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Li M, Tang Q, Yang X, Yang Q, Zeng M, Zhang Y, Huang P, Yin D, Li S. Application of modified spiral tracheoplasty in thyroid carcinoma with trachea invasion: a retrospective analysis of 15 cases. World J Surg Oncol 2024; 22:264. [PMID: 39363373 PMCID: PMC11448305 DOI: 10.1186/s12957-024-03541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/21/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND To describe the indications, techniques and preliminary experience of modified spiral tracheoplasty in the reconstruction of large tracheal defect after thyroidectomy. METHODS The medical records of patients who underwent tracheal torsion to repair large tracheal defects after thyroid carcinoma surgery from January 2019 to January 2022 were retrospectively reviewed. The extent of tracheal defect, duration of tracheal reconstruction, postoperative complications and surgery results were analyzed. RESULTS The duration of tracheal reconstruction was 30-60 min. No postoperative bleeding, incision infection, tracheostomy stenosis occurred. Recurrent laryngeal nerve palsy occurred in 5 patients. All patients were followed up for 24 to 60 months. The 2-year overall survival rate was 100%, the 2-year local control rate of trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. CONCLUSION The modified spiral tracheoplasty is a safe and effective method to repair the large defect of trachea after thyroid carcinoma invading the trachea.
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Affiliation(s)
- Mengmeng Li
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Qinglai Tang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xinming Yang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Qian Yang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Miao Zeng
- Department of Operating Room, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yuming Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Peiying Huang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Danhui Yin
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Shisheng Li
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Sessa L, De Crea C, Voloudakis N, Pennestrì F, Raffaelli M. ASO Author Reflections: Advanced Thyroid Cancers: Individualized Treatments in the Era of the Standard Surgical Approaches. Ann Surg Oncol 2024; 31:5539-5540. [PMID: 38767801 DOI: 10.1245/s10434-024-15462-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Luca Sessa
- Division of Endocrine and Obesity Surgery, Fondazione Istituto G. Giglio, Cefalù, PA, Italy
| | - Carmela De Crea
- Division of Endocrine Surgery, Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Francesco Pennestrì
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Marco Raffaelli
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy.
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3
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Sessa L, De Crea C, Voloudakis N, Pennestri' F, Revelli L, Gallucci P, Perotti G, Tagliaferri L, Rossi E, Rossi ED, Pontecorvi A, Bellantone R, Raffaelli M. Single Institution Experience in the Management of Locally Advanced (pT4) Differentiated Thyroid Carcinomas. Ann Surg Oncol 2024; 31:5515-5524. [PMID: 38700801 PMCID: PMC11300486 DOI: 10.1245/s10434-024-15356-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/09/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Locally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of patients with T4 DTC who underwent multidisciplinary evaluation and treatment is reported. The main study endpoints were the oncologic outcome, complication rates, and risk factors for tumor recurrence. PATIENTS AND METHODS All DTC cases operated between 2009 and 2021 were reviewed and T4 DTC cases were identified. En bloc resection of inferior laryngeal nerve (ILN), tracheal, and/or internal jugular vein (IJV) was performed in cases of massive infiltration. In cases of pharyngoesophageal junction (PEJ) invasion, the shaving technique was always applied. RESULTS Among 4775 DTC cases, 60 were T4. ILN infiltration was documented in 45 cases (en bloc resection in 9), tracheal infiltration in 14 (tracheal resection in 2), PEJ invasion in 11 (R0 resection in 7 cases and < 1 cm residual tissue in 4 cases), IJV resection in 6, and laryngeal in 2. In total, 11 postoperative ILN palsy, 23 transient hypoparathyroidisms, and 2 hematomas requiring reoperation were registered. Final histology showed 7 pN0, 22 pN1a, and 31 pN1b tumors. Aggressive variants were observed in 47 patients. All but 1 patient underwent radioiodine treatment, 12 underwent adjuvant external beam radiation therapy (EBRT), and 2 underwent chemotherapy. At a median follow-up of 58 months, no tumor-related death was registered, and seven patients required reoperation for recurrence. Tracheal invasion was the only significant factor negatively impacting recurrence (p = 0.045). CONCLUSIONS A multidisciplinary approach is essential for the management of T4 DTC. Individualized and balanced surgical strategy and adjuvant treatments, in particular EBRT, ensure control of locally advanced disease with acceptable morbidity.
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Affiliation(s)
- Luca Sessa
- Division of Endocrine and Obesity Surgery, Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Carmela De Crea
- Division of Endocrine Surgery, Fatebenefratelli Isola Tiberina - Gemelli Isola, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Francesco Pennestri'
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Luca Revelli
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Pierpaolo Gallucci
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Germano Perotti
- Division of Nuclear Medicine, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Ernesto Rossi
- Department of Medical Oncology, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Endocrinology, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Rocco Bellantone
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Marco Raffaelli
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy.
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Raffaelli M, Voloudakis N, Barczynski M, Brauckhoff K, Durante C, Gomez-Ramirez J, Koutelidakis I, Lorenz K, Makay O, Materazzi G, Pandev R, Randolph GW, Tolley N, Vriens M, Musholt T. European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. Br J Surg 2024; 111:znae199. [PMID: 39158073 PMCID: PMC11331340 DOI: 10.1093/bjs/znae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità (CREO), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joaquin Gomez-Ramirez
- Endocrine Surgery Unit, General Surgery Department, Hospital Universitario La Paz, IdiPaz Madrid, Madrid, Spain
| | - Ioannis Koutelidakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ozer Makay
- Centre for Endocrine Surgery, Ozel Saglik Hospital, Izmir, Turkey
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Rumen Pandev
- Department of General Surgery, University Hospital St Marina, Medical University Pleven, Pleven, Bulgaria
| | - Gregory W Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Tolley
- Endocrine Surgery Service, Imperial College NHS Healthcare Trust, London, UK
| | - Menno Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thomas Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Mainz, Germany
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5
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Bapat N, Ferraro T, Esper L, Joshi AS, Haroun F, Baldwin CK. Treatment of Unresectable BRAF V600E, TERT-Mutated Differentiated Papillary Thyroid Cancer With Dabrafenib and Trametinib. JCEM CASE REPORTS 2024; 2:luae112. [PMID: 39081697 PMCID: PMC11288368 DOI: 10.1210/jcemcr/luae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Indexed: 08/02/2024]
Abstract
Complete surgical resection of differentiated papillary thyroid cancer (PTC) is associated with an excellent prognosis. However, for locally invasive PTC, disease-specific morbidity and mortality increases when microscopic margin negative resection (R0) or complete macroscopic resection (R1) is not feasible. Neoadjuvant dabrafenib and trametinib (DT) used in BRAF V600E-positive, unresectable anaplastic thyroid cancer has allowed for R0 or R1 resection and improved survival rates. We demonstrate feasibility of using neoadjuvant DT in a patient with BRAF V600E and TERT-mutated PTC for whom R0/R1 resection was initially aborted due to predicted unacceptable morbidity. The patient was treated with neoadjuvant DT for 5 months, at which time disease was undetectable on imaging with near resolution on final pathology; however, subsequent rapid recurrence after discontinuation of neoadjuvant DT occurred. Neoadjuvant DT offers promise in future cohorts of patients with locally invasive BRAF V600E and TERT-mutated PTC for whom neoadjuvant therapy can reduce surgical morbidity while still allowing for R0/R1 resection.
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Affiliation(s)
- Neha Bapat
- Department of Endocrinology, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA
| | - Tatiana Ferraro
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA
| | - Layal Esper
- Department of Endocrinology, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA
| | - Arjun S Joshi
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA
| | - Faysal Haroun
- Division of Hematology and Oncology, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA
| | - Chelsey K Baldwin
- Department of Endocrinology, The George Washington University School of Medicine & Health Sciences, Washington, DC 20037, USA
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Tao Z, Deng X, Ding Z, Guo B, Fan Y. Improved survival after primary tumor resection in distant metastasis medullary thyroid carcinoma: a population-based cohort study with propensity score matching. Sci Rep 2024; 14:17260. [PMID: 39068197 PMCID: PMC11283511 DOI: 10.1038/s41598-024-68458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024] Open
Abstract
Few studies have investigated the impact of primary tumor resection (PTR) on patients with distant metastasis medullary thyroid carcinoma (DMMTC). This population-based study aims to assess the application of PTR in DMMTC patients, ascertain its benefits, and identify optimal surgical indications. DMMTC Patients diagnosed between 2010 and 2020 were included through the Surveillance, Epidemiology, and End Results (SEER) program. Logistic regression analysis identified driving factors of surgical decision-making. Propensity score matching (PSM), Kaplan-Meier method, and Cox regression were utilized to compare overall survival (OS) and disease-specific survival (DSS) between surgical and non-surgical groups. Subgroup analyses were performed to determine optimal surgical indications. Of 238 DMMTC patients included, 122 (51.3%) patients underwent PTR. Extrathyroidal extension and N1 stage emerged as independent factors promoting the surgical decision. PSM-adjusted survival analyses revealed significant advantages in both OS and DSS for the surgical group. Moreover, subgroup analyses indicated that except for patients aged ≥ 65 years, tumors ≤ 20 mm, or with multiple metastasized sites (> 1), the others significantly benefit from PTR. PTR significantly improves prognosis in selected DMMTC patients. The decision to undergo PTR in other patients should be based on a comprehensive assessment of the disease, surgeon's experience, and family discussions for potential survival benefits.
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Affiliation(s)
- Zixia Tao
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Xianzhao Deng
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Zheng Ding
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Bomin Guo
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Youben Fan
- Department of General Surgery, Thyroid and Parathyroid Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
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Qian K, Wang Y, An N, Liu C, Guo K, Yang L, Wang J, Li X, Wang Z. Effect and Safety of Apatinib as Neoadjuvant Therapy in Locally Advanced Differentiated Thyroid Cancer: A Phase 2 Trial. J Endocr Soc 2024; 8:bvae132. [PMID: 39071474 PMCID: PMC11273224 DOI: 10.1210/jendso/bvae132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Indexed: 07/30/2024] Open
Abstract
Context Presently, there is a paucity of prospective clinical trials investigating neoadjuvant therapy for locally advanced thyroid cancer. Objective This study was a multicenter, open-label, single-arm, phase II trial evaluating the efficacy and safety of apatinib as neoadjuvant therapy in patients with local advanced differentiated thyroid cancer (DTC). Methods Patients were treated with preoperative apatinib over a course of 2 to 4 cycles, culminating in surgical resection. The primary endpoints were objective response rate (ORR) and disease control rate (DCR); the secondary endpoints were the rate of R0 surgery, alterations in serum thyroglobulin levels, disease-free survival, and adverse events (AEs). Results A total of 14 patients who met the inclusion criteria were administered neoadjuvant apatinib. Among these, 13 patients underwent surgical procedures following apatinib treatment and were enrolled in the ITT population. The ORR was 53.8% and the DCR was 100%. Of the patients, 84.6% received R0 surgery, while the remaining 15.4% underwent R1 resection. Predominant among the observed AEs were hypertension, hand-foot syndrome, hepatic dysfunction, proteinuria, and hypothyroidism, with no instances of grade 4 or 5 AEs reported. Subsequent to surgery, patients were followed up for a median period of 34 months, during which disease progression occurred in 5 individuals (35.7%), encompassing 3 cases of locoregional recurrences and 2 cases of distant metastases. Conclusion Apatinib may be an effective agent in the use of neoadjuvant therapy for locally advanced DTC. Patients may therefore benefit from surgical outcomes and their long-term prognosis.
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Affiliation(s)
- Kai Qian
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
| | - Yunjun Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ning An
- Department of Head and Neck Surgery, Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Chunhao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Kai Guo
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
| | - Lingyi Yang
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
| | - Jun Wang
- Department of Head and Neck Surgery, Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhuoying Wang
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
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8
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Zhu F, Shen Y, Zhu L, Chen L, Li F, Xie X, Wu Y. The Effect of Hemithyroidectomy in Papillary Thyroid Carcinoma with an Exclusive Involvement of the Recurrent Laryngeal Nerve: A Retrospective Study with a Propensity Score-Matched Analysis. Curr Oncol 2024; 31:3603-3614. [PMID: 38920748 PMCID: PMC11203164 DOI: 10.3390/curroncol31060265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Involvement of the recurrent laryngeal nerve (RLN) in papillary thyroid carcinoma (PTC) is an important prognostic factor and is associated with a higher risk of recurrence. This study aimed to retrospectively analyze the outcomes of patients treated with hemithyroidectomy (HT) in PTC patients with an exclusive RLN invasion who could not tolerate staged surgery, did not wish to undergo another operation, or had other reasons. METHODS A retrospective review was conducted on 163 patients with PTC and exclusive RLN involvement at our institution between 2013 and 2019. Patients were divided into a total thyroidectomy (TT) group and HT group. The clinicopathologic factors and prognostic outcomes were compared between the two groups. A propensity score-matched analysis was carried out to reduce selection bias, with the following covariates: gender, age, tumor size, multifocality, central lymph node metastasis (CLNM), and RLN resection. The Kaplan-Meier method was used for a comparison of recurrence outcomes. RESULTS In the baseline data of the 163 PTC patients, tumor size (p < 0.001), multifocality (p = 0.011), CLNM (p < 0.001), and RLN resection (p < 0.008) in the TT and HT groups differed significantly, whereas age and gender did not differ between the two groups. The TT group reported significantly higher temporary and permanent hypoparathyroidism than the HT group (p < 0.001 and p = 0.042, respectively). With 72-month median follow-up, 11 (6.7%) patients developed recurrence. After propensity score matching, 24 patients with HT and 43 patients with TT were included. Recurrence-free survival (RFS) in the matched samples showed no difference between the TT and HT groups (p = 0.092). CONCLUSION Our results indicate that HT may be a feasible treatment for PTC patients with exclusive RLN involvement in specific circumstances without significantly increasing the risk of recurrence. Performing a thorough preoperative examination is crucial to exclude multifocal tumors and lymph node metastasis before undergoing HT.
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Affiliation(s)
| | | | | | | | | | | | - Yijun Wu
- The Department of Thyroid Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China; (F.Z.); (Y.S.); (L.Z.); (L.C.); (F.L.); (X.X.)
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9
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Chen CS, Luo SD, Chang YH, Chou CK, Chi SY, Wu SC, Chen YH, Yang JCS, Huang EY, Wang YM, Lin WC. Salvage radiofrequency ablation followed by external beam radiotherapy for inoperable recurrent differentiated thyroid cancer. Int J Hyperthermia 2024; 41:2358054. [PMID: 38816274 DOI: 10.1080/02656736.2024.2358054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/16/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE The treatment of recurrent thyroid cancer with critical organ invasion is challenging. The combination of radiofrequency ablation (RFA) and external beam radiation therapy (EBRT) has been proposed as an effective option. This study evaluates outcomes for inoperable residual/recurrent differentiated thyroid cancer (rDTC) patients treated with RFA followed by EBRT. MATERIALS AND METHODS Patients with rDTC treated with RFA followed by EBRT were retrospectively studied. RFA was performed using a free-hand, 'moving-shot' technique under US or CT guidance. For lesions invading critical structures intolerant to 'en bloc' high-temperature RFA, limited-field EBRT using 6- or 10-MV photons was used for adjuvant treatment at a dose of 66 Gy in 33 daily fractions. Toxicities and outcomes were reviewed. RESULTS Between April 2020 and January 2022, 11 patients with 14 rDTC lesions underwent RFA followed by EBRT. Five patients had metastatic lesions at rDTC diagnosis. With a median follow-up period of 33.7 months, all patients maintained locoregional control, while achieving a 2-year survival rate of 90.9%. This combined treatment achieved a volume reduction ratio of 92.1% ± 5.1%. The mean nadir thyroglobulin level in patients without initial distant metastases after treatment was 1.40 ± 0.81 ng/ml. Regarding treatment-related complications, one patient (9%) experienced temporary hoarseness after RFA, grade 2 radiation dermatitis occurred in 3 patients (27.2%), and grade 2 dysphagia was noted in 4 patients (36.4%). No grade 3 or greater toxicities occurred. CONCLUSIONS Salvage RFA followed by EBRT is feasible, effective and safe for patients with rDTC.
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Affiliation(s)
- Chung-Shih Chen
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hao Chen
- Division of Hemotology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Johnson Chia-Shen Yang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Che Lin
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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10
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Zhu F, Shen Y, Zhu L, Chen L, Li F, Xie X, Wu Y. Impact of thyroid carcinoma invasion of recurrent laryngeal nerve on cervical lymph node metastasis. Endocrine 2024:10.1007/s12020-024-03879-0. [PMID: 38767775 DOI: 10.1007/s12020-024-03879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) has a favorable prognosis. However, involvement of the recurrent laryngeal nerve (RLN) significantly increases the risk of recurrence. RLN invasion was an important factor in determining the extent of thyroid surgery. The purpose of this study was to compare clinicopathologic features and characterize risk factors of central and lateral lymph node metastasis (LLNM) of RLN invasion in patients with PTC. METHODS A retrospective review was conducted of 130 patients with PTCs who had exclusive tumor involvement of the RLN at our institution between January 2014 and February 2019. All patients underwent total thyroidectomy and high-dose radioactive iodine (RAI) therapy. The clinicopathologic factors and prognostic outcomes of the patients with solitary and multiple RLN involvements were compared. Kaplan-Meier method was performed to compare the outcomes of tumor recurrence. Univariate and multivariate logistic regression analyses were used to identify risk factors associated with LLNM. RESULTS The invasion of the RLN was similar on both sides, with 58.5% on the right, 40.0% on the left, and 1.5% on both sides. Significant differences were observed in tumor size (p < 0.001), lymph node metastasis classification (p = 0.002), RLN resection (p < 0.001), and thyroglobulin (p = 0.010) in the solitary and multiple groups. During the median follow-up of 67 months, 9 (6.9%) patients developed recurrence. There were no statistical differences in recurrence for age, tumor size, gender, multifocality, lymph node metastasis (LNM), and RLN resection. According to receiver operating characteristic (ROC) curve analyses, a cut-off of tumor size > 1.7 cm was identified as the most sensitive and specific predictor of RLN with multiple involvements or LNM invasion. Univariate and multivariate analyses revealed that central lymph node metastasis (CLNM) and RLN invasion by LNM can serve as independent risk factors for LLNM (p = 0.006 and p < 0.001, respectively). CONCLUSION Our results indicate that recurrence was comparable in patients with solitary and multiple RLN involvements. Multiple RLN involvement was associated with pathological features such as larger tumors, RLN resection, and LLNM. The presence of LNM invading RLN and multiple nerve involvement increases the risk of intraoperative RLN resection. A higher risk of multiple invasion or LNM invasion should be considered when tumor size > 1.7 cm. The presence of CLNM and RLN invaded by LNM were independent predictors for LLNM, which could aid surgeons in deciding on lateral lymph node dissection.
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Affiliation(s)
- Feng Zhu
- The Department of Thyroid Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - YiBin Shen
- The Department of Thyroid Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - LiXian Zhu
- The Department of Thyroid Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - LinHui Chen
- The Department of Thyroid Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - FuQiang Li
- The Department of Thyroid Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - XiaoJun Xie
- The Department of Thyroid Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - YiJun Wu
- The Department of Thyroid Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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11
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Chakrabarty N, Mahajan A, Basu S, D’Cruz AK. Comprehensive Review of the Imaging Recommendations for Diagnosis, Staging, and Management of Thyroid Carcinoma. J Clin Med 2024; 13:2904. [PMID: 38792444 PMCID: PMC11122658 DOI: 10.3390/jcm13102904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Thyroid cancer is the most common head and neck cancer (HNC) in the world. In this article, we comprehensively cover baseline, posttreatment, and follow-up imaging recommendations for thyroid carcinomas along with the eighth edition of the tumor, node, metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). We include characterization and risk stratification of thyroid nodules on ultrasound (US) proposed by various international bodies. Management guidelines (depending upon the type of thyroid carcinoma) based on the international consensus recommendations (mainly by the American Thyroid Association) are also extensively covered in this article, including the role of a radioiodine scan. The management of recurrent disease is also briefly elucidated in this article. In addition, we cover the risk factors and etiopathogenesis of thyroid carcinoma along with the non-imaging diagnostic workup essential for thyroid carcinoma management, including the significance of genetic mutations. US is the diagnostic imaging modality of choice, with US-guided fine needle aspiration (FNA) being the procedure of choice for tissue diagnosis. The roles of computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) in thyroid carcinoma staging are also specified. Through this article, we aim to provide a comprehensive reference guide for the radiologists and the clinicians in the pursuit of optimal care for patients with thyroid carcinoma.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Anil K. D’Cruz
- Apollo Hospitals, Navi Mumbai 400614, Maharashtra, India;
- Foundation of Head Neck Oncology, Mumbai 400012, Maharashtra, India
- Union International Cancer Control (UICC), 1202 Geneva, Switzerland
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12
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Velayutham P, Thiagarajan S, Dhar H, Chidambaranathan N, Vaidya A, Teja K. A Nationwide Survey to Assess the Practices and Patterns of Use of Intraoperative Nerve Monitoring During Thyroid Surgery Among Surgeons in India. Indian J Surg Oncol 2024; 15:18-24. [PMID: 38511027 PMCID: PMC10948657 DOI: 10.1007/s13193-023-01818-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/06/2023] [Indexed: 03/22/2024] Open
Abstract
There is still equipoise for the routine use of intraoperative nerve monitoring (IONM) for thyroid surgeries; however, some surgeons tend to use it for various reasons. In our study, we did a national survey to assess the patterns and practice of the use of IONM among surgeons during thyroid surgery in India. A questionnaire survey was sent to surgeons (head and neck surgical oncologists, general surgical oncologists, endocrine surgeons and otolaryngologists) in different zones in India via email, and their responses were analysed. One hundred and one responses were received. The majority of the respondents were head and neck surgical oncologists (n = 56, 55.4%). Forty-three (42.6%) respondents used IONM during thyroid surgeries in this survey. Surgeons with ≤ 15 years of experience performing thyroid surgeries (p = 0.02) and surgeons performing > 50 thyroid surgeries also tended to use IONM. Mostly IONM was used for surgeries on thyroid malignancies (p = 0.016). The respondents used IONM for more than one reason such as medicolegal purposes and surgeon comfort among others. IONM was most often used during redo surgeries (n = 46, 45.5%) and in patients with already one fixed cord (n = 39, 38.6%). The majority felt IONM was not cost-effective (n = 53, 52.5%). The use of IONM during thyroid surgery in our survey was nearly 43%. It was used mostly for surgery for thyroid malignancies, and it was found to be used for more than one reason and indications such as redo surgeries (most commonly). Supplementary Information The online version contains supplementary material available at 10.1007/s13193-023-01818-5.
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Affiliation(s)
- Parthiban Velayutham
- Department of Neurosurgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra India
| | - Shivakumar Thiagarajan
- Department of Head & Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra 400012 India
| | - Harsh Dhar
- Medica Super Speciality Hospital, Kolkata, Mumbai, India
| | | | - Abhishek Vaidya
- National Cancer Institute, Nagpur, Maharashtra India
- NKPSIMS, Nagpur, Maharashtra India
| | - Kantamani Teja
- Department of Head & Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra 400012 India
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13
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Huang NS, Li Q, Gao XY, Xiang SY, Ji QH, Xiang J, Wang YL, Wei WJ, Chen JY, Yu Q, Cao YM, Guan Q, Gu YJ, Wang Y. Using a CT-based scale to evaluate disease extension and the resectability of locally advanced thyroid cancer. Eur Radiol 2023; 33:9063-9073. [PMID: 37439940 DOI: 10.1007/s00330-023-09799-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES To establish a computed tomography (CT)-based scale to evaluate the resectability of locally advanced thyroid cancer. METHODS This twin-centre retrospective study included 95 locally advanced thyroid cancer patients from the 1st centre as the training cohort and 31 patients from the 2nd centre as the testing cohort, who were categorised into the resectable and unresectable groups. Three radiologists scored the CT scans of each patient by evaluating the extension to the recurrent laryngeal nerve (RLN), trachea, oesophagus, artery, vein, soft tissue, and larynx. A 14-score scale (including all comprised structures) and a 12-score scale (excluding larynx) were developed. Receiver-operating characteristic (ROC) analysis was used to evaluate the performance of the scales. Stratified fivefold cross-validation and external verification were used to validate the scale. RESULTS In the training cohort, compromised RLN (p < 0.001), trachea (p = 0.001), oesophagus (p = 0.002), artery (p < 0.001), vein (p = 0.005), and soft tissue (p < 0.001) were predictors for unresectability, while compromised larynx (p = 0.283) was not. The 12-score scale (AUC = 0.882, 95%CI: 0.812-0.952) was not inferior to the 14-score scale (AUC = 0.891, 95%CI: 0.823-0.960). In subgroup analysis, the AUCs of the 12-score scale were 0.826 for treatment-naïve patients and 0.976 for patients with prior surgery. The 12-score scale was further validated with a fivefold cross-validation analysis, with an overall accuracy of 78.9-89.4%. Finally, external validation using the testing cohort showed an AUC of 0.875. CONCLUSIONS The researchers built a CT-based 12-score scale to evaluate the resectability of locally advanced thyroid cancer. Validation with a larger sample size is required to confirm the efficacy of the scale. CLINICAL RELEVANCE STATEMENT This 12-score CT scale would help clinicians evaluate the resectability of locally advanced thyroid cancer. KEY POINTS • The researchers built a 12-score CT scale (including recurrent laryngeal nerve, trachea, oesophagus, artery, vein, and soft tissue) to evaluate the resectability of locally advanced thyroid cancer. • This scale has the potential to help clinicians make treatment plans for locally advanced thyroid cancer.
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Affiliation(s)
- Nai-Si Huang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiao Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
| | - Xin-Yi Gao
- Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China
| | - Shi-Yu Xiang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Jun Xiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Long Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Jun Wei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jia-Ying Chen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing Yu
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China
- Department of Thyroid Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Key Laboratory of Head & Neck Cancer, Translational Research of Zhejiang Province, Hangzhou, China
| | - Yi-Ming Cao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing Guan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Jia Gu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China.
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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14
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Saxton AT, Scheri RP. Resection of Papillary Thyroid Carcinoma Involving a Functioning Recurrent Laryngeal Nerve: Pushing Boundaries to Preserve Nerve Function. Ann Surg Oncol 2023; 30:6960-6962. [PMID: 37713120 DOI: 10.1245/s10434-023-14287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Anthony T Saxton
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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15
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Qi Q, Huang X, Zhang Y, Cai S, Liu Z, Qiu T, Cui Z, Zhou A, Yuan X, Zhu W, Min X, Wu Y, Wang W, Zhang C, Xu P. Ultrasound image-based deep learning to assist in diagnosing gross extrathyroidal extension thyroid cancer: a retrospective multicenter study. EClinicalMedicine 2023; 58:101905. [PMID: 37007735 PMCID: PMC10050776 DOI: 10.1016/j.eclinm.2023.101905] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Background The presence of gross extrathyroidal extension (ETE) in thyroid cancer will affect the prognosis of patients, but imaging examination cannot provide a reliable diagnosis for it. This study was conducted to develop a deep learning (DL) model for localization and evaluation of thyroid cancer nodules in ultrasound images before surgery for the presence of gross ETE. Methods From January 2016 to December 2021 grayscale ultrasound images of 806 thyroid cancer nodules (4451 images) from 4 medical centers were retrospectively analyzed, including 517 no gross ETE nodules and 289 gross ETE nodules. 283 no gross ETE nodules and 158 gross ETE nodules were randomly selected from the internal dataset to form a training set and validation set (2914 images), and a multitask DL model was constructed for diagnosing gross ETE. In addition, the clinical model and the clinical and DL combined model were constructed. In the internal test set [974 images (139 no gross ETE nodules and 83 gross ETE nodules)] and the external test set [563 images (95 no gross ETE nodules and 48 gross ETE nodules)], the diagnostic performance of DL model was verified based on the pathological results. And then, compared the results with the diagnosis by 2 senior and 2 junior radiologists. Findings In the internal test set, DL model demonstrated the highest AUC (0.91; 95% CI: 0.87, 0.96), which was significantly higher than that of two senior radiologists [(AUC, 0.78; 95% CI: 0.71, 0.85; P < 0.001) and (AUC, 0.76; 95% CI: 0.70, 0.83; P < 0.001)] and two juniors radiologists [(AUC, 0.65; 95% CI: 0.58, 0.73; P < 0.001) and (AUC, 0.69; 95% CI: 0.62, 0.77; P < 0.001)]. DL model was significantly higher than clinical model [(AUC, 0.84; 95% CI: 0.79, 0.89; P = 0.019)], but there was no significant difference between DL model and clinical and DL combined model [(AUC, 0.94; 95% CI: 0.91, 0.97; P = 0.143)]. In the external test set, DL model also demonstrated the highest AUC (0.88, 95% CI: 0.81, 0.94), which was significantly higher than that of one of senior radiologists [(AUC, 0.75; 95% CI: 0.66, 0.84; P = 0.008) and (AUC, 0.81; 95% CI: 0.72, 0.89; P = 0.152)] and two junior radiologists [(AUC, 0.72; 95% CI: 0.62, 0.81; P = 0.002) and (AUC, 0.67; 95 CI: 0.57, 0.77; P < 0.001]. There was no significant difference between DL model and clinical model [(AUC, 0.85; 95% CI: 0.79, 0.91; P = 0.516)] and clinical + DL model [(AUC, 0.92; 95% CI: 0.87, 0.96; P = 0.093)]. Using DL model, the diagnostic ability of two junior radiologists was significantly improved. Interpretation The DL model based on ultrasound imaging is a simple and helpful tool for preoperative diagnosis of gross ETE thyroid cancer, and its diagnostic performance is equivalent to or even better than that of senior radiologists. Funding Jiangxi Provincial Natural Science Foundation (20224BAB216079), the Key Research and Development Program of Jiangxi Province (20181BBG70031), and the Interdisciplinary Innovation Fund of Natural Science, Nanchang University (9167-28220007-YB2110).
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Affiliation(s)
- Qi Qi
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xingzhi Huang
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yan Zhang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Shuangting Cai
- Ultrasound Department, Jiujiang First People's Hospital, Jiujiang, Jiangxi, China
| | - Zhaoyou Liu
- Ultrasound Department, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Taorong Qiu
- School of Information Engineering, Nanchang University, Nanchang, Jiangxi, China
| | - Zihan Cui
- School of Information Engineering, Nanchang University, Nanchang, Jiangxi, China
| | - Aiyun Zhou
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xinchun Yuan
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wan Zhu
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiang Min
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yue Wu
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weijia Wang
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Corresponding author.
| | - Pan Xu
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Corresponding author.
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16
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Abiri A, Pang JC, Roman K, Goshtasbi K, Birkenbeuel JL, Kuan EC, Tjoa T, Haidar YM. Facility Volume as a Prognosticator of Survival in Locally Advanced Papillary Thyroid Cancer. Laryngoscope 2023; 133:443-450. [PMID: 35822421 PMCID: PMC9837308 DOI: 10.1002/lary.30280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/26/2022] [Accepted: 06/13/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the influence of facility case-volume on survival in patients with locally advanced papillary thyroid cancer (PTC), and to identify prognostic case-volume thresholds for facilities managing this patient population. STUDY DESIGN Retrospective database study. METHODS The 2004-2017 National Cancer Database was queried for patients receiving definitive surgery for locally advanced PTC. Using K-means clustering and multivariable Cox proportional-hazards (CPH) regression, two groups with distinct spectrums of facility case-volumes were generated. Multivariable CPH regression and Kaplan-Meier analysis assessed for the influence of facility case-volume and the prognostic value of its stratification on overall survival (OS). RESULTS Of 48,899 patients treated at 1304 facilities, there were 34,312 (70.2%) females and the mean age was 48.0 ± 16.0 years. Increased facility volume was significantly associated with reduced all-cause mortality (HR 0.996; 95% CI, 0.992-0.999; p = 0.008). Five facility clusters were generated, from which two distinct cohorts were identified: low (LVF; <27 cases/year) and high (HVF; ≥27 cases/year) facility case-volume. Patients at HVFs were associated with reduced mortality compared to those at LVFs (HR 0.791; 95% CI, 0.678-0.923, p = 0.003). Kaplan-Meier analysis of propensity score-matched N0 and N1 patients demonstrated higher OS in HVF cohorts (all p < 0.001). CONCLUSIONS Facility case-volume was an independent predictor of improved OS in locally advanced PTC, indicating a possible survival benefit at high-volume medical centers. Specifically, independent of a number of sociodemographic and clinical factors, facilities that treated ≥27 cases per year were associated with increased OS. Patients with locally advanced PTC may, therefore, benefit from referrals to higher-volume facilities. LEVEL OF EVIDENCE 4 Laryngoscope, 133:443-450, 2023.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Kelsey Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
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17
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Chen J, Zhong Q, Hou L, Ma H, Shi Q, Feng L, He S, Lin Y, Lian M, Shen X, Wang R, Fang J. Preoperative voice analysis and survival outcomes in papillary thyroid cancer with recurrent laryngeal nerve invasion. Front Endocrinol (Lausanne) 2022; 13:1041538. [PMID: 36387905 PMCID: PMC9646574 DOI: 10.3389/fendo.2022.1041538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the clinicopathological characteristics of papillary thyroid cancer (PTC) and identify risk factors for postoperative recurrence of PTC with recurrent laryngeal nerve (RLN) involvement. Methods In total, 171 patients (112 women and 59 men, age: 18-80 years, and 65 patients aged ≥ 55) with T4a PTC with RLN involvement, treated at Beijing Tongren Hospital, Capital Medical University, from January 2006 to December 2020, were retrospectively examined. Clinicopathological characteristics, including voice analysis results, and survival outcomes were assessed. The Mann-Whitney U and Kruskal-Wallis H tests were used to analyze differences in acoustic parameters. The Kaplan-Meier method was used to calculate the overall survival (OS) and recurrence-free (RFS) rates. Univariate and multivariate Cox regression analyses were performed of the clinical data. Results The postoperative follow-up period ranged from 12 to 196 months (mean: 66.18 months). Of the 171 patients, 16 had recurrence and 8 died of thyroid-related diseases. The 5-year OS rate was 95.22%. The 5-year RFS rate was 89.38%. Jitter and shimmer were higher and maximum phonation time was shorter in patients with preoperative vocal cord paralysis (VCP) than in those without RLN involvement, and in those with RLN involvement but without preoperative VCP. Acoustic parameters were similar in patients with no preoperative VCP and those without RLN involvement. Voice analysis results did not differ between cases with RLN adhesion and RLN invasion. Univariate analysis showed that age at onset ≥ 55 years, preoperative RLN palsy, and esophageal invasion were risk factors for postoperative recurrence of PTC with RLN involvement. Multivariate analysis showed that onset age ≥ 55 years (OR 4.52, 95% confidence interval: 1.44-14.19, P = 0.010) was an independent risk factor for recurrence. Conclusions PTC patients with RLN invasion can achieve good outcomes. Preoperative voice analysis may offer insights into RLN function. Age of onset ≥ 55 years is an independent risk factor for postoperative recurrence in T4a PTC patients.
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Affiliation(s)
- Jiaming Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Zhong
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lizhen Hou
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongzhi Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qian Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ling Feng
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shizhi He
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yansong Lin
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Meng Lian
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xixi Shen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jugao Fang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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18
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Bulfamante AM, Lori E, Bellini MI, Bolis E, Lozza P, Castellani L, Saibene AM, Pipolo C, Fuccillo E, Rosso C, Felisati G, De Pasquale L. Advanced Differentiated Thyroid Cancer: A Complex Condition Needing a Tailored Approach. Front Oncol 2022; 12:954759. [PMID: 35875142 PMCID: PMC9300941 DOI: 10.3389/fonc.2022.954759] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Differentiated thyroid cancers (DTCs) are slow-growing malignant tumours, including papillary and follicular carcinomas. Overall, prognosis is good, although it tends to worsen when local invasion occurs with bulky cervical nodes, or in the case of distant metastases. Surgery represents the main treatment for DTCs. However, radical excision is challenging and significant morbidity and functional loss can follow the treatment of the more advanced forms. Literature on advanced thyroid tumours, both differentiated and undifferentiated, does not provide clear and specific guidelines. This emerges the need for a tailored and multidisciplinary approach. In the present study, we report our single-centre experience of 111 advanced (local, regional, and distant) DTCs, investigating the rate of radical excision, peri-procedural and post-procedural complications, quality of life, persistence, recurrence rates, and survival rates. Results are critically appraised and compared to the existing published evidence review.
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Affiliation(s)
- Antonio Mario Bulfamante
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eleonora Lori
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Eleonora Lori,
| | | | | | - Paolo Lozza
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Castellani
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Emanuela Fuccillo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Cecilia Rosso
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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19
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Dahan A, Al Ghuzlan A, Chehab R, Guerlain J, Breuskin I, Garcia C, Lamartina L, Hadoux J, Baudin E, Hartl DM. Pathological Analysis of Encased Resected Recurrent Nerves in Locally Invasive Thyroid Cancer. Cancers (Basel) 2022; 14:cancers14122961. [PMID: 35740626 PMCID: PMC9221102 DOI: 10.3390/cancers14122961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Thyroid cancer encasing the recurrent nerve is rare, and the decision to resect or preserve the nerve is multifactorial. The aim of this retrospective study was to evaluate the rate of actual invasion of the nerve beyond the nerve sheath in cancers encasing the nerve. Fifty-two patients were included: 7 cases of medullary thyroid carcinoma, 8 papillary thyroid carcinomas in children and 37 follicular derived cancers in adults. Tumor-related vocal fold paralysis was present in 30% of cases. The nerve was invaded in 82% of follicular cell-derived tumors, 88% of pediatric cases, and 100% of medullary carcinomas. Only agressive histology was a risk factor for nerve invasion. Vocal fold paralysis was not predictive. To our knowledge, this is one of the largest series with pathologic analysis of resected recurrent nerves, showing a high rate of nerve invasion in these rare cases of cancer encasing the reucrrent nerve. Abstract Objective: Thyroid cancer encasing the recurrent nerve is rare, and the decision to resect or preserve the nerve is multifactorial. The objective of this study was to histopathologically analyze resected encased nerves to assess the rate of nerve invasion and risk factors. Materials and Methods: A retrospective study was carried out on consecutive patients with resection of the recurrent nerve for primary or recurrent follicular cell-derived or medullary thyroid carcinoma from 2005 to 2020. Demographics, pathology, locoregional invasion, metastases, recurrences and survival were analyzed. Slides were reviewed blindly by two specialized pathologists (AAG, RC) for diagnosis of invasion deep to the epineurium. Results: Fifty-two patients were included: 25 females; average age, 55 (range 8–87). In total, 87% percent (45/52) were follicular cell-derived with 17/45 (37.8%) aggressive variants; 13% (7/52) were medullary carcinoma. Preoperative vocal fold (VF) paralysis was present in 16/52 (30.7%). Pathologically, the nerve was invaded in 44/52 cases (85%): 82% of follicular cell-derived tumors (37/45), 88% of pediatric cases, and 100% of medullary carcinomas (7/7). Nerve invasion was observed in 11/16 (69%) with preoperative VF paralysis and 33/36 (92%) with normal VF function. Only aggressive histology was correlated with nerve invasion in follicular cell-derived tumors (p = 0.019). Conclusions: The encased nerves were pathologically invaded in 82% of follicular cell-derived tumors and in 100% of medullary carcinomas. Nerve invasion was statistically correlated with aggressive histopathological subtypes and was observed in the absence of VF paralysis in 92% of cases.
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Affiliation(s)
- Alexandre Dahan
- Thyroid Surgery Unit, Department of Anesthesia, Surgery, and Interventional Radiology, Institute Gustave Roussy, 94805 Villejuif, France; (A.D.); (J.G.); (I.B.)
| | - Abir Al Ghuzlan
- Department of Biology and Pathology, Institute Gustave Roussy, 94805 Villejuif, France; (A.A.G.); (R.C.)
| | - Randa Chehab
- Department of Biology and Pathology, Institute Gustave Roussy, 94805 Villejuif, France; (A.A.G.); (R.C.)
| | - Joanne Guerlain
- Thyroid Surgery Unit, Department of Anesthesia, Surgery, and Interventional Radiology, Institute Gustave Roussy, 94805 Villejuif, France; (A.D.); (J.G.); (I.B.)
| | - Ingrid Breuskin
- Thyroid Surgery Unit, Department of Anesthesia, Surgery, and Interventional Radiology, Institute Gustave Roussy, 94805 Villejuif, France; (A.D.); (J.G.); (I.B.)
| | - Camilo Garcia
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, 94805 Villejuif, France; (C.G.); (L.L.); (J.H.); (E.B.)
| | - Livia Lamartina
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, 94805 Villejuif, France; (C.G.); (L.L.); (J.H.); (E.B.)
| | - Julien Hadoux
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, 94805 Villejuif, France; (C.G.); (L.L.); (J.H.); (E.B.)
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, 94805 Villejuif, France; (C.G.); (L.L.); (J.H.); (E.B.)
| | - Dana M. Hartl
- Thyroid Surgery Unit, Department of Anesthesia, Surgery, and Interventional Radiology, Institute Gustave Roussy, 94805 Villejuif, France; (A.D.); (J.G.); (I.B.)
- Correspondence:
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20
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Shonka DC, Ho A, Chintakuntlawar AV, Geiger JL, Park JC, Seetharamu N, Jasim S, Abdelhamid Ahmed AH, Bible KC, Brose MS, Cabanillas ME, Dabekaussen K, Davies L, Dias-Santagata D, Fagin JA, Faquin WC, Ghossein RA, Gopal RK, Miyauchi A, Nikiforov YE, Ringel MD, Robinson B, Ryder MM, Sherman EJ, Sadow PM, Shin JJ, Stack BC, Tuttle RM, Wirth LJ, Zafereo ME, Randolph GW. American Head and Neck Society Endocrine Surgery Section and International Thyroid Oncology Group consensus statement on mutational testing in thyroid cancer: Defining advanced thyroid cancer and its targeted treatment. Head Neck 2022; 44:1277-1300. [PMID: 35274388 DOI: 10.1002/hed.27025] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The development of systemic treatment options leveraging the molecular landscape of advanced thyroid cancer is a burgeoning field. This is a multidisciplinary evidence-based statement on the definition of advanced thyroid cancer and its targeted systemic treatment. METHODS An expert panel was assembled, a literature review was conducted, and best practice statements were developed. The modified Delphi method was applied to assess the degree of consensus for the statements developed by the author panel. RESULTS A review of the current understanding of thyroid oncogenesis at a molecular level is presented and characteristics of advanced thyroid cancer are defined. Twenty statements in topics including the multidisciplinary management, molecular evaluation, and targeted systemic treatment of advanced thyroid cancer are provided. CONCLUSIONS With the growth in targeted treatment options for thyroid cancer, a consensus definition of advanced disease and statements regarding the utility of molecular testing and available targeted systemic therapy is warranted.
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Affiliation(s)
- David C Shonka
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Alan Ho
- Department of Hematology and Medical Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Jong C Park
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nagashree Seetharamu
- Division of Hematology-Oncology, Donald and Barbara Zucker School of Medicine at Hofstra University, New Hyde Park, New York, USA
| | - Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, Department of Internal Medicine, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Amr H Abdelhamid Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marcia S Brose
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Kirsten Dabekaussen
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise Davies
- Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James A Fagin
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raj K Gopal
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew D Ringel
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Bruce Robinson
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mabel M Ryder
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Sherman
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology - Head and Neck Surgery, Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lori J Wirth
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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21
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Diercks GR, Rastatter JC, Kazahaya K, Kamani D, Quintanilla-Dieck L, Shindo ML, Hartnick C, Shin JJ, Singer MC, Stack BC, Chen AY, St John MA, Scharpf J, Agrawal N, Jayawardena ADL, Iwata AJ, Okose O, Wang B, McIlroy D, Cheung A, Wu CW, Chiang FY, Dionigi G, Barczynski M, Brauckhoff K, Lorenz K, Hartl D, Tolley N, Brooks JA, Schneider R, Dralle H, Abdelhamid Ahmed AH, Randolph GW. Pediatric intraoperative nerve monitoring during thyroid surgery: A review from the American Head and Neck Society Endocrine Surgery Section and the International Neural Monitoring Study Group. Head Neck 2022; 44:1468-1480. [PMID: 35261110 DOI: 10.1002/hed.27010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 12/23/2022] Open
Abstract
Children are more likely to experience recurrent laryngeal nerve (RLN) injury during thyroid surgery. Intraoperative nerve monitoring (IONM) may assist in nerve identification and surgical decision making. A literature review of pediatric IONM was performed and used to inform a monitoring technique guide and expert opinion statements. Pediatric IONM is achieved using a variety of methods. When age-appropriate endotracheal tubes with integrated surface electrodes are not available, an alternative method should be used. Patient age and surgeon experience with laryngoscopy influence technique selection; four techniques are described in detail. Surgeons must be familiar with the nuances of monitoring technique and interpretation; opinion statements address optimizing this technology in children. Adult IONM guidelines may offer strategies for surgical decision making in children. In some cases, delay of second-sided surgery may reduce bilateral RLN injury risk.
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Affiliation(s)
- Gillian R Diercks
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeff C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Anne & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Lourdes Quintanilla-Dieck
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Maisie L Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Christopher Hartnick
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael C Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Amy Y Chen
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Department of Head and Neck Surgery, Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Joseph Scharpf
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Asitha D L Jayawardena
- Department of ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ayaka J Iwata
- Department of Otolaryngology Head and Neck Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California, USA
| | - Okenwa Okose
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Wang
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dioan McIlroy
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Cheung
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Che Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng Yu Chiang
- Department of Otolaryngology, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- Division of General Surgery, Endocrine Surgery Section, Istituto Auxologico Italiano IRCCS (Istituto di ricovero e cura a carattere scientifico), Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marcin Barczynski
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University, Medical College, Kraków, Poland
| | - Katrin Brauckhoff
- Department of Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kerstin Lorenz
- Department of Endocrine Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle, Martin-Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Dana Hartl
- Thyroid Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
| | - Neil Tolley
- Department of Otolaryngology-Head & Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Jennifer A Brooks
- Department of Otolaryngology-Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Rick Schneider
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle, Martin-Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Henning Dralle
- Division of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University of Duisburg Essen, Essen, Germany
| | - Amr H Abdelhamid 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, USA
| | - 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, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Brooks JA, Abdelhamid Ahmed AH, Al-Qurayshi Z, Kamani D, Kyriazidis N, Hammon RJ, Ma H, Sritharan N, Wasserman I, Trinh LN, Iwata AJ, Saito Y, Soylu S, Randolph GW. Recurrent Laryngeal Nerve Invasion by Thyroid Cancer: Laryngeal Function and Survival Outcomes. Laryngoscope 2022; 132:2285-2292. [PMID: 35363394 DOI: 10.1002/lary.30115] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) invasion by thyroid carcinoma represents an advanced disease status with potentially significant co-morbidity. METHODS In a retrospective single-center study, we included patients with invaded RLNs operated on while using nerve monitoring techniques. We studied pre-, intra-, and postoperative parameters associated with postoperative vocal cord paralysis (VCP); 5-year recurrence-free survival (RFS); and 5-year overall survival (OS) in addition to two subgroup analyses of postoperative VCP in patients without preoperative VCP and based on source of RLN invasion. RESULTS Of 65 patients with 66 nerves-at-risk, 39.3% reported preoperative voice complaints. Preoperative VCP was documented in 43.5%. The RLN was invaded by primary tumor in 59.3% and nodal metastasis in 30.5%. Papillary thyroid carcinoma was the most common pathologic subtype (80%). After 6 months, 81.8% had VCP. Complete tumor resection of the RLN was not associated with 5-year RFS (p = 0.24) or 5-year OS (p = 0.9). Resecting the RLN did not offer statistically significant benefit on 5-year RFS (p = 0.5) or 5-year OS (p = 0.38). Radioactive Iodine (RAI) administration was associated with improvement in 5-year RFS (p = 0.006) and 5-year OS (p = 0.004). Patients without preoperative VCP had higher IONM amplitude compared with patients with VCP. After a mean follow-up of 65.8 months, 35.9% of patients had distant metastases, whereas 36.4% had recurrence. CONCLUSION Preoperative VCP accompanies less than half of patients with RLN invasion. Invaded RLNs may have existent electrophysiologic stimulability. Complete tumor resection and RLN resection were not associated with better 5-year RFS or OS, but postoperative RAI was. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Jennifer A Brooks
- Department of Otolaryngology-Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Amr H Abdelhamid 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, USA
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Kyriazidis
- Department of Otolaryngology-Head & Neck Surgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Rebecca Jean Hammon
- Department of Head and Neck Surgery, Northwest Permanente, Portland, Oregon, USA
| | - Hongzhi Ma
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otorhinolaryngology-Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, China
| | - Niranjan Sritharan
- Department of Otolaryngology-Head and Neck Surgery, Westmead & Nepean Hospitals, Sydney, Australia
| | - Isaac Wasserman
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Lily N Trinh
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayaka J Iwata
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Santa Clara Medical Center, California, USA
| | - Yoshiyuki Saito
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Selen Soylu
- Department of General Surgery, Basaksehir Cam and Sakura City Hospital., Istanbul, Turkey
| | - 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, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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23
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Surgery for Thyroid Cancer Invading the Trachea. Indian J Surg Oncol 2022; 13:184-190. [PMID: 35462665 PMCID: PMC8986919 DOI: 10.1007/s13193-021-01466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022] Open
Abstract
Thyroid cancer invading the trachea can be asymptomatic, but when tumour invasion reaches the mucosal surface, it causes bloody sputum and dyspnoea. The treatment plan for thyroid cancer is determined based on the site, depth, and extent of the invasion. Different from tumours arising from the tracheal mucosa, in thyroid cancer, invasion begins outside the airway and progresses toward the lumen, making it difficult to accurately diagnose the extent of the invasion even with bronchoscopy. Therefore, surgeons must determine the range of resection during surgery. Invasion reaching the tracheal mucosa requires full-thickness resection and is performed using tracheal window resection combined with tracheocutaneous fistula or tracheal sleeve resection followed by end-to-end anastomosis. The airway is safely secured with window resection, but closing the tracheal stoma often requires multi-stage reconstruction. Sleeve resection is an oncologically appropriate surgical method that can be completed in one stage, although there is a risk of serious complications associated with anastomotic dehiscence. Since well-differentiated thyroid cancer progresses slowly, some degree of survival can be expected even with incomplete resection. However, when shaving is performed for tumours with deep invasion that reaches the tracheal mucosa, the residual tumour tissue continues to grow steadily and eventually leads to airway stenosis. Since reoperation for tracheal resection is difficult, radical full-thickness resection should be performed in the initial surgery. Although this surgical intervention is far more demanding for both patients and surgeons than shaving, the procedure eventually improves patient's prognosis and quality of life.
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24
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Importance of Intraoperative Neuromonitoring Parameters in Predicting Temporary Recurrent Laryngeal Nerve Palsy Following Thyroid Surgery for Malignancy. Indian J Surg Oncol 2022; 13:218-224. [PMID: 35462654 PMCID: PMC8986907 DOI: 10.1007/s13193-021-01490-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022] Open
Abstract
Recurrent laryngeal nerve (RLN) palsy is one of the feared complications following thyroid surgery. Intraoperative neuromonitoring (IONM) has been used as an adjunct to reduce this complication. In the present study, we attempted to evaluate the IONM parameters such as latency, current requirement, and baseline amplitude that could predict temporary RLN palsy along with factors that could influence these parameters during thyroid surgery. This was a retrospective study of patients who underwent hemi, total, or completion thyroidectomy for cancer at our institute between June 1, 2017 to May 31, 2019 in whom IONM was used during surgery. The study consisted of 84 consecutive patients with 138 nerves at risk. The RLN palsy rate in our study was 5% (n = 7). Patients with low baseline amplitude and/or requiring higher current to maintain normal baseline amplitude were often associated with temporary RLN palsy. In the multivariate analysis, age > 40 years (p = 0.001, OR = 4.14) influenced the baseline EMG amplitude the most. The intraoperative current management was influenced by advanced pT stage (p = 0.001, OR = 2.87), and structural nerve injury (p = 0.001, OR = 3.15). Patients with low baseline amplitude and/or requiring higher current to maintain normal baseline amplitude were often associated with temporary RLN palsy. Factors such as age, pT stage, and structural nerve injury influenced the IONM stimulation and recording parameters.
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Staged surgical treatment for a giant hypervascular extra-intracranial metastasis of thyroid cancer using preoperative embolization and total microsurgical removal. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chakravarthy NS, Thomas V, Sam TS, Sen S, Cherian AJ, Abraham DT, Jacob PM. Laryngotracheal Resection in Thyroid Cancer - Experience from a Single Centre Series of 22 Cases. Indian J Surg Oncol 2022; 13:51-60. [PMID: 35462653 PMCID: PMC8986935 DOI: 10.1007/s13193-021-01407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
Involvement of the aerodigestive tract is reported in one-third of patients with locally invasive thyroid cancer. It is associated with significant morbidity and mortality, with airway obstruction being the immediate cause of death in 50% of patients who die of thyroid cancer. Management is challenging and includes the risks of extensive surgery as well as decisions regarding the type of surgery and adjuvant therapy. Retrospective cohort study, reporting institutional experience with patients who underwent laryngotracheal resection for invasive thyroid cancer over the past 10 years. Twenty-two patients were included in the study. All patients had Shin stage 4 disease. The median follow-up was 18 months. Five patients had systemic metastasis at diagnosis. Nineteen patients underwent tracheal resection and end to end anastomosis, and 3 underwent laryngectomy. The mean length of the resected trachea was 2.94 cm. Tracheal releasing manoeuvres were utilized in 11 patients. Three patients required a tracheostomy postoperatively. Other complications included a temporary vocal cord palsy in 5 patients, temporary hypocalcemia in 6 and permanent hypocalcemia in 1 patient. Adjuvant radiotherapy was utilized in 9 patients and I-131 therapy in 13 patients. Three patients died during follow-up. Two patients developed thyroid bed recurrence, two patients developed systemic metastasis on follow-up. Most patients survived for a prolonged period with only biochemical evidence of disease persistence and three with no evidence of disease. Laryngotracheal resection with primary anastomosis is a safe and effective option, providing adequate symptomatic relief as well as prolonged survival in carefully selected patients with invasive Shin stage 4 disease.
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Affiliation(s)
| | - Varghese Thomas
- grid.11586.3b0000 0004 1767 8969Department of Endocrine Surgery, CMC, Vellore, Tamil Nadu India
| | - Thomas Shawn Sam
- grid.11586.3b0000 0004 1767 8969Department of Endocrine Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu 6320004 India
| | - Supriya Sen
- grid.11586.3b0000 0004 1767 8969Department of Endocrine Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu 6320004 India
| | - Anish Jacob Cherian
- grid.11586.3b0000 0004 1767 8969Department of Endocrine Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu 6320004 India
| | - Deepak Thomas Abraham
- grid.11586.3b0000 0004 1767 8969Department of Endocrine Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu 6320004 India
| | - Paul Mazhuvanchary Jacob
- grid.11586.3b0000 0004 1767 8969Department of Endocrine Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu 6320004 India
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Groen AH, van Dijk D, Sluiter W, Links TP, Bijl HP, Plukker JTM. Postoperative external beam radiotherapy for locoregional control in iodine refractory differentiated thyroid cancer. Eur Thyroid J 2022; 11:e210033. [PMID: 34981752 PMCID: PMC9142801 DOI: 10.1530/etj-21-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022] Open
Abstract
Background The role of postoperative external beam radiotherapy (EBRT) in patients with residual iodine refractory-differentiated thyroid cancer (IR-DTC) is still inconclusive. The aim of this retrospective study was to evaluate locoregional control (LRC) and overall survival (OS), and potential side effects after postoperative EBRT for both microscopic and macroscopic non-radically resected, locally advanced IR-DTC. Methods Between 1990 and 2016, 49 patients with locally advanced IR-DTC received EBRT for microscopic (R1; n = 28) or macroscopic (R2; n = 21) locoregional residual disease. For more insight into the added effect of EBRT, we performed an intrapatient sub-analysis in 32 patients who had undergone more than 1 surgical intervention, comparing LRC after primary, curative-intended surgery with LRC after repeated surgery plus EBRT. To estimate LRC and OS, we used Kaplan-Meier curves. From 2007 onward, we prospectively recorded toxicity data in our head and neck cancer database (n = 10). Results LRC rates 5 years after EBRT were higher for R1 (84.3%) than for R2 (44.9%) residual disease (P = 0.016). The 5-year OS rate after EBRT was 72.1% for R1 and 33.1% for R2 disease (P = 0.003). In the intrapatient analysis (n = 32), LRC rates were 6.3% 5 years after only initial surgery and 77.9% after repeated surgery with EBRT (P < 0.001). Acute toxicity was limited to grade I and II xerostomia, mucositis, and hoarseness; only one patient developed late grade III dysphagia. Conclusions Postoperative EBRT is associated with long-lasting LRC and OS with acceptable toxicity in patients with locally advanced IR-DTC, especially in microscopic residual disease.
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Affiliation(s)
- Andries H Groen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Deborah van Dijk
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim Sluiter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hendrik P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - John T M Plukker
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Outcome of Patients with Locally Advanced Metastatic Medullary Thyroid Cancer and Induction Therapy with Tyrosine Kinase Inhibitors in Slovenia. Adv Ther 2021; 38:5684-5699. [PMID: 34674146 DOI: 10.1007/s12325-021-01940-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of our retrospective study was to evaluate the outcome of patients with metastatic medullary thyroid cancer (MTC) treated with tyrosine kinase inhibitors (TKIs) and/or chemotherapy with the emphasis on analysis on the cohort treated by induction TKI because of locally advanced metastatic MTC. METHODS We analyzed the outcome of 30 patients (21 males, 9 females; median age 63.8 years) with metastatic MTC treated between 2000-2020. Sunitinib was used in 20 patients. RESULTS Median progression-free survival on TKI and on chemotherapy was 10.6 (95% CI 7.1-14) months and 3.5 (95% CI 1.4-5.5) months, respectively. Median overall survival from diagnosis and from metastasis presentation was 38.2 (95% CI 4.7-71.7) months and 20.9 (95% CI 13.8-27.9) months, respectively. Eight patients (five females, three males; 58-86 years of age, median age 70 years) were treated with induction TKI because of inoperable locally advanced and metastatic MTC. The response rate to induction TKI was 50%; two patients (25%) had stable disease, and two patients (25%) had progressive disease. CONCLUSION Our data support a new paradigm that TKIs may be the first treatment option in selected patients with locally advanced metastatic MTC, followed by locoregional treatment with surgery and/or external beam radiotherapy. Further studies are required to consolidate the presented data.
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Piazza C, Lancini D, Tomasoni M, D’Cruz A, Hartl DM, Kowalski LP, Randolph GW, Rinaldo A, Shah JP, Shaha AR, Simo R, Vander Poorten V, Zafereo M, Ferlito A. Tracheal and Cricotracheal Resection With End-to-End Anastomosis for Locally Advanced Thyroid Cancer: A Systematic Review of the Literature on 656 Patients. Front Endocrinol (Lausanne) 2021; 12:779999. [PMID: 34858348 PMCID: PMC8632531 DOI: 10.3389/fendo.2021.779999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Airway involvement by advanced thyroid carcinoma (TC) constitutes a negative prognosticator, besides being a critical clinical issue since it represents one of the most frequent causes of death in locally advanced disease. It is generally agreed that, for appropriate laryngo-tracheal patterns of invasion, (crico-)tracheal resection and primary anastomosis [(C)TRA] is the preferred surgical technique in this clinical scenario. However, the results of long-term outcomes of (C)TRA are scarce in the literature, due to the rarity of such cases. The relative paucity of data prompts careful review of the available relevant series in order to critically evaluate this surgical technique from the oncologic and functional points of view. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement on the PubMed, Scopus, and Web of Science databases. English-language surgical series published between January 1985 and August 2021, reporting data on ≥5 patients treated for TC infiltrating the airway by (C)TRA were included. Oncologic outcomes, mortality, complications, and tracheotomy-dependency rates were assessed. Pooled proportion estimates were elaborated for each end-point. Thirty-seven studies were included, encompassing a total of 656 patients. Pooled risk of perioperative mortality was 2.0%. Surgical complications were reported in 27.0% of patients, with uni- or bilateral recurrent laryngeal nerve palsy being the most common. Permanent tracheotomy was required in 4.0% of patients. Oncologic outcomes varied among different series with 5- and 10-year overall survival rates ranging from 61% to 100% and 42.1% to 78.1%, respectively. Five- and 10-year disease specific survival rates ranged from 75.8% to 90% and 54.5% to 62.9%, respectively. Therefore, locally advanced TC with airway invasion treated with (C)TRA provides acceptable oncologic outcomes associated with a low permanent tracheotomy rate. The reported incidence of complications, however, indicates the need for judicious patient selection, meticulous surgical technique, and careful postoperative management.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology – Head and Neck Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology – Head and Neck Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Anil D’Cruz
- Director Oncology Apollo Group of Hospitals, Mumbai, India
| | - Dana M. Hartl
- Department of Head and Neck Oncology, Gustave Roussy, Université Paris Saclay, Paris, France
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Antonio Cândido (AC) Camargo Cancer Center, Sao Paulo, Brazil
| | - Gregory W. Randolph
- John and Claire Bertucci Endowed Chair in Thyroid Surgical Oncology, Harvard Medical School, Boston, MA, United States
| | | | - Jatin P. Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Ashok R. Shaha
- Jatin P Shah Chair in Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ricard Simo
- Department of Otorhinolaryngology – Head and Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy’s and St Thomas’ Hospital National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Vincent Vander Poorten
- Otorhinolaryngology – Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Mark Zafereo
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Outcomes of Tracheal Resections in Well-Differentiated Thyroid Cancer-A case series and meta-analysis. World J Surg 2021; 45:2752-2758. [PMID: 34023920 DOI: 10.1007/s00268-021-06172-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tracheal invasion in thyroid cancer is a well-known form of advanced disease. There is an ongoing controversy over outcomes of tracheal shaving in this situation. The aim of this study was to compare the results of tracheal shaving to radical resections in patients with low-volume tracheal involvement. METHODS An institutional case series and a meta-analysis was conducted. All studies that included patients diagnosed with well-differentiated thyroid cancer (WDTC) and tracheal invasion were analyzed. Patients with low-volume tracheal invasion (according to the Shin classification) were extracted from the various studies and subsequently included in this study. The outcomes of tracheal shaving and radical resection were consolidated and compared. All recurrences and mortality over 10 years of follow-up were calculated using the Kaplan-Meier method. RESULTS Institutional case series included 22 patients diagnosed with WDTC and tracheal invasion that underwent resection. There was one case of recurrence (4.5%) during the follow-up period and no mortality. The meta-analysis yielded a total of 284 patients from six studies who met the inclusion criteria. The 10-year overall survival was 82.4% for the shave group and 80.8% for the resection group. The combined Kaplan-Meier curves revealed no statistically significant difference between the two techniques (hazard ratio [HR] = 0.86, P = .768). The combined 10-year local control rate of the shave group was 90.2%. CONCLUSIONS The outcomes of tracheal shaving in low-volume invasion are similar to more aggressive forms of tracheal resections. Shave resection is oncologically safe in carefully selected WDTC patients demonstrating minimal tracheal invasion.
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Maneeprasopchoke P, Chongkolwatana C, Pongsapich W, Iwata AJ, Kamani D, Randolph GW. Intraoperative nerve monitoring in thyroid surgery: Analysis of recurrent laryngeal nerve identification and operative time. Laryngoscope Investig Otolaryngol 2021; 6:354-361. [PMID: 33869769 PMCID: PMC8035947 DOI: 10.1002/lio2.543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate the clinical value of intraoperative nerve monitoring (IONM) by comparing the procedure times for thyroidectomies performed with and without IONM. METHODS A prospective, randomized, controlled study was conducted on 32 patients (representing 41 nerves at risk) undergoing thyroidectomies carried out by two experienced head and neck surgeons (CC & WP). Sixteen thyroidectomies were performed without IONM (the "non-IONM group"), while 16 thyroidectomies were performed with IONM (the "IONM group"). The measured datapoints were setup time, time to visual identification of the recurrent laryngeal nerve (RLN), time to confirm the RLN electrophysiologically, dissection time, and total operative time. RESULTS With both surgeons, the IONM group had shorter visual times to RLN identification than the non-IONM group (CC: 3.7 minutes vs 5.3 minutes; WP: 3.4 minutes vs 9.7 minutes). Additionally, the electrophysiological identification time for the IONM group was shorter than the visual identification time for the non-IONM group. The setup times, dissection times, and total operative times of the 2 groups did not significantly differ (P > .05). No RLN injuries were observed. CONCLUSIONS IONM reduces the time needed for RLN identification in thyroidectomies. Functional RLN confirmation can reassure surgeons of the operative results. Moreover, use of IONM does not significantly impact setup and total operative times. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Prachya Maneeprasopchoke
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Cheerasook Chongkolwatana
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Warut Pongsapich
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Ayaka J. Iwata
- Division of Thyroid and Parathyroid Surgery, Department of OtolaryngologyMassachusetts Eye and Ear Infirmary, Harvard Medical SchoolBostonMassachusettsUSA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of OtolaryngologyMassachusetts Eye and Ear Infirmary, Harvard Medical SchoolBostonMassachusettsUSA
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery, Department of OtolaryngologyMassachusetts Eye and Ear Infirmary, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Surgical Oncology, Department of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Zhao Y, Zhang D, Zhou L, Li S, Wang T, Li F, Han Y, Dionigi G, Sun H. Proprieties of adhesive surface arrays to thyroid cartilage for recurrent laryngeal nerve monitoring. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:690. [PMID: 33987388 PMCID: PMC8106000 DOI: 10.21037/atm-21-1229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background To investigate the optimal placement and size of adhesive thyroid cartilage electrodes (ATCEs) placed on the thyroid cartilage in porcine models for evaluating recurrent laryngeal nerve function compared with the other 3 recording electrode types. Methods Four Meishan piglets were used for this study. The electromyogram (EMG) signal stability was detected by intraoperative nerve monitoring (IONM). Best location and size of ATCEs were detected, and the EMG signals from each were compared. Latency data were tested by stimulating the different nerve points, and 6 manipulations of the trachea and endotracheal tube (ET) were applied to test the stability of EMG signals. ET electrodes, needle electrodes, and transcutaneous recording electrodes were simultaneously tested with comparison to ATCEs. Results The optimal placement locations and sizes of ATCEs were determined. The amplitudes and latencies recorded from the ATCEs were consistent with those of the ET electrodes. More anti-interference was observed with the ATCEs than with the ET electrodes in surgical manipulations. ATCEs could be used during intermittent and continuous monitoring in similar fashion to ET electrodes and needle electrodes. Conclusions ATCEs had consistent monitoring function with ET electrodes and needle electrodes. Feasibility, EMG stability, and optimal location and size of ATCEs for IONM were resolved. The EMG profiles from the ATCEs were more stable during surgical manipulations.
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Affiliation(s)
- Yishen Zhao
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Le Zhou
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Shijie Li
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Tie Wang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Fang Li
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Yujia Han
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
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Matsumoto F, Ikeda K. Surgical Management of Tracheal Invasion by Well-Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13040797. [PMID: 33672929 PMCID: PMC7918429 DOI: 10.3390/cancers13040797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/25/2023] Open
Abstract
Simple Summary Tracheal invasion is a poor prognostic factor in well-differentiated thyroid cancer. Appropriate resection can improve the prognosis and maintain the patient’s quality of life. Shaving resection for superficial tracheal invasion is minimally invasive because it does not involve the tracheal lumen, despite the problematic risk of local recurrence. Window resection for tracheal mucosal and luminal invasion provides good tumor control and does not cause postoperative airway obstruction; however, the need for surgical closure of the tracheocutaneous fistula is a disadvantage of this method. Circumferential (sleeve) resection and end-to-end anastomosis are highly curative, but the risk of fatal complications, such as anastomosis dehiscence, is a concern. Abstract Well-differentiated thyroid carcinoma (WDTC) is a slow-growing cancer with a good prognosis, but may show extraglandular progression involving the invasion of tumor-adjacent tissues, such as the trachea, esophagus, and recurrent laryngeal nerve. Tracheal invasion by WDTC is infrequent. Since this condition is rare, relevant high-level evidence about it is lacking. Tracheal invasion by a WDTC has a negative impact on survival, with intraluminal tumor development constituting a worse prognostic factor than superficial tracheal invasion. In WDTC, curative resection is often feasible with a small safety margin, and complete resection can ensure a good prognosis. Despite its resectability, accurate knowledge of the tracheal and peritracheal anatomy and proper selection of surgical techniques are essential for complete resection. However, there is no standard guideline on surgical indications and the recommended procedure in trachea-invading WDTC. This review discusses the indications for radical resection and the three currently available major resection methods: shaving, window resection, and sleeve resection with end-to-end anastomosis. The review shows that the decision for radical resection should be based on the patient’s general condition, tumor status, expected survival duration, and the treating facility’s strengths and weaknesses.
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Carrillo JF, Flores JM, Espinoza G, Vázquez-Romo R, Ramírez-Ortega MC, Carrillo LC, Cortés-García BY, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Treatment of Unresectable Differentiated Thyroid Carcinoma With Upfront External Radiotherapy and Salvage Surgery: A STROBE-Compliant Retrospective Cohort Study. Front Oncol 2021; 10:572958. [PMID: 33542898 PMCID: PMC7851046 DOI: 10.3389/fonc.2020.572958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC. METHODS This is a cohort study of patients with initially unresectable DTC who received EBRT. Cohort A received EBRT followed by rescue surgery and cohort B, EBRT only. The Kaplan-Meier method and Cox model were employed for survival analysis. RESULTS Thirty-three patients were included; 69.6% females and 30.3% males. Mean age was 60.6 and mean tumor diameter was 10.4 cm; 17 and 16 patients were included in cohorts A and B, respectively. Belonging to cohort A (Hazard ratio [HR] 0.177, 95% CI 0.05-0.7) and use of intensity modulated radiotherapy (HR 0.177, 95% CI 0.03-1.08) were associated to better PFS, while high-risk histopathology (HR 6.6, 95% CI 0.9-50) and EBRT dose (HR 1.05, 95% CI 1.01-1.08) were independently associated with lower PFS. Patients from cohort A (HR 0.061, 95% CI 0.01-0.3) had improved OS, while high-risk histopathology (HR 5.7, 95% CI 1.1-28.6) and EBRT dose (HR 1.05, 95% CI 1.01-1.09) were independently associated to worse OS. CONCLUSION EBRT, and when feasible, salvage surgery, should be an integral part of the therapeutic strategy in initially unresectable DTC.
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Affiliation(s)
- José F. Carrillo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Jesús Manuel Flores
- Departamento de Radioterapia, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Gilberto Espinoza
- Subdirección de Cirugía, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Rafael Vázquez-Romo
- Subdirección de Cirugía, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Liliana C. Carrillo
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | - Luis F. Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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Stack BC, Twining C, Rastatter J, Angelos P, Baloch Z, Diercks G, Faquin W, Kazahaya K, Rivkees S, Sheyn T, Shin JJ, Smith J, Thompson G, Viswanathan P, Wassner A, Brooks J, Randolph GW. Consensus statement by the American Association of Clinical Endocrinology (AACE) and the American Head and Neck Society Endocrine Surgery Section (AHNS-ES) on Pediatric Benign and Malignant Thyroid Surgery. Head Neck 2021; 43:1027-1042. [PMID: 33386657 DOI: 10.1002/hed.26586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To provide a clinical disease state review of recent relevant literature and to generate expert consensus statements regarding the breadth of pediatric thyroid cancer diagnosis and care, with an emphasis on thyroid surgery. To generate expert statements to educate pediatric practitioners on the state-of-the-art practices and the value of surgical experience in the management of this unusual and challenging disease in children. METHODS A literature search was conducted and statements were constructed and subjected to a modified Delphi process to measure the consensus of the expert author panel. The wording of statements, voting tabulation, and statistical analysis were overseen by a Delphi expert (J.J.S.). RESULTS Twenty-five consensus statements were created and subjected to a modified Delphi analysis to measure the strength of consensus of the expert author panel. All statements reached a level of consensus, and the majority of statements reached the highest level of consensus. CONCLUSION Pediatric thyroid cancer has many unique nuances, such as bulky cervical adenopathy on presentation, an increased incidence of diffuse sclerosing variant, and a longer potential lifespan to endure potential complications from treatment. Complications can be a burden to parents and patients alike. We suggest that optimal outcomes and decreased morbidity will come from the use of advanced imaging, diagnostic testing, and neural monitoring of patients treated at high-volume centers by high-volume surgeons.
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Affiliation(s)
- Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Christine Twining
- Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine
| | - Jeff Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Anne & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gillian Diercks
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - William Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ken Kazahaya
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott Rivkees
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Tony Sheyn
- Department of Otolaryngology-Head and Neck Surgery, LeBonheur Children's Hospital, St. Jude Children's Research Hospital, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica Smith
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Pushpa Viswanathan
- Department of Pediatrics, Pittsburgh Children's Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ari Wassner
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Brooks
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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Huang TY, Lin YC, Tseng HY, Kim HY, Dionigi G, Lu IC, Chang PY, Chiang FY, Wu CW. Full percutaneous intraoperative neuromonitoring technique in remote thyroid surgery: Porcine model feasibility study. Head Neck 2020; 43:505-513. [PMID: 33026701 DOI: 10.1002/hed.26500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In remote thyroid surgery, a reliable intraoperative neuromonitoring (IONM) procedure is an important tool for reducing injury to recurrent laryngeal nerve (RLN). This study proposes an alternative or adjunct technique for performing full percutaneous (PC) IONM and confirms its feasibility in animal experiments. METHODS This prospective porcine model study enrolled four piglets with eight nerve sides. Evoked electromyography (EMG) was stimulated from PC ball-tip probe, and recorded from EMG endotracheal tube (ETT) and from PC paired long-needle electrodes on the perichondrium of the lateral aspect of thyroid cartilage. RESULTS In all RLNs and vagus nerves, typical laryngeal EMG waveforms were successfully evoked by PC probe stimulation and recorded by both ETT and PC needle electrodes. CONCLUSIONS This study confirms the feasibility of the full PC IONM techniques in porcine model. However, further clinical studies are needed to compare the practicality of different remote-access approaches for thyroid surgery.
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Affiliation(s)
- Tzu-Yen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Chu Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yi Tseng
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - I-Cheng Lu
- Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pi-Ying Chang
- Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Feng-Yu Chiang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Otolaryngology, E-Da Hospital, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Lorntzsen B, Brøndbo K, Osnes T. From the clavicle to the windpipe: Tracheal window resections reconstructed with calcifying periosteum in thyroid cancer. Laryngoscope Investig Otolaryngol 2020; 5:961-968. [PMID: 33134546 PMCID: PMC7585236 DOI: 10.1002/lio2.463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/08/2020] [Accepted: 09/13/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the outcomes of tracheal window resection and reconstruction using a vascularized periosteal flap (intended for calcification) harvested from the medial clavicle. This is one of several surgical techniques for tracheal resection and reconstruction used for patients with thyroid carcinoma invading the trachea. Importantly, in partial tracheal resection postoperative dynamic airway collapse must be prevented. Reconstruction of the tracheal defect with a vascularized periosteal flap is one method of achieving a stable airway. METHODS Twelve patients with locally advanced thyroid carcinoma who underwent tracheal resection and reconstruction at Oslo University Hospital from 2004 to 2017 were studied retrospectively. The primary outcome was a stable airway not requiring airway stenting. The secondary outcomes were the time to decannulation, morbidity, and survival. RESULTS Eleven of 12 patients did not require airway stenting postoperatively after a median of 111 days. Seven patients developed postoperative complications. The median observation time was 74.8 months (range 10.5-153.5) for all patients. The median disease-free survival was 40 months (range 0-147). By February 1, 2020, seven patients were alive, of whom five showed no evidence of disease. CONCLUSIONS Tracheal reconstruction with a vascularized periosteal flap yielded good results in terms of establishing a stable airway. This procedure is a viable reconstructive option that allows for decannulation by preventing airway collapse, thereby potentially mitigating the need for end-to-end (ETE) anastomosis or sleeve resections. For selected patients, this procedure may prevent local fatal complications from thyroid cancer invading the trachea. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Bianca Lorntzsen
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloNorway
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Head, Neck and Reconstructive SurgeryOslo University HospitalOsloNorway
| | - Kjell Brøndbo
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Head, Neck and Reconstructive SurgeryOslo University HospitalOsloNorway
| | - Terje Osnes
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloNorway
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Head, Neck and Reconstructive SurgeryOslo University HospitalOsloNorway
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38
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Roka R. Surgical treatment of locally advanced thyroid cancer. Innov Surg Sci 2020; 5:27-34. [PMID: 33506091 PMCID: PMC7798306 DOI: 10.1515/iss-2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
Operations in this area are demanding and require special experience in endocrine, thoracic and vascular surgery, an experienced anaesthesiologist, as well as the interdisciplinary cooperation with other medical specialists (nuclear medicine, oncology, radiology, otolaryngology). A reliable system of surgical guidelines has been developed from a few individual publications with special impact.
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Affiliation(s)
- Rudolf Roka
- Acute and Endocrine Surgery, Sigmund Freud Private University Vienna, Wien, Austria
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39
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Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. Sonographic Assessment of the Extent of Extrathyroidal Extension in Thyroid Cancer. Korean J Radiol 2020; 21:1187-1195. [PMID: 32729261 PMCID: PMC7458864 DOI: 10.3348/kjr.2019.0983] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/15/2022] Open
Abstract
Objective This study aimed to determine the sonographic features suggestive of extrathyroidal extension (ETE) of thyroid cancers. Materials and Methods We retrospectively reviewed the sonographic images of 1656 consecutive patients who had undergone thyroidectomy in 2017. The diagnostic performance of sonographic features suggestive of ETE was evaluated using operation and histopathologic reports. Sonographic features for gross ETE to the strap muscle and minor ETE were assessed for thyroid cancer abutting the anterolateral thyroid capsule. Sonographic features for tracheal invasion were assessed according to whether the angle between the tumor and the trachea was an acute, right, or obtuse angle. Sonographic features for recurrent laryngeal nerve (RLN) invasion were assessed based on the association between the tumor and tracheoesophageal groove (TEG) as preserved normal tissue, abutting or protruding into the TEG. Results ETE was observed in 783 patients (47.3%), including 123 patients with gross ETE (7.4% [strap muscle, n = 97; RLN, n = 24; and trachea, n = 14]) and 660 patients with minor ETE (39.9%). Regarding the diagnosis of gross and minor ETE to the strap muscle, sonographic features of replacement of the strap muscle and capsular disruption showed the highest positive predictive value (75.9% and 58.5%, respectively). Thyroid cancer forming an obtuse angle with the trachea had the highest sensitivity for the diagnosis of tracheal invasion (85.7%), and thyroid cancer protrusion into the TEG showed the highest sensitivity for the diagnosis of RLN (83.3%). Conclusion Sonography is considered beneficial in the diagnosis of ETE to the strap muscle, trachea, and RLN. Assessment of ETE is important for the accurate staging of thyroid cancer, which in turn determines the extent of surgery or whether active surveillance is appropriate or not.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Yon Sung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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40
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Total thyroidectomy with therapeutic level II-IV neck dissection for papillary thyroid carcinoma: level VI recurrence patterns. Eur Arch Otorhinolaryngol 2020; 277:3449-3455. [PMID: 32488373 DOI: 10.1007/s00405-020-06079-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Lateral and central compartments cervical lymph nodes metastases are common among patients with papillary thyroid carcinoma (PTC). Elective level VI neck dissection during thyroidectomy and lateral neck dissection (LND) for the treatment of PTC with lateral compartment lymph node metastases is controversial because of the uncertain benefit in clinical outcomes and increased risks of surgical morbidity. We aimed to determine the potential benefit of elective level VI neck dissection in patients with cN1 papillary thyroid carcinoma (PTC) by investigating the rate and pattern of locoregional recurrence in PTC patients who underwent total thyroidectomy and therapeutic lateral node dissection (LND; levels II-IV) without elective level VI dissection. METHODS A retrospective cohort study. Data on demographics, clinical presentation and workup, intraoperative and pathological report, postoperative course, adjuvant therapy, recurrence patterns, and overall survival were retrieved from the medical charts of patients who underwent thyroid surgery in our hospital between January 2006 and December 2017. RESULTS A total of 1415 thyroidectomies were performed during the study period, of which 802 (56.67%) were for PTC. Of those PTC patients, 228 (28.42%) also underwent LND (levels II-VI) during the same thyroidectomy procedure. Thirty-four (14.91%) of those 228 patients, underwent total thyroidectomy with therapeutic lateral ND II-IV without elective level VI ND. During the follow-up period, five (14.7%) of the latter cohort were diagnosed with recurrence in central neck (level VI) lymph nodes, and four of them (11.7%) were diagnosed with ipsilateral recurrence at level VI. CONCLUSION Our results revealed 11.7% rate of clinically significant recurrent disease in ipsilateral level VI which, in our opinion, does not justify routine prophylactic level VI ND dissection when the ipsilateral lateral neck is operated for metastases.
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41
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Sims JR, O'Malley QF, Spaulding SL, Yue LE, Urken ML. Stair-step tracheal repair: Surgical technique. Head Neck 2020; 42:2741-2744. [PMID: 32348004 DOI: 10.1002/hed.26173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/06/2020] [Accepted: 04/03/2020] [Indexed: 01/14/2023] Open
Abstract
Typical surgical treatment for invasive thyroid carcinoma at the level of the cricoid substantially reduces surrounding cartilaginous support and risks damage to the recurrent laryngeal nerve (RLN). We present a novel tracheal reconstructive technique that minimizes this injury risk. A 72-year-old man with recurrent invasive thyroid carcinoma underwent cricotracheal resection and reconstruction using a stair-step approach. Diseased cartilage was removed by a left hemitracheal and hemicricoid resection. A portion of normal trachea was also resected on the contralateral right side, removing the third and fourth hemitracheal rings, to close the defect with a sliding tracheoplasty and avoid dissection near the right cricothyroid joint on the side of the functioning RLN. The trachea was elevated superiorly and reanastomosed to the cut margin of the cricoid. This novel stair-step approach to tracheal reconstruction offers reduced risk of injury to the contralateral RLN while still establishing a patent airway.
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Affiliation(s)
- John R Sims
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Downtown, New York, New York, USA
| | - Quinn F O'Malley
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Sarah L Spaulding
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Downtown, New York, New York, USA
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42
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van Dijk D, van Dijk BAC, Weistra A, Links TP, Plukker JTM. Surgical Complications and Referral Patterns in 567 Patients with Differentiated Thyroid Cancer in the Northern Region of the Netherlands: A Population-Based Study Towards Clinical Management Implementation. Ann Surg Oncol 2020; 27:3872-3881. [PMID: 32328986 PMCID: PMC7471192 DOI: 10.1245/s10434-020-08470-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the Netherlands, differentiated thyroid cancer (DTC) is treated surgically in three different hospital types, including university, teaching, and non- teaching peripheral hospitals. This study evaluates postoperative complications and referral patterns in patients with DTC in the northern region of the Netherlands to gain an understanding on how to improve management implementation. METHODS Data from 567 patients diagnosed between 1989 and 2009 were obtained from the Netherlands Cancer Registry and were supplemented with information from hospital digital information systems and patient records from 15 hospitals: 1 university, 3 teaching, and 11 peripheral hospitals. Surgically treated patients with a histologically proven DTC derived from the original pathology reports were included. RESULTS Surgical treatment could be performed in a single procedure in 234 patients (41.3%), but several surgeries were needed in the remaining 333 patients (58.7%). Recurrent laryngeal nerve (RLN) palsy occurred after all types of thyroid surgical procedures, but mostly after initial (hemi)thyroidectomy and reoperations. RLN was temporary in 3.2% of the nerves at risk and persistent in 1.8%. Temporary hypocalcemia developed in 13.7% of patients, and persistent hypocalcemia occurred in 4.8%. Patients were mainly referred to the university hospital from a non-teaching (40.7%, 48/118) or teaching hospital (11.1%, 16/144); however, 80% of patients were not referred. CONCLUSIONS The complication rate and number of multiple surgeries support the efforts in optimizing clinical management in thyroid cancer. Careful considerations prior to initial surgical treatment by early discussion in telemedicine-based regional tumor boards could possibly prevent reoperations and potentially diminish complications.
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Affiliation(s)
- Deborah van Dijk
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Boukje A C van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annemieke Weistra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - John Th M Plukker
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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43
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Russell MD, Kamani D, Randolph GW. Modern surgery for advanced thyroid cancer: a tailored approach. Gland Surg 2020; 9:S105-S119. [PMID: 32175251 DOI: 10.21037/gs.2019.12.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Surgical treatment of advanced thyroid malignancy can be morbid, compromising normal functions of the upper aerodigestive tract. There is a paucity of guidelines dedicated to the management of advanced disease. In fact, there is not even a uniform definition for advanced thyroid cancer currently. The presence of local invasion, bulky cervical nodes, distant metastases or recurrent disease should prompt careful preoperative evaluation and planning. Surgical strategy should evolve from multidisciplinary discussion that integrates individual disease characteristics and patient preference. Intraoperative neuromonitoring has important applications in surgery for advanced disease and should be used to guide surgical strategy and intraoperative decision-making. Recent paradigm shifts, including staged surgery and use of neoadjuvant targeted therapy hold potential for decreasing surgical morbidity and improving clinical outcomes. Modern surgical planning provides optimal treatment for each patient through a tailored approach based on exact extent and type of disease as well as incorporating appreciation of surgical complications, patient preferences and intraoperative findings.
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Affiliation(s)
- Marika D Russell
- Department of Otolaryngology & Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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44
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Metere A, Aceti V, Giacomelli L. The surgical management of locally advanced well-differentiated thyroid carcinoma: changes over the years according to the AJCC 8th edition Cancer Staging Manual. Thyroid Res 2019; 12:10. [PMID: 31673294 PMCID: PMC6815458 DOI: 10.1186/s13044-019-0071-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/10/2019] [Indexed: 01/11/2023] Open
Abstract
Background Well-differentiated thyroid carcinoma is defined as locally advanced in the presence of an extra thyroid extension, e.g., when the surrounding structures such as the trachea, larynx, esophagus and main blood vessels are invaded by cancer. The 8th edition AJCC Cancer Staging Manual states that this is the main characteristic to evaluate for the staging and consequently for the prognosis in patients over 55 years old. Main body Distinguishing different forms of locally advanced thyroid cancer is essential, and the various anatomical structures and the clinical and therapeutic consequences must be taken into account. An accurate diagnosis of the organs invaded by thyroid cancer is necessary for the planning of surgical treatment, and both aspects are crucial to improving the patients’ survival. Patients affected by thyroid cancer with extra thyroid extension have a poor prognosis and the removal of the entire neoplasm represents a key factor for better disease-free survival. Conclusions We discuss the changes introduced by the 8th edition AJCC Cancer Staging Manual, in terms of the diagnostic and surgical management of extra thyroid extension, in patients affected by papillary and follicular thyroid cancer.
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Affiliation(s)
- Alessio Metere
- Department of Surgical Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Valerio Aceti
- Department of Surgical Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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45
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Nava CF, Scheffel RS, Cristo AP, Ferreira CV, Weber S, Zanella AB, Paixão FC, Migliavaca A, Guimarães JR, Graudenz MS, Dora JM, Maia AL. Neoadjuvant Multikinase Inhibitor in Patients With Locally Advanced Unresectable Thyroid Carcinoma. Front Endocrinol (Lausanne) 2019; 10:712. [PMID: 31695679 PMCID: PMC6817485 DOI: 10.3389/fendo.2019.00712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Papillary thyroid carcinoma (PTC) is the most common and less aggressive thyroid cancer, but some patients may display locally advanced disease. Therapeutic options are limited in these cases, particularly for those patients with unresectable tumors. Neoadjuvant therapy is not part of the recommended work up. Methods: Report a case of an unresectable grossly locally invasive PTC successfully managed with neoadjuvant therapy and provide a systematic review (SR) using the terms "Neoadjuvant therapy" AND "Thyroid carcinoma." Results: A 32-year-old man with a 7.8 cm (in the largest dimension) PTC was referred to total thyroidectomy, but tumor resection was not feasible due to extensive local invasion (trachea, esophagus, and adjacent structures). Sorafenib, a multikinase inhibitor (MKI), was initiated; a 70% tumor reduction was observed after 6 months, allowing new surgical intervention and complete resection. Radioactive iodine (RAI) was administered as adjuvant therapy, and whole body scan (WBS) shows uptake on thyroid bed. One-year post-surgery the patient is asymptomatic with a status of disease defined as an incomplete biochemical response. The SR retrieved 123 studies on neoadjuvant therapy use in thyroid carcinoma; of them, 6 were extracted: 4 case reports and 2 observational studies. MKIs were used as neoadjuvant therapy in three clinical cases with 70-84% of tumor reduction allowing surgery. Conclusion: Our findings, along with other reports, suggest that MKIs is an effective neoadjuvant therapy and should be considered as a therapeutic strategy for unresectable grossly locally invasive thyroid carcinomas.
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Affiliation(s)
- Carla Fernanda Nava
- Thyroid Unit, Endocrine Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Selbach Scheffel
- Thyroid Unit, Endocrine Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Patrícia Cristo
- Pathology Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carla Vaz Ferreira
- Thyroid Unit, Endocrine Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Shana Weber
- Thyroid Unit, Endocrine Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Borsatto Zanella
- Thyroid Unit, Endocrine Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Francisco Costa Paixão
- Surgical Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alceu Migliavaca
- Surgical Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José Ricardo Guimarães
- Surgical Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcia Silveira Graudenz
- Pathology Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José Miguel Dora
- Thyroid Unit, Endocrine Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Endocrine Division, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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46
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Onoda N, Noda S, Tauchi Y, Asano Y, Kusunoki Y, Ishihara S, Morisaki T, Kashiwagi S, Takashima T, Ohira M. Continuous intraoperative neuromonitoring for thyroid cancer surgery: A prospective study. Laryngoscope Investig Otolaryngol 2019; 4:455-459. [PMID: 31453357 PMCID: PMC6703108 DOI: 10.1002/lio2.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 01/02/2023] Open
Abstract
Objective We evaluated the utility of continuous intraoperative neuromonitoring (CIONM) during surgery for thyroid cancer (TC) in an educational university hospital. Study Design Prospective observational study. Methods During the period April 2016 to March 2017, 43 patients who underwent standardized surgery with CIONM were prospectively included: 5 men and 38 women, 24–87 years old (median 52 years); 23 lobectomies and 20 total thyroidectomies with node dissection were conducted. Thirty‐six operations were performed by a supervising surgeon, and seven were performed by trainees. Results Temporal vocal cord paresis (VCP) was identified in 9 of 63 nerves at risk (14.3%) by postoperative laryngoscopy. VCP was not related to clinical factors including the surgeon's experience or the severe nerve stress demonstrated by CIONM. A significant relation only between VCP and loss of signal (LOS) was demonstrated (P = .002). The recovery of VCP was rapid (<1 month) in patients with global injury even when LOS was demonstrated, but was prolonged in patients demonstrating obvious segmental nerve injury and LOS. Conclusion The present standard protocol of CIONM was useful to some extent to protect prolonged VCP, but not enough to detect every nerve stress causing VCP during TC surgery. On the other hand, CIONM is a promising method that could contribute surgical education at training hospitals enabling the instant confirmation of the procedure safely. Levels of Evidence 3b
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Affiliation(s)
- Naoyoshi Onoda
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Satoru Noda
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Yukie Tauchi
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Yuka Asano
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Yukina Kusunoki
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Sae Ishihara
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Tamami Morisaki
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Shinichiro Kashiwagi
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Tsutomu Takashima
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
| | - Masaichi Ohira
- Department of Breast and Endocrine Surgery Osaka City University Graduate School of Medicine Osaka Japan
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47
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Wu C, Da D, Wang J, Qiao G, Zheng M, Ming X, Jiang Y, Liu J. Dyspnea after thyroidectomy induced by intratracheal lymphoma: A case report. Mol Clin Oncol 2019; 11:285-288. [PMID: 31423311 DOI: 10.3892/mco.2019.1896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/27/2019] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to report a rare case of dyspnea caused by rapid growth of intratracheal lymphoma in the 2 weeks following thyroid surgery. A 53-year-old male patient underwent a right thyroidectomy due to tracheal compression by a mass of the right thyroid lobe. However, 2 weeks after the surgery, the patient developed dyspnea, which was managed by tracheotomy. An urgent computed tomography scan revealed that the soft tissue of the upper trachea was significantly thickened compared with prior to surgery, resulting in narrowing of the airway. Postoperative pathology revealed right thyroid lymphoma, and the final diagnosis was intratracheal lymphoma. The intratracheal mass regressed after chemotherapy combined with rituximab. We herein review the diagnostic and treatment process of this case of dyspnea, and analyze the outcome, in order to provide a reference for the timely diagnosis and treatment of patients developing dyspnea following thyroid surgery.
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Affiliation(s)
- Chaojie Wu
- Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, P.R. China.,Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Dongzhu Da
- Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, P.R. China.,Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Jing Wang
- Shanghai Jiao Tong University School of Medicine Pathology Center, Shanghai 201620, P.R. China
| | - Gaoang Qiao
- Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, P.R. China.,Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Miao Zheng
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Xu Ming
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Yongxin Jiang
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
| | - Jun Liu
- Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, P.R. China.,Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai 201620, P.R. China
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Feng AL, Puram SV, Singer MC, Modi R, Kamani D, Randolph GW. Increased prevalence of neural monitoring during thyroidectomy: Global surgical survey. Laryngoscope 2019; 130:1097-1104. [PMID: 31361342 DOI: 10.1002/lary.28210] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/17/2019] [Accepted: 07/10/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate intraoperative nerve monitoring (IONM) use among thyroid surgeons. METHODS A 25-question survey was used to assess attitudes regarding IONM use. Surveys were sent to surgeons registered to the American Academy of Otolaryngology-Head and Neck Surgery, International Association of Endocrine Surgeons, and American Head and Neck Society. RESULTS Among 1,015 respondents, 83% reported using IONM (65.1% always using IONM and 18.1% reporting selective use). For selective users, a majority reported using IONM for reoperative cases (95.1%) and in cases with preoperative vocal cord paralysis (59.8%). When comparing location, there was a significant difference in IONM implementation (P < 0.001), with 70.4% of North American responders using it ubiquitously compared to 27.4% of non-North American responders. Preoperative laryngeal exam was performed more universally by North American surgeons and more selectively by non-North American surgeons (P < 0.001). Other attitudes toward their implementation and the postoperative laryngeal exam were similar. Surgeons ≤45 years of age and those with ≤15 years of practice used IONM more than their peers (P < 0.001). Thyroid surgery volume, fellowship training, and type of practice had no bearing on IONM use. CONCLUSION The prevalence of IONM in thyroid and parathyroid surgeries has increased significantly over the past decade, with 83% of surgeons using IONM in some or all cases. Although IONM use may be more ubiquitous in North America, attitudes toward its implementation and pre- and postoperative laryngeal exams are fairly uniform. IONM use is more prevalent among younger surgeons, whereas its use has no correlation with thyroid surgery volume or type of practice. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1097-1104, 2020.
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Affiliation(s)
- Allen L Feng
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School Boston, Massachusetts, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School Boston, Massachusetts, U.S.A
| | - Michael C Singer
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Rahul Modi
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School Boston, Massachusetts, U.S.A
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School Boston, Massachusetts, U.S.A
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School Boston, Massachusetts, U.S.A.,Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts, U.S.A
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49
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Liu J, Ren J, Lv D, Wang J, Deng D, Li L, Wang H, Chen F. Simultaneous tracheal and esophageal reconstruction for thyroid cancer involving trachea and esophagus using a free bipaddled posterior tibial artery perforator flap. Head Neck 2019; 41:3472-3477. [PMID: 31240807 PMCID: PMC6771656 DOI: 10.1002/hed.25850] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Simultaneous tracheal and esophageal reconstruction after tumor resection is a great challenge. Here we present an innovative operative technique to simultaneously reconstruct tracheal and esophageal defects, in which a free posterior tibial artery perforator flap was made into a free bipaddled flap to cover both tracheal and esophageal defects. METHODS A free bipaddled posterior tibial artery perforator flap was utilized to conduct simultaneous tracheal and esophageal reconstruction for a 72-year-old female patient with papillary thyroid carcinoma and massive trachea and esophagus invasion, who underwent radical resection. RESULTS Satisfactory breathing and swallowing functions were gained independent of nasal feeding and tracheotomy. Voice was still hoarse due to tumor invasion of left recurrent laryngeal nerve. During a period of 2-year follow-up, no sign of tumor recurrence was observed. CONCLUSION A free bipaddled posterior tibial artery perforator flap could be a decent choice for simultaneous reconstruction of large tracheal and esophageal defects.
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Affiliation(s)
- Jun Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianjun Ren
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Lv
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ji Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Di Deng
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Linke Li
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Haiyang Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
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Stewart KE, Strachan MW, Srinivasan D, MacNeill M, Wall L, Nixon IJ. Tyrosine Kinase Inhibitor Therapy in Locally Advanced Differentiated Thyroid Cancer: A Case Report. Eur Thyroid J 2019; 8:102-107. [PMID: 31192150 PMCID: PMC6514483 DOI: 10.1159/000494880] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022] Open
Abstract
A 73-year-old female presenting with haemoptysis and dyspnoea was found to have a locally advanced left thyroid mass and vocal cord palsy. A CT scan of the neck and thorax and endoscopy demonstrated invasion into the tracheal lumen. Histopathology of the intraluminal tracheal mass confirmed a papillary thyroid cancer (PTC). The tumour was deemed unresectable due to local extent and patient comorbidities. TKI therapy with lenvatinib was used for 14 months. On serial scanning, a marked reduction in tumour volume from 31 × 59 × 32 mm to 17 × 28 × 22 mm was noted. This subsequently allowed a successful surgical resection with a total thyroidectomy and central neck dissection with no evidence of residual macroscopic disease. Histopathology confirmed a well-differentiated PTC with features of tumour regression. In this case, TKI therapy in a locally advanced unresectable DTC reduced tumour size and infiltration to a degree that surgical resection of macroscopic disease was possible, without requiring airway resection. This raises the possibility that TKIs may have a neoadjuvant role in selected cases of locally advanced DTC to reduce tumour volume and therefore morbidity of subsequent surgical resection.
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Affiliation(s)
- Kirsten E. Stewart
- Department of Head and Neck Surgery, St John's Hospital at Howden, Livingston, United Kingdom
- *Kirsten E. Stewart, MRCS, DO-HNS, Department of Head and Neck Surgery, St John's Hospital at Howden, Howden Road West, Livingston, EH54 6PP (UK), E-Mail
| | | | - Devraj Srinivasan
- Department of Oncology, Western General Hospital, Edinburgh, United Kingdom
| | - Morna MacNeill
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Lucy Wall
- Department of Oncology, Western General Hospital, Edinburgh, United Kingdom
| | - Iain J. Nixon
- Department of Head and Neck Surgery, St John's Hospital at Howden, Livingston, United Kingdom
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