectomy provides access via the oral vestibule and gas insufflation to provide reliable remote access surgery to perform a total thyroidectomy. The da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA) is a next generation flexible single port system that offers unique advantages over previous robotic rigid systems. Here we sought to evaluate the feasibility of performing transoral thyroidectomy with this next generation flexible robotic system. Methods Cadaveric dissection with gas insufflation to test the feasibility of performing transoral thyroidectomy with the da Vinci SP. Results A 2 cm incision was made in the oral vestibule and the working space created with a 1cm central port and two lateral 5 mm ports. Then an extra small wound protector (Applied Medical, Rancho Santa Margarita, CA) was placed through the central incision after closure of the 5 mm ports. The robotic system was then deployed through the wound protector while insufflation was maintained at ~6 mmHg. Three instrument arms were deployed. A fenestrated bipolar was used to grasp the thyroid gland while Maryland bipolars and monopolar scissors were used to mobilize each hemi lobe of the thyroid. The recurrent laryngeal nerves were seen and preserved bilaterally. After completion of the surgery and removal of the wound protector the vestibular incision was measured to be 3 cm. Further dissection to identify the mental nerves identified each nerve to be >1 cm from the lateral extent of the central incision. Conclusions In summary, it is feasible to perform a total thyroidectomy with gas insufflation utilizing this next generation flexible robotic system. Further evaluation will be needed to validate the clinical applicability of this technique.
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Affiliation(s)
- Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Yoon W Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Jaewook Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Soonchunhyang University Hospital, College of Medicine, Seoul, South Korea
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Lisa Orloff
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Angkoon Anuwong
- Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, Bangkok, Thailand
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Wu CW, Dionigi G, Barczynski M, Chiang FY, Dralle H, Schneider R, Al-Quaryshi Z, Angelos P, Brauckhoff K, Brooks JA, Cernea CR, Chaplin J, Chen AY, Davies L, Diercks GR, Duh QY, Fundakowski C, Goretzki PE, Hales NW, Hartl D, Kamani D, Kandil E, Kyriazidis N, Liddy W, Miyauchi A, Orloff L, Rastatter JC, Scharpf J, Serpell J, Shin JJ, Sinclair CF, Stack BC, Tolley NS, Slycke SV, Snyder SK, Urken ML, Volpi E, Witterick I, Wong RJ, Woodson G, Zafereo M, Randolph GW. International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data. Laryngoscope 2018; 128 Suppl 3:S18-S27. [PMID: 30291765 DOI: 10.1002/lary.27360] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [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: 02/27/2018] [Revised: 04/22/2018] [Accepted: 05/24/2018] [Indexed: 12/30/2022]
Abstract
The purpose of this publication was to inform surgeons as to the modern state-of-the-art evidence-based guidelines for management of the recurrent laryngeal nerve invaded by malignancy through blending the domains of 1) surgical intraoperative information, 2) preoperative glottic function, and 3) intraoperative real-time electrophysiologic information. These guidelines generated by the International Neural Monitoring Study Group (INMSG) are envisioned to assist the clinical decision-making process involved in recurrent laryngeal nerve management during thyroid surgery by incorporating the important information domains of not only gross surgical findings but also intraoperative recurrent laryngeal nerve functional status and preoperative laryngoscopy findings. These guidelines are presented mainly through algorithmic workflow diagrams for convenience and the ease of application. These guidelines are published in conjunction with the INMSG Guidelines Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal. Level of Evidence: 5 Laryngoscope, 128:S18-S27, 2018.
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Affiliation(s)
- Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University, Third Chair of General Surgery, Krakow, Poland
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Henning Dralle
- Department of General Surgery, University Hospital Halle, Halle/Saale, Germany
| | - Rick Schneider
- Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Zaid Al-Quaryshi
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Peter Angelos
- Division of Endocrine Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jennifer A Brooks
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Claudio R Cernea
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - John Chaplin
- Department of Otolaryngology-Head and Neck Surgery, Gillies Hospital and Clinics, Epsom, New Zealand
| | - Amy Y Chen
- VA Endocrine Surgery, Department of Otolaryngology Emory University School of Medicine, Atlanta, GA, USA
| | - Louise Davies
- Outcomes Group, Veterans Affairs Medical Center, Norwich, Vermont, U.S.A
| | - Gill R Diercks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Quan Yang Duh
- Department of Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Christopher Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Peter E Goretzki
- P.G. Stadtische Kliniken Neuss Lukaskrankenhaus GmbH, Neuss, Nordrhein-Westfalen, DE
| | - Nathan W Hales
- Department of Otolaryngology, Uniformed Services of the Health Sciences, San Antonio, Texas, U.S.A.,San Antonio Head and Neck, San Antonio, Texas, U.S.A
| | - Dana Hartl
- Department of Otolaryngology Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Dipti Kamani
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Natalia Kyriazidis
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York, U.S.A
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | | | - Lisa Orloff
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Jeff C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Joseph Scharpf
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Jonathan Serpell
- Breast, Endocrine and General Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University School of Languages, Literatures, Cultures, and Linguistics, Clayton, Victoria, Australia
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York, U.S.A
| | - Brendan C Stack
- Department of Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Neil S Tolley
- Department of Otolaryngology-Head and Neck Surgery, Imperial College Hospitals NHS Trust, St. Mary's Hospital, London, United Kingdom
| | | | - Samuel K Snyder
- Department of General Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, U.S.A
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York, U.S.A
| | - Erivelto Volpi
- Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ian Witterick
- Department of Otolaryngology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Richard J Wong
- Department of Surgery-Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A
| | | | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Gregory W Randolph
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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10
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Schneider R, Randolph GW, Dionigi G, Wu CW, Barczynski M, Chiang FY, Al-Quaryshi Z, Angelos P, Brauckhoff K, Cernea CR, Chaplin J, Cheetham J, Davies L, Goretzki PE, Hartl D, Kamani D, Kandil E, Kyriazidis N, Liddy W, Orloff L, Scharpf J, Serpell J, Shin JJ, Sinclair CF, Singer MC, Snyder SK, Tolley NS, Van Slycke S, Volpi E, Witterick I, Wong RJ, Woodson G, Zafereo M, Dralle H. International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope 2018; 128 Suppl 3:S1-S17. [DOI: 10.1002/lary.27359] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Rick Schneider
- Martin Luther University Halle-Wittenberg; Department of General, Visceral, and Vascular Surgery; Halle Germany
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology; Massachusetts Eye and Ear Harvard Medical School; Boston Massachusetts
- Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, at the Department of Human Pathology in Adulthood and Childhood “G. Barresi,” University Hospital G. Martino; University of Messina; Italy
| | - Che-Wei Wu
- Kaohsiung Medical University Hospital, Kaohsiung Medical University; Otolaryngology-Head and Neck Surgery; Kaohsiung Taiwan
| | - Marcin Barczynski
- Jagiellonian University, Department of Endocrine Surgery, Third Chair of General Surgery; Krakow Poland
| | - Feng-Yu Chiang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University; Otolaryngology-Head and Neck Surgery; Kaohsiung Taiwan
| | - Zaid Al-Quaryshi
- University of Iowa Hospitals and Clinics, Otolaryngology; Iowa City Iowa
| | - Peter Angelos
- University of Chicago; Division of Endocrine Surgery, Department of Surgery; Chicago Illinois
| | - Katrin Brauckhoff
- Haukeland Universitetssjukehus; Department of Breast and Endocrine Surgery; Bergen Norway
| | - Claudio R. Cernea
- University of Sao Paulo Medical School; Department of Head and Neck Surgery; Sao Paulo SP Brazil
| | | | - Jonathan Cheetham
- Cornell University, Clinical Sciences, College of Veterinary Medicine; Ithaca New York
| | - Louise Davies
- VA Outcomes Group at the Veterans Affairs Medical Center; Norwich Vermont
| | - Peter E. Goretzki
- Stadtische Kliniken Neuss Lukaskrankenhaus GmbH; Neuss Nordrhein-Westfalen Germany
| | - Dana Hartl
- Institut Gustave Roussy, Otolaryngology Head & Neck Surgery; Villejuif France
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology; Massachusetts Eye and Ear Harvard Medical School; Boston Massachusetts
| | - Emad Kandil
- Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana
| | - Natalia Kyriazidis
- State University of New York Upstate Medical University; Otolaryngology; Syracuse New York
| | - Whitney Liddy
- Northwestern University Feinberg School of Medicine Department of Psychiatry and Behavioral Sciences, Otolaryngology; Chicago Illinois
| | - Lisa Orloff
- Stanford University School of Medicine, Otolaryngology, Division of Head and Neck Surgery; Stanford California
| | | | - Jonathan Serpell
- Alfred Hospital; Melbourne Victoria Australia
- Monash University School of Languages Literatures Cultures and Linguistics; Clayton Victoria Australia
| | | | | | - Michael C. Singer
- Henry Ford Hospital, Otolaryngology-Head & Neck Surgery; Detroit Michigan
| | - Samuel K. Snyder
- University of Texas Rio Grande Valley School of Medicine; Department of General Surgery; Edinburg Texas
| | - Neil S. Tolley
- St. Mary's Hospital, Imperial College Hospitals NHS Trust, St. Mary's Hospital; London United Kingdom
| | | | - Erivelto Volpi
- Hospital das Clinicas-University of Sao Paulo Medical School; Sao Paulo Brazil
| | - Ian Witterick
- Mount Sinai Hospital; Department of Otolaryngology; Toronto Ontario Canada
| | - Richard J. Wong
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, Head and Neck Service; New York New York
| | | | - Mark Zafereo
- MD Anderson Cancer Center, Head and Neck Surgery; Houston Texas U.S.A
| | - Henning Dralle
- Allgemeinchirurgie, Uniklinik Halle; Halle/Saale Germany
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11
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Ferris RL, Nikiforov Y, Terris D, Seethala RR, Ridge JA, Angelos P, Duh Q, Wong R, Sabra MM, Fagin JA, McIver B, Bernet VJ, Harrell RM, Busaidy N, Cibas ES, Faquin WC, Sadow P, Baloch Z, Shindo M, Orloff L, Davies L, Randolph GW. AHNS Series: Do you know your guidelines? AHNS Endocrine Section Consensus Statement: State-of-the-art thyroid surgical recommendations in the era of noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Head Neck 2018; 40:1881-1888. [PMID: 29947030 PMCID: PMC6175359 DOI: 10.1002/hed.25141] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 01/31/2023] Open
Abstract
The newly introduced pathologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) will result in less bilateral thyroid surgery as well as deescalation in T4 suppressive and radioactive iodine treatment. Although, NIFTP is a nonmalignant lesion that has nuclear features of some papillary malignancies, the challenge for the surgeon is to identify a lesion as possibly NIFTP before the pathologic diagnosis. NIFTP, due to its reduction of overall rates of malignancy, will result in the initial surgical pendulum swinging toward lobectomy instead of initial total thyroidectomy. This American Head and Neck Society endocrine section consensus statement is intended to inform preoperative evaluation to attempt to identify those patients whose final pathology report may ultimately harbor NIFTP and can be offered a conservative surgical plan to assist in cost-effective, optimal management of patients with NIFTP.
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Affiliation(s)
- Robert L. Ferris
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Yuri Nikiforov
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Davis Terris
- Department of Otolaryngology ‐ Head and Neck SurgeryAugusta UniversityAugustaGeorgia
| | - Raja R. Seethala
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - J. Andrew Ridge
- Department of Surgical OncologyFox Chase Cancer CenterPhiladelphiaPennsylvania
| | - Peter Angelos
- Department of SurgeryUniversity of Chicago Medical CenterChicagoIllinois
| | - Quan‐Yang Duh
- Department of SurgeryUniversity of California San FranciscoSan FranciscoCalifornia
| | - Richard Wong
- Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Mona M. Sabra
- Department of EndocrinologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - James A. Fagin
- Department of EndocrinologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Bryan McIver
- Department of Head and Neck ‐ Endocrine OncologyMoffitt Cancer CenterTampaFlorida
| | - Victor J. Bernet
- Department of EndocrinologyMayo Clinic JacksonvilleJacksonvilleFlorida
| | - R. Mack Harrell
- Department of EndocrinologyMemorial Regional HospitalHollywoodFlorida
| | - Naifa Busaidy
- Department of Endocrine NeoplasiaMD Anderson Cancer Center; HoustonTexas
| | - Edmund S. Cibas
- Department of PathologyBrigham and Women's HospitalBostonMassachusetts
| | - William C. Faquin
- Department of PathologyMassachusetts General HospitalBostonMassachusetts
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
| | - Peter Sadow
- Department of PathologyMassachusetts General HospitalBostonMassachusetts
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
| | - Zubair Baloch
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Maisie Shindo
- Department of OtolaryngologyOregon Health Science UniversityPortlandOregon
| | - Lisa Orloff
- Department of OtolaryngologyStanford UniversityStanfordCalifornia
| | - Louise Davies
- Department of Otolaryngology and AudiologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Gregory W. Randolph
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
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12
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Urken ML, Randolph G, Orloff L, Wenig BM, Machado R, Osorio M, Griffin M, Tuttle RM. THE ROLE OF ELECTRONIC FEEDBACK LOOPS IN THE CONTINUOUS QUALITY IMPROVEMENT OF THYROID NODULE AND THYROID CANCER CARE. Endocr Pract 2017; 23:1024-1027. [PMID: 28614008 DOI: 10.4158/ep161739.co] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Likhterov I, Tuttle RM, Haser GC, Su HK, Bergman D, Alon EE, Bernet V, Brett E, Cobin R, Dewey EH, Doherty G, Dos Reis LL, Klopper J, Lee SL, Lupo MA, Machac J, Mechanick JI, Milas M, Orloff L, Randolph G, Ross DS, Rowe ME, Smallridge R, Terris D, Tufano RP, Urken ML. Improving the adoption of thyroid cancer clinical practice guidelines. Laryngoscope 2016; 126:2640-2645. [PMID: 27074952 DOI: 10.1002/lary.25986] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present an overview of the barriers to the implementation of clinical practice guidelines (CPGs) in thyroid cancer management and to introduce a computer-based clinical support system. DATA SOURCES PubMed. REVIEW METHODS A review of studies on adherence to CPGs was conducted. RESULTS Awareness and adoption of CPGs is low in thyroid cancer management. Barriers to implementation include unfamiliarity with the CPGs and financial concerns. Effective interventions to improve adherence are possible, especially when they are readily accessible at the point of care delivery. Computerized clinical support systems show particular promise. The authors introduce the clinical decision making modules (CDMMs) of the Thyroid Cancer Care Collaborative, a thyroid cancer-specific electronic health record. These computer-based modules can assist clinicians with implementation of these recommendations in clinical practice. CONCLUSION Computer-based support systems can help clinicians understand and adopt the thyroid cancer CPGs. By integrating patient characteristics and guidelines at the point of care delivery, the CDMMs can improve adherence to the guidelines and help clinicians provide high-quality, evidence-based, and individualized patient care in the management of differentiated thyroid cancer. Laryngoscope, 126:2640-2645, 2016.
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Affiliation(s)
- Ilya Likhterov
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | | | - Grace C Haser
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York.
| | - Henry K Su
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Donald Bergman
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eran E Alon
- Department of Otolaryngology - Head and Neck Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Victor Bernet
- Department of Endocrinology, Mayo Clinic Jacksonville, Jacksonville, Florida, U.S.A
| | - Elise Brett
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rhoda Cobin
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eliza H Dewey
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Gerard Doherty
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Laura L Dos Reis
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Joshua Klopper
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Stephanie L Lee
- Section of Endocrinology, Diabetes, and Nutrition, Department of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Mark A Lupo
- Thyroid & Endocrine Center of Florida, Florida State University College of Medicine, Sarasota, Florida, U.S.A
| | - Josef Machac
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mira Milas
- Section of Endocrine Surgery, Department of Surgery, Banner-University Medical Center Phoenix, Phoenix, Arizona, U.S.A
| | - Lisa Orloff
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Gregory Randolph
- Department of Otolaryngology and the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Douglas S Ross
- Department of Otolaryngology and the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Meghan E Rowe
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Robert Smallridge
- Department of Endocrinology, Mayo Clinic Jacksonville, Jacksonville, Florida, U.S.A
| | - David Terris
- Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, U.S.A
| | - Ralph P Tufano
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Mark L Urken
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
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14
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Mehra S, Tuttle RM, Milas M, Orloff L, Bergman D, Bernet V, Brett E, Cobin R, Doherty G, Judson BL, Klopper J, Lee S, Lupo M, Machac J, Mechanick JI, Randolph G, Ross DS, Smallridge R, Terris D, Tufano R, Alon E, Clain J, DosReis L, Scherl S, Urken ML. Database and registry research in thyroid cancer: striving for a new and improved national thyroid cancer database. Thyroid 2015; 25:157-68. [PMID: 25517683 DOI: 10.1089/thy.2014.0270] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health registries have become extremely powerful tools for cancer research. Unfortunately, certain details and the ability to adapt to new information are necessarily limited in current registries, and they cannot address many controversial issues in cancer management. This is of particular concern in differentiated thyroid cancer, which is rapidly increasing in incidence and has many unknowns related to optimal treatment and surveillance recommendations. SUMMARY In this study, we review different types of health registries used in cancer research in the United States, with a focus on their advantages and disadvantages as related to the study of thyroid cancer. This analysis includes population-based cancer registries, health systems-based cancer registries, and patient-based disease registries. It is important that clinicians understand the way data are collected in, as well as the composition of, these different registries in order to more critically interpret the clinical research that is conducted using that data. In an attempt to address shortcoming of current databases for thyroid cancer, we present the potential of an innovative web-based disease management tool for thyroid cancer called the Thyroid Cancer Care Collaborative (TCCC) to become a patient-based registry that can be used to evaluate and improve the quality of care delivered to patients with thyroid cancer as well as to answer questions that we have not been able to address with current databases and registries. CONCLUSION A cancer registry that follows a specific patient, is integrated into physician workflow, and collects data across different treatment sites and different payers does not exist in the current fragmented system of healthcare in the United States. The TCCC offers physicians who treat thyroid cancer numerous time-saving and quality improvement services, and could significantly improve patient care. With rapid adoption across the nation, the TCCC could become a new paradigm for database research in thyroid cancer to improve our understanding of thyroid cancer management.
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Affiliation(s)
- Saral Mehra
- 1 Department of Surgery (Otolaryngology), Yale School of Medicine , New Haven, Connecticut
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15
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Dos Reis LL, Tuttle RM, Alon E, Bergman DA, Bernet V, Brett EM, Cobin R, Doherty G, Harris JR, Klopper J, Lee SL, Lupo M, Milas M, Machac J, Mechanick JI, Orloff L, Randolph G, Ross DS, Smallridge RC, Terris DJ, Tufano RP, Mehra S, Scherl S, Clain JB, Urken ML. What is the gold standard for comprehensive interinstitutional communication of perioperative information for thyroid cancer patients? A comparison of existing electronic health records with the current American Thyroid Association recommendations. Thyroid 2014; 24:1466-72. [PMID: 25036190 DOI: 10.1089/thy.2014.0209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Indexed: 11/13/2022]
Abstract
BACKGROUND Appropriate management of well-differentiated thyroid cancer requires treating clinicians to have access to critical elements of the patient's presentation, surgical management, postoperative course, and pathologic assessment. Electronic health records (EHRs) provide an effective method for the storage and transmission of patient information, although most commercially available EHRs are not intended to be disease-specific. In addition, there are significant challenges for the sharing of relevant clinical information when providers involved in the care of a patient with thyroid cancer are not connected by a common EHR. In 2012, the American Thyroid Association (ATA) defined the critical elements for optimal interclinician communication in a position paper entitled, "The Essential Elements of Interdisciplinary Communication of Perioperative Information for Patients Undergoing Thyroid Cancer Surgery." SUMMARY We present a field-by-field comparison of the ATA's essential elements as applied to three contemporary electronic reporting systems: the Thyroid Surgery e-Form from Memorial Sloan-Kettering Cancer Center (MSKCC), the Alberta WebSMR from the University of Calgary, and the Thyroid Cancer Care Collaborative (TCCC). The MSKCC e-form fulfills 21 of 32 intraoperative fields and includes an additional 14 fields not specifically mentioned in the ATA's report. The Alberta WebSMR fulfills 45 of 82 preoperative and intraoperative fields outlined by the ATA and includes 13 additional fields. The TCCC fulfills 117 of 120 fields outlined by the ATA and includes 23 additional fields. CONCLUSIONS Effective management of thyroid cancer is a highly collaborative, multidisciplinary effort. The patient information that factors into clinical decisions about thyroid cancer is complex. For these reasons, EHRs are particularly favorable for the management of patients with thyroid cancer. The MSKCC Thyroid Surgery e-Form, the Alberta WebSMR, and the TCCC each meet all of the general recommendations for effective reporting of the specific domains that they cover in the management of thyroid cancer, as recommended by the ATA. However, the TCCC format is the most comprehensive. The TCCC is a new Web-based disease-specific database to enhance communication of patient information between clinicians in a Health Insurance Portability and Accountability Act (HIPAA)-compliant manner. We believe the easy-to-use TCCC format will enhance clinician communication while providing portability of thyroid cancer information for patients.
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16
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Mehra S, Tuttle RM, Bergman D, Bernet V, Brett E, Cobin R, Doherty G, Klopper J, Lee S, Machac J, Milas M, Mechanick JI, Orloff L, Randolph G, Ross DS, Smallridge R, Terris D, Tufano R, Alon E, Clain J, Dos Reis L, Scherl S, Urken ML. Improving the quality of thyroid cancer care: how does the Thyroid Cancer Care Collaborative cross the Institute of Medicine's Quality Chasm? Thyroid 2014; 24:615-24. [PMID: 24512449 DOI: 10.1089/thy.2013.0441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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] [Indexed: 11/12/2022]
Abstract
BACKGROUND The current systems of healthcare delivery in the United States suffer from problems that often leave patients with inadequate quality of care. In their report entitled "Crossing the Quality Chasm," the Institute of Medicine (IOM) identified reasons for poor and/or inconsistent quality of healthcare delivery and provided recommendations to improve it. The purpose of this review is to describe features of an innovative web-based program called the Thyroid Cancer Care Collaborative (TCCC) and see how it addresses IOM recommendations to improve the quality of healthcare delivery. SUMMARY The TCCC addresses the three actionable IOM recommendations directed at healthcare organizations and clinicians to redesign the care process. It does so by exploiting information technology (IT) in ways suggested by the IOM, and it fits within a set of 10 rules provided by the IOM. Some features of the TCCC include: (i) automated disease staging based on three validated scoring systems; (ii) highly illustrated educational videos on all aspects of thyroid cancer care; (iii) personalized clinical decision-making modules for clinicians and physicians; (iv) portability of data to share among treating physicians; (v) virtual tumor boards, "ask the expert," and frequently asked questions modules; (vi) physician workflow integration; and (vii) data for comprehensive analysis to answer difficult questions in thyroid cancer management. CONCLUSION The TCCC has the potential to improve thyroid cancer care delivery and offers several benefits to patients, clinicians, and researchers. The TCCC is a valuable example of how IOM initiatives can improve the healthcare system.
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Affiliation(s)
- Saral Mehra
- 1 Department of Surgery (Otolaryngology), Yale University , New Haven, Connecticut
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Terris DJ, Snyder S, Carneiro-Pla D, Inabnet WB, Kandil E, Orloff L, Shindo M, Tufano RP, Tuttle RM, Urken M, Yeh MW. American Thyroid Association statement on outpatient thyroidectomy. Thyroid 2013; 23:1193-202. [PMID: 23742254 DOI: 10.1089/thy.2013.0049] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [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] [Indexed: 11/13/2022]
Abstract
BACKGROUND The primary goals of this interdisciplinary consensus statement are to define the eligibility criteria for outpatient thyroidectomy and to explore preoperative, intraoperative, and postoperative factors that should be considered in order to optimize the safe and efficient performance of ambulatory surgery. SUMMARY A series of criteria was developed that may represent relative contraindications to outpatient thyroidectomy, and these fell into the following broad categories: clinical, social, and procedural issues. Intraoperative factors that bear consideration are enumerated, and include choice of anesthesia, use of nerve monitoring, hemostasis, management of the parathyroid glands, wound closure, and extubation. Importantly, postoperative factors are described at length, including suggested discharge criteria and recognition of complications, especially bleeding, airway distress, and hypocalcemia. CONCLUSIONS Outpatient thyroidectomy may be undertaken safely in a carefully selected patient population provided that certain precautionary measures are taken to maximize communication and minimize the likelihood of complications.
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Affiliation(s)
- David J Terris
- 1 GRU Thyroid Center, Department of Otolaryngology, Georgia Regents University , Augusta, Georgia
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Dasgupta T, Shugard E, Weinberg V, Kased N, Huang K, Glastonbury C, Orloff L, Clark O, Yom S, Quivey J. Retrospective Outcome Analysis of High-Risk Thyroid Cancer treated with High Dose Intensity Modulated Radiation Therapy (IMRT) at a Single Institution. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011; 121 Suppl 1:S1-16. [PMID: 21181860 DOI: 10.1002/lary.21119] [Citation(s) in RCA: 605] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problem-solving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options.
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Affiliation(s)
- Gregory W Randolph
- Department of Otology and Laryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Steward DL, Terris D, Randolph G, Tufano R, Orloff L. Thyroid Nodule FNA Update: When to Do It, When Not, and How. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Stenzel M, Preuss S, Orloff L, Jecker P, Mann W. Cerebrospinal Fluid Leaks of Temporal Bone Origin: Etiology and Management. ORL J Otorhinolaryngol Relat Spec 2005; 67:51-5. [PMID: 15753623 DOI: 10.1159/000084306] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 10/01/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leaks of the temporal bone region require surgical treatment as they pose life-threatening risks such as meningitis. AIM The aim of the study was to determine the surgical outcome depending on different operation techniques and grafts. METHOD We performed a retrospective review of 28 cases of CSF leaks, operated in our department from 1983 to 2002. After a mean follow-up of 8 years, patients were interviewed concerning otorrhea or rhinorrhea and meningitis. In this context, our management of CSF leaks is presented. RESULTS The CSF leak had arisen spontaneously (n = 3), traumatically (n = 6) or postoperatively (n = 19). The surgical CSF leak repairs were performed via a transmastoid (n = 13), a middle fossa (n = 11) or a combined (n = 4) approach. Surgical outcome was independent on the used graft. CSF leak could be sealed in 25 of 28 cases. Only 3 patients suffered from recurrences. Meningitis or other complications did not occur. CONCLUSIONS Comparing different techniques and grafts, there were no differences in the surgical outcome.
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Affiliation(s)
- Mark Stenzel
- Department of Otorhinolaryngology, University Hospital, School of Medicine, Mainz, Germany.
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22
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Teomim D, Fishbien I, Golomb G, Orloff L, Mayberg M, Domb AJ. Perivascular delivery of heparin for the reduction of smooth muscle cell proliferation after endothelial injury. J Control Release 1999; 60:129-42. [PMID: 10370177 DOI: 10.1016/s0168-3659(99)00071-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Thin flexible sheets composed of poly(lactic acid) (PLA) laminated polyanhydride, poly(erucic acid dimer-sebacic anhydride) (P(EAD-SA)), loaded with heparin were evaluated in vitro and in vivo. PLA was used for coating the polyanhydride to improve the release profile and improve the strength of the films. Heparin was released constantly for 20 days from PLA-coated 2% loaded P(EAD-SA). The uncoated film of P(EAD-SA) released heparin for only 4 days. The localized delivery of heparin around the carotid artery was investigated by implanting polymer loaded with [3H]heparin around the carotid artery of rats and the heparin release and tissue distribution was monitored. The maximum heparin concentration in the artery exposed to the drug was on day 4 for the P(EAD-SA) uncoated device (fast releasing system) and day 11 for the coated devices. The control artery, the uncovered segments of the artery, and the surrounding tissue contained negligible amounts of radioactivity. These data confirm that heparin was delivered locally without systemic exposure. Two independent animal studies were conducted to evaluate the effectiveness of these heparin-releasing devices. In both studies the balloon catheter injury in a rat model was used. After inflicting an injury to the common carotid, a matrix oriented with its long axis along the artery was placed under the injured portion of the vessel. In both studies the treated rats showed a very thin layer of neointima where the control group showed a significant reduction of the artery internal diameter with SMC neointima ratio greater than 1.
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Affiliation(s)
- D Teomim
- Department of Medicinal Chemistry, School of Pharmacy-Faculty of Medicine, The Hebrew University of Jerusalem, 91120, Jerusalem, Israel
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Robbins KT, Fontanesi J, Wong FS, Vicario D, Seagren S, Kumar P, Weisman R, Pellitteri P, Thomas JR, Flick P, Palmer R, Weir A, Kerber C, Murry T, Ferguson R, Los G, Orloff L, Howell SB. A novel organ preservation protocol for advanced carcinoma of the larynx and pharynx. Arch Otolaryngol Head Neck Surg 1996; 122:853-7. [PMID: 8703389 DOI: 10.1001/archotol.1996.01890200043010] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To pilot a targeted chemoradiation protocol for patients with advanced carcinoma of the larynx and pharynx that would circumvent upper aerodigestive tract dysfunction related to major oncologic surgery. DESIGN Weekly intra-arterial infusions of supradose cisplatin (150 mg/m2 per week x 4) rapidly delivered to the tumor bulk, simultaneous intravenous sodium thiosulfate for systemic drug neutralization, and conventional external-beam irradiation (1.80-2.00 Gy per fraction x 35) were used. Between February 1991 and April 1994, 42 patients were treated who would otherwise have required a major resection of the tongue base, pharyngeal wall, or larynx. MAIN OUTCOME MEASURES Tumor response, toxic effects, disease control above the clavicle, preservation of the larynx, maintenance of oral nutrition, and overall and disease-related 2-year survival. RESULTS Three complications were related to the weekly transfemoral superselective intra-arterial procedures performed 160 times. Grade 3 to 4 chemotoxic effects were infrequent, occurring in 9 (5.5%) of 160 cycles, and only 1 patient required a radiotherapy break because of severe mucositis. A complete response in the primary site was obtained in 36 (86%) of 42 patients, 2 of whom had residual disease in the neck. Median follow-up was 13 months (range, 3-46 months). To date, there have been 5 recurrences: 2 regional and 3 distant. The 2-year overall and disease-related survival was 64% and 76%, respectively. The rate of disease control above the clavicle at 2 years was 86%. CONCLUSIONS We believe this chemoradiation protocol represents an effective management scheme for patients with advanced head and neck cancer while minimizing dysfunction and possibly improving survival.
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Affiliation(s)
- K T Robbins
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee School of Medicine, Memphis, USA
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Robbins KT, Vicario D, Seagren S, Weisman R, Pellitteri P, Kerber C, Orloff L, Los G, Howell SB. A targeted supradose cisplatin chemoradiation protocol for advanced head and neck cancer. Am J Surg 1994; 168:419-22. [PMID: 7977964 DOI: 10.1016/s0002-9610(05)80089-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hypothesizing that cisplatin (DDP) drug resistance is dose dependent and the radiosensitizing effect of DDP is clinically beneficial, we conducted a chemoradiation protocol using extremely high doses of DDP delivered intra-arterially (IA) to locally advanced head and neck tumors. PATIENTS AND METHODS Twenty-nine patients with untreated stage IV disease received 4 weekly infusions of 150 mg/m2, simultaneous systemic DDP neutralization with intravenous (IV) bolus sodium thiosulfate, and concomitant radiotherapy (180 to 200 cGy/day x 35 fractions). RESULTS The complete response rate of the 24 evaluable patients as determined with repeat biopsies was 23/24 (96%). Of the 29 patients evaluable for toxicity, central nervous system complications related to the infusion technique occurred with 2/110 infusions, both of which were reversible. The rate of grade III to IV chemotoxicity was 13%. The median length of follow-up was 22 months. There have been 6 recurrences: 1 local; 3 regional; and 2 at distant sites. The projected overall and disease-free 3-year survival was 88% and 53%, respectively. CONCLUSION We conclude that the combination of rapid selective delivery of supradose DDP/IV thiosulfate neutralization and concomitant radiotherapy can be safely and effectively applied to patients with advanced head and neck cancer. Preliminary survival analysis indicates that this approach may improve the prognosis for patients with an otherwise devastating disease.
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Affiliation(s)
- K T Robbins
- Department of Otolaryngology/Head and Neck Surgery, University of Tennessee, Memphis 38163
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Bifano J, Orloff L. Advances in documentation: the impact of service and empowerment. Top Health Inf Manage 1994; 14:43-7. [PMID: 10131591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Chart completion is a controversial issue in most health care facilities, impacting chart availability for both patient care and timely billing purposes. A collaborative approach empowering HIS and medical staff professionals yielded significantly better service for patients, physicians, and the billing department at The Milton S. Hershey Medical Center, Hershey, Pennsylvania. The result is the beginning of a trend in team empowerment that continues to improve patient care and financial performance.
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Affiliation(s)
- J Bifano
- Pennsylvania State University's Milton S. Hershey Medical Center, Hershey
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Eavey RD, Santos JI, Arriaga MA, Gliklich R, Odio C, Desmond MS, Villasenor A, Beltran S, Orloff L, Stool SE. An education model for otitis media care field-tested in Latin America. Otolaryngol Head Neck Surg 1993; 109:895-8. [PMID: 8247571 DOI: 10.1177/019459989310900519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The World Health Organization has designated the teaching of otitis media management skills a "priority" status. Effective treatment of ear disease requires that the physician be both informationally educated as well as physically trained to use otoscopy. Little is known about how well this education can be provided in a short time and in a foreign country. To more objectively assess teaching effect, results of an education session for rural Mexican pediatric primary-care providers who were given an intensive otitis media lecture and otoscopy skills workshop in 1990 were evaluated. To test immediate cognitive impact, an anonymous written examination was given both before and after the teaching session. Average test scores after the educational sessions improved 24% (p < 0.001) over baseline scores before the sessions. To evaluate long-term impact on clinical practice, a follow-up telephone survey 2 years later was conducted. The use of an otoscope to diagnose otitis media had increased from 40% to 93% of respondents. We conclude that pediatric primary-care providers in rural Mexico possess a baseline level of knowledge about otitis media that can be significantly enhanced with one educational session. Further, this teaching effort produces an impact on practice pattern that lasts at least 2 years.
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Affiliation(s)
- R D Eavey
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114
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