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Wang YH, Chiang PL, Lin AN, Wang CK, Lee CY, Chou CK, Chang YH, Chi SY, Luo SD, Lin WC. Long-term outcomes of radiofrequency ablation for intrathoracic goiter up to 5 years: evaluated by computed tomography/magnetic resonance imaging and ultrasound. Int J Hyperthermia 2024; 41:2378865. [PMID: 39004424 DOI: 10.1080/02656736.2024.2378865] [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: 04/09/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVES This study evaluated the long-term efficacy and safety of radiofrequency ablation (RFA) for intrathoracic goiter (ITG) over a follow-up period exceeding six months. METHODS From 2017 to 2022, 22 patients (6 males, 16 females) with 24 ITGs treated with RFA at a single medical center were evaluated. All patients underwent ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI) before RFA. Follow-up CT/MRI was performed six months after the initial RFA and then every 6-12 months. The primary outcomes measured were the degree of extension, goiter volume, volume reduction rate (VRR), tracheal deviation, and tracheal lumen. Additionally, we assessed the outcomes of single-session RFA (n = 16) vs. multiple sessions (n = 8) on goiters and explored the correlation between ITG volume measurements obtained using ultrasonography and CT/MRI. RESULTS The median follow-up period was 12 months (interquartile range: 6-36.8 months). At the last follow-up, the nodule volume measured by CT/MRI had significantly decreased (76.2 vs. 24.6 mL; p < 0.05), with a VRR of 64.6%. Patients who underwent multiple RFA sessions showed a significantly higher VRR than the single-session patients (63.8 vs. 80.1%, p < 0.05). The intraclass correlation between goiter volumes measured using US and CT/MRI was moderate. CONCLUSION This study affirms the long-term efficacy and safety of RFA for ITG, providing an alternative treatment for nonsurgical candidates. Multiple RFA sessions may be beneficial for achieving better volume reduction. Sole reliance on ultrasonography is inadequate; therefore, integrating CT/MRI is essential for accurate pre-RFA and follow-up assessments.
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Affiliation(s)
- Yu-Hsin Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Ying Lee
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Radiology, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Devaraja K, Aggarwal S, Pillai S, Singh BMK. Large atypical lipomatous tumour of the neck with mediastinal extension managed by transcervical excision. BMJ Case Rep 2024; 17:e258292. [PMID: 38789269 DOI: 10.1136/bcr-2023-258292] [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] [Indexed: 05/26/2024] Open
Abstract
Tumours of adipose tissue origin are relatively rare in the head and neck. Here, we report a case of an unfamiliar lipomatous lesion that involved the neck and mediastinum. A nil-comorbid man in his 40s presented with a slowly progressive anterior neck swelling of 3 years, which was diagnosed as lipoma by histopathological sampling. Computed tomography demonstrated the lesion to be involving parapharyngeal and retropharyngeal spaces with mediastinal extension. The lesion was removed by the transcervical approach. The final histology of the excised specimen, with immunohistochemistry for mouse double minute 2 (MDM2) and p16, suggested an atypical lipomatous tumour (ALT). This report accentuates the occurrence of this rare neoplasm in the neck, which often mimics lipoma clinically. Although radiology can demonstrate suggestive features, histology with MDM2 and/or p16 positivity can confirm the diagnosis of ALT as against the lipoma. A successful transcervical excision, despite the deeper extension of the lesion between the critical structures of the neck and mediastinum, demonstrates the non-infiltrating nature of the tumour.
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Affiliation(s)
- K Devaraja
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Shruti Aggarwal
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Suresh Pillai
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Brij Mohan Kumar Singh
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
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Carsote M, Ciobica ML, Sima OC, Ciuche A, Popa-Velea O, Stanciu M, Popa FL, Nistor C. Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach. Cancers (Basel) 2024; 16:1868. [PMID: 38791947 PMCID: PMC11120123 DOI: 10.3390/cancers16101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Oana-Claudia Sima
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Adrian Ciuche
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | - Ovidiu Popa-Velea
- Department of Medical Psychology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania;
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
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Piccioni G, Siciliani A, Messa F, Mercantini P, D'Andrilli A, Tiracorrendo M, Rendina EA, Ibrahim M. Combined Cervicotomy and Robot-Assisted Surgical Approach for Intrathoracic Thyroid Goiter: A Case Series. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241247850. [PMID: 38733131 DOI: 10.1177/15569845241247850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- Giorgia Piccioni
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandra Siciliani
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Fabiana Messa
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Paolo Mercantini
- Department of General Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Matteo Tiracorrendo
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Peng H, He Y, Sheng S, Maitiyasen M, Li J, Liu Y, Chen J, Hou X, Song H, Yi J. Clinical efficiency of three-port inflatable robot-assisted thoracoscopic surgery in mediastinal tumor resection. World J Surg Oncol 2024; 22:83. [PMID: 38523264 PMCID: PMC10962077 DOI: 10.1186/s12957-024-03357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Aimed to assess clinical effect of three-port inflatable robot-assisted thoracoscopic surgery in mediastinal tumor resection by comparing results of the robot group with the video group. METHODS Retrospectively analyze 179 patients diagnosed with anterior mediastinal tumor from May 2017 to August 2021. Two groups were divided according to the surgical approach, including 92 cases in the RATS group and 87 cases in the VATS group. The results were analyzed between two groups with variables of age, sex, BMI, tumor size, and diagnosis. Perioperative clinical data was gathered to compare. RESULT There were no significant differences between the 2 groups with regards to demographic data and clinical features. There were no significant differences inoperative time and duration of chest tube via RATS vs. VATS. The intraoperative blood loss was statistically significantly different among the RATS and VATS groups (75.9 ± 39.6 vs. 97.4 ± 35.8 ml p = 0.042). The postoperative stay of patients in RATS group were significantly shorter than that in VATS group (2.3 ± 1.0 vs. 3.4 ± 1.4 day p = 0.035), CONCLUSION: Three-port inflatable robot-assisted thoracoscopic surgery for mediastinal tumor is feasible and reliable it is more advantageous, and it provides the surgeon with advice on treatment choice.
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Affiliation(s)
- Hao Peng
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - YuanPeng He
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Siqi Sheng
- Department of Medical Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Maierhaba Maitiyasen
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Jingfeng Li
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Yvxuan Liu
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Jing Chen
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing University Of Chinese Medicine, Nanjing, Jiangsu Province, PR China
| | - Xinyu Hou
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Haizhu Song
- Department of Medical Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China.
| | - Jun Yi
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China.
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Chang CC, Lin CY, Liu YS, Chen YY, Huang WL, Lai WW, Yen YT, Ma MC, Tseng YL. Therapeutic Decision Making in Prevascular Mediastinal Tumors Using CT Radiomics and Clinical Features: Upfront Surgery or Pretreatment Needle Biopsy? Cancers (Basel) 2024; 16:773. [PMID: 38398164 PMCID: PMC10886806 DOI: 10.3390/cancers16040773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The study aimed to develop machine learning (ML) classification models for differentiating patients who needed direct surgery from patients who needed core needle biopsy among patients with prevascular mediastinal tumor (PMT). Patients with PMT who received a contrast-enhanced computed tomography (CECT) scan and initial management for PMT between January 2010 and December 2020 were included in this retrospective study. Fourteen ML algorithms were used to construct candidate classification models via the voting ensemble approach, based on preoperative clinical data and radiomic features extracted from the CECT. The classification accuracy of clinical diagnosis was 86.1%. The first ensemble learning model was built by randomly choosing seven ML models from a set of fourteen ML models and had a classification accuracy of 88.0% (95% CI = 85.8 to 90.3%). The second ensemble learning model was the combination of five ML models, including NeuralNetFastAI, NeuralNetTorch, RandomForest with Entropy, RandomForest with Gini, and XGBoost, and had a classification accuracy of 90.4% (95% CI = 87.9 to 93.0%), which significantly outperformed clinical diagnosis (p < 0.05). Due to the superior performance, the voting ensemble learning clinical-radiomic classification model may be used as a clinical decision support system to facilitate the selection of the initial management of PMT.
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Affiliation(s)
- Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-Y.L.); (Y.-S.L.)
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-Y.L.); (Y.-S.L.)
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
- Division of Thoracic Surgery, Department of Surgery, An-Nan Hospital, China Medical University, Tainan 70965, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
- Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Mi-Chia Ma
- Department of Statistics and Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
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Cappellacci F, Canu GL, Rossi L, De Palma A, Mavromati M, Kuczma P, Di Filippo G, Morelli E, Demarchi MS, Brazzarola P, Materazzi G, Calò PG, Medas F. Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation. Front Surg 2024; 11:1341683. [PMID: 38379818 PMCID: PMC10876881 DOI: 10.3389/fsurg.2024.1341683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy. Methods In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B). Results We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, p < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, p = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, p = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, p = 0.015). Discussion Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, p = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable.
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Affiliation(s)
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Andrea De Palma
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Maria Mavromati
- Service D'endocrinologie, Diabétologie, Nutrition et éducation du Patient, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Paulina Kuczma
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Giacomo Di Filippo
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Eleonora Morelli
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | | | | | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Ghabisha SA, Ahmed F, Al-Wageeh S, Alyhari Q, Badheeb MA, Altam A, Alsharif A. Management of Retrosternal Goiter in Resource-Limited Settings: Outcomes From 28 Cases Using Cervical Approach. Cureus 2023; 15:e41288. [PMID: 37539408 PMCID: PMC10395659 DOI: 10.7759/cureus.41288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/05/2023] Open
Abstract
Background Despite thyroidectomy being the preferred approach for retrosternal goiter (RSG), controversies surround its rationale in asymptomatic cases. This study aimed to investigate the treatment of RSG in resource-limited settings. Methods A retrospective study conducted between April 2010 and June 2022 included 28 RSG cases who underwent thyroidectomy using the cervical approach at Al-Nasar Hospital, Ibb, Yemen. A bivariate analysis was performed to investigate the risk factors for postoperative complications. Results The main age was 49.4±9.9 years, and most of them (60.7%) were females. The main symptoms were cervical mass appearance and breathing difficulty in 75 %, and 32.1%, respectively. Twenty-four (86%) cases were classified as Grade 1 (above aortic arch) and four (14%) cases were classified as Grade 2 (aortic arch to the pericardium). All patients underwent total thyroidectomy through the cervical approach without needing sternotomy. The mean operative time was 121.9±26.7min (99-200 min) and the mean intraoperative bleeding was 321.2±137.4 mL. Postoperatively, the malignant entity was histopathologically proven in seven patients (25%). The postoperative complications (14%) were transient hypocalcemia in two (7.1%) and hematoma in two (7.1%). Older age, bigger thyroid mass, extension below the aortic arch (Grade 2), longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications (all p < 0.05). Conclusion Cervical approach for patients with RSG in our experience is an optimum, feasible, and less invasive surgical approach, in a resource-limited setting. Older age, bigger thyroid, extension below the aortic arch, longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications.
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Affiliation(s)
- Saif A Ghabisha
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, YEM
| | | | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, YEM
| | - Qasem Alyhari
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, YEM
| | | | | | - Afaf Alsharif
- Department of Gynecology, Jeblah University for Medical and Health Sciences, Ibb, YEM
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Ultrasound-guided microwave ablation combined with ethanol injection for the treatment of solitary nodular retrosternal goiter: a prospective study of 72 patients. Eur Radiol 2023; 33:752-762. [PMID: 35976394 DOI: 10.1007/s00330-022-09052-3] [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: 02/07/2022] [Revised: 07/15/2022] [Accepted: 07/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We prospectively evaluated the efficacy and safety of microwave ablation (MWA) combined with ethanol injection (EI) in solitary nodular retrosternal goiters (RSGs). METHODS From November 2018 to November 2020, 72 patients diagnosed with solitary nodular RSG were treated by ultrasound-guided MWA with EI. Patients were followed up at 1, 3, 6, and 12 months and every 6-12 months thereafter by ultrasound and contrast-enhanced ultrasound (CEUS). The nodule volume, volume reduction ratio (VRR), neck circumference, symptom score, and cosmetic grading score were recorded to evaluate the treatment efficacy. RESULTS All patients successfully underwent treatment. The mean initial nodule volume was 71.25 mL ± 61.61 mL, which decreased significantly to 7.47 mL ± 9.19 mL at a mean follow-up time of 23.89 months ± 7.66 months (range 15-39 months) with a mean VRR of 90.99% ± 7.52%. The neck circumference, symptom score, and cosmetic grading score significantly decreased from 36.94 cm ± 3.04 cm to 35.06 cm ± 2.84 cm, from 3.78 ± 1.19 to 0.36 ± 0.63, and from 3.42 ± 0.76 to 1.13 ± 0.37, at the 12 months after treatment, respectively (all 7 p < 0.001). Of all the nodules, eight (11.1%) received a second ablation. No major complications occurred. CONCLUSION Ultrasound-guided MWA combined with EI is an effective and safe treatment for solitary nodular RSG and may be a potential alternative to surgery in selected patients, especially for those who are ineligible or unwilling to receive surgical treatment. KEY POINTS • MWA combined with EI is an effective and safe approach for the treatment of solitary nodular RSG. • This treatment should be conducted by experienced physicians. • It provides a potential alternative to surgery for solitary nodular RSG in patients who are ineligible or unwilling to receive surgical treatment.
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Wang R, Li J, Jiang J, Ding J, Yang M, Wang S, Lin M. Modified subxiphoid approach for surgical resection of a retrosternal goiter. Front Surg 2022; 9:923389. [PMID: 36743897 PMCID: PMC9891250 DOI: 10.3389/fsurg.2022.923389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds Unilateral Video-Assisted Thorascopic Surgery (VATS) is a traditional minimally invasive transthoracic approach for the surgical resection of a subxiphoid goiter. Recently, the subxiphoid approach was recommended for an anterior mediastinal mass. This study aims to investigate the feasibility and efficacy of a modified subxiphoid VATS for the resection of a retrosternal goiter as an alternative transthoracic approach. Methods We retrospectively collected all patients who underwent subxiphoid VATS for the resection of a retrosternal goiter from June 2017 to June 2021 in the Zhongshan Hospital or the Zhongshan Hospital Xiamen branch. Ten patients were found. Patient characteristics, perioperative data, and surgical information were collected and further analyzed. Results In our study, all 10 patients underwent a thoracoscopic subxiphoid resection of a retrosternal goiter. The mean age was 49.4 years, and all were female. The majority of patients (70%) were asymptomatic. All patients were assessed by CT imaging before surgery. The mean postoperative hospital stay was 4.9 days. The drainage tube was removed 3 days after operation, and the average drainage volume was 73.1 ml. Postoperative pain was mild, with an average pain grade of 2.4 (measured on a scale from 0 to 10, with lower scores indicating less pain). There were no conversions or perioperative complications in these 10 patients. Conclusions Most retrosternal goiters can be completely resected through the modified subxiphoid approach after an adequate preoperative evaluation and careful intraoperative management. This thoracoscopic subxiphoid approach is feasible and safe for retrosternal goiter resection.
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Affiliation(s)
- Renfeng Wang
- Department of Thoracic Surgery, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Jianfeng Li
- Department of Thoracic Surgery, Yizheng Hospital, Drum Tower Hospital Group of Nanjing, Yangzhou, China,Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minghui Yang
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China,Correspondence: Shuai Wang Miao Lin
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China,Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China,Correspondence: Shuai Wang Miao Lin
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11
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Retrosternal Goitre: Anatomical Aspects and Technical Notes. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030349. [PMID: 35334525 PMCID: PMC8951771 DOI: 10.3390/medicina58030349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022]
Abstract
Background and Objectives: surgery for substernal goitre is still debated in the literature, due to the wide range of surgical options. This article outlines the findings of our extensive experiences, which include 264 cases of patients with “goitre plongeant“, and compares postoperative complications, despite surgical approaches. Material and Methods: preoperative planning and anatomical landmarks are described to determine the potential need of a combined approach. The surgical procedure is described, along with some stratagems, to ensure that the operation is completed safely. A statistical analysis of complications and the length of stay, with a comparison of cervicotomy and combined access, was performed using the Pearson chi-square significance test. Results: 264 patients underwent thyroid surgery for substernal goitre. The Kocher incision was the surgical approach chosen in 256 patients (96.6%), while an accessory incision was performed in 8 patients (3.4%). The necessity to use a two-fold surgical access was linked to a higher rate of postoperative complications (p-value < 0.01). The average length of stay (LOS) for cervicotomy was 2 days (1−3 days), while the average LOS was 5 days (4−7 days) (p-value = n.s.) for combined access. Conclusions: cervicotomy should be the gold standard technique for exploring intrathoracic goitre with a digital dissection, which, in almost all cases, enables the externalization of the mediastinal portion associated. Sternotomy is related to a higher rate of complications, so it should be performed only in selected cases. Management in large-volume centres may be more appropriate.
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12
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Yankov G, Ivanovа S, Genadieva M, Alexieva M, Yanev N, Ivanova D. A mediastinal malignant thyroid paraganglioma: A case report and literature review. Int J Surg Case Rep 2022; 90:106649. [PMID: 34920317 PMCID: PMC8686023 DOI: 10.1016/j.ijscr.2021.106649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Thyroid cancer is the most common endocrine malignancy, while primary paraganglioma of the thyroid gland (TP) is an unusual tumour and in rare cases, this disease tends to mimic thyroid cancer. They are rare extra-adrenal neuroendocrine tumours originating from the neural crest, and are found almost exclusively in the head and neck area. Case presentation We present a case of a 53-year-old man, in whom a mediastinal lesion originating from the left lobe of the thyroid gland was found on routine ultrasound and subsequent computed tomography (CT). Clinical discussion Total thyroidectomy and lymph dissection were performed. A review of the literature was made and a discussion was held regarding the diagnosis, the importance of surgical treatment and further behaviour. Conclusion Surgical removal of the thyroid gland is the main treatment, followed by radiation therapy. The diagnosis and differential diagnosis with other thyroid tumours is extremely important in terms of subsequent behaviour and prognosis. Lesions like the one we described should be operated on. Examination of surgical specimen is more accurate than transcutaneous biopsy. Cervicotomy is an appropriate approach but extension to sternotomy could occur.
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Affiliation(s)
- Georgi Yankov
- Surgical Department of Pulmonary Diseases, University Hospital for Pulmonary Diseases "St. Sofia", Medical University of Sofia, Sofia, Bulgaria
| | - Silvia Ivanovа
- Department of Pathology, University Hospital for Pulmonary Diseases "St. Sofia", Medical University of Sofia, Sofia, Bulgaria.
| | - Marusya Genadieva
- Department of Pathology, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Magdalena Alexieva
- Surgical Department of Pulmonary Diseases, University Hospital for Pulmonary Diseases "St. Sofia", Medical University of Sofia, Sofia, Bulgaria
| | - Nikolay Yanev
- Department of Pulmonary Diseases, University Hospital for Pulmonary Diseases "St. Sofia", Medical University of Sofia, Sofia, Bulgaria
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Machboua A, Thumerel M, Hustache-Castaing R, Jougon J. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6541452. [PMID: 35237808 PMCID: PMC9252114 DOI: 10.1093/icvts/ivac056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/29/2022] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
The substernal goitre is defined as a goitre for which >50% of the mass is located below the superior orifice of the thorax, surgical resection remains the reference treatment, the approach used is the cervicotomy, which often allows to extract the mediastinal portion of the plunging goitre, and we report a rare case of a huge cancerous plunging goitre whose complete resection required the enlargement of the cervicotomy in right hemi-clamshell, for the carcinological, vascular and recurrent control.
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Affiliation(s)
- Alia Machboua
- Department of Thoracic and Neck Surgery, Esophageal, Lung and Heart-Lung, Transplantation, Haut-Lévêque Hospital, University Hospital, Bordeaux, France
- Corresponding author. Department of Thoracic and Neck Surgery, Esophageal, Lung and Heart-Lung, Transplantation, Haut-Lévêque Hospital, University Hospital, Bordeaux, France. Tel: +212636814548; e-mail: (A. Machboua)
| | - Mathieu Thumerel
- Department of Thoracic and Neck Surgery, Esophageal, Lung and Heart-Lung, Transplantation, Haut-Lévêque Hospital, University Hospital, Bordeaux, France
| | - Romain Hustache-Castaing
- Department of Thoracic and Neck Surgery, Esophageal, Lung and Heart-Lung, Transplantation, Haut-Lévêque Hospital, University Hospital, Bordeaux, France
| | - Jacques Jougon
- Department of Thoracic and Neck Surgery, Esophageal, Lung and Heart-Lung, Transplantation, Haut-Lévêque Hospital, University Hospital, Bordeaux, France
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14
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Melo GM, Gonçalves AJ, Walder F, Ferraz C, Neves MC, Abrahão M, Cervantes O. Analysis of the status of treatment of benign thyroid diseases - a public health problem aggravated in the COVID-19 pandemic era. Braz J Otorhinolaryngol 2021; 88:982-989. [PMID: 34799264 PMCID: PMC8536560 DOI: 10.1016/j.bjorl.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Goiters and benign nodules detected in the thyroid are growing lesions and the COVID-19 pandemic have negatively impacted on their surgical treatment. The appropriate selection of patients to treatment will improve the overall health status. This article review will focus on the impact of the COVID-19 pandemic on treatment of benign conditions of the thyroid gland and their implications. METHODS This review pointed out the status of the health system in developing country and the problems to treat benign surgical diseases of thyroid. Aspects of epidemiology, incidence, clinical presentation and surgical treatment of goiters, economic and health status impact were cited. RESULTS All surgical treatment of goiter and other benign conditions were postponed, forced to redirect, and reschedule all benign surgeries, situation aggravated by poor public management and closure of hospital beds. These conditions have caused deterioration in patients' physical (decompensated thyroid disease) and mental health status, increasing work disabilities and burdening society by increasing the social and health cost. The overall situation could be catastrophic in emergent countries where this increased disease-related social expenditure on surgical treatment may increase the risk of national impoverishment as increase the treatment cost. Brazilian Society Head and Neck Surgery related some recommendations and new suggestions were made to safely treat these high potential hazard surgical conditions. CONCLUSIONS Surgeries for goiter and benign thyroid conditions can be performed during the COVID-19 pandemic, following strict safety protocols for the patient and the medical team, reducing the negative economic and on patient health impact.
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Affiliation(s)
- Giulianno Molina Melo
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil; Sociedade Brasileira de Cirurgia de Cabeça e Pescoço (SBCCP), Departamento de Tireoide, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
| | - Antonio José Gonçalves
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Cirurgia - Divisão de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Sociedade Brasileira de Cirurgia de Cabeça e Pescoço (SBCCP), São Paulo, SP, Brazil
| | - Fernando Walder
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil; Sociedade Brasileira de Cirurgia de Cabeça e Pescoço (SBCCP), São Paulo, SP, Brazil
| | - Carolina Ferraz
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Murilo Catafesta Neves
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil; Beneficencia Portuguesa de São Paulo Hospital, Departamento de Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil
| | - Marcio Abrahão
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil
| | - Onivaldo Cervantes
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil
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Bianchi D, Scamporlino A, Costantini M, Cavallesco G, Morandi U, Stefani A. A case of cervico-mediastinal paraganglioma mimicking an ectopic goiter. Int J Surg Case Rep 2021; 86:106357. [PMID: 34464842 PMCID: PMC8408516 DOI: 10.1016/j.ijscr.2021.106357] [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: 07/27/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Mediastinal paragangliomas are rare neuroendocrine tumors that originate from extra-adrenal paraganglia, occasionally secreting catecholamines. Nonfunctional mediastinal paragangliomas present nonspecific clinical and radiological features and represent a diagnostic challenge. Case presentation A 53-year old woman presented with cough and dyspnea increasing over time. CT-scan and ultrasonography showed a large vascularized cervico-mediastinal mass, consistent with an intrathoracic ectopic goiter. Preoperative angiography showed a blood supply from neck vessels. The lesion was completely removed through a cervical approach. The diagnosis of paraganglioma was a histological surprise. The patient is alive without recurrence 30 months after surgery. Clinical discussion When preoperatively diagnosed, the treatment of choice of a mediastinal paraganglioma is surgical excision. However, a preoperative diagnosis of mediastinal paraganglioma is difficult to obtain, especially in cases of nonfunctional lesions. Distinction between an intrathoracic goiter and a nonfunctional paraganglioma can be extremely difficult and, given the rarity of the latter, an ectopic goiter is suspected in first instance. CT-scan and ultrasonography are of little use in the differential diagnosis. However, scintigraphy with 123I-metaiodobenzylguanidine can be an useful diagnostic tool when a paraganglioma is suspected. In case of vascularized cervico-mediastinal mass, such as paragangliomas or intrathoracic goiter, preoperative angiography should be performed to study the blood supply and orient the surgical approach. Conclusion Although uncommon, paragangliomas should be considered in the differential diagnosis of mediastinal masses, especially when an ectopic goiter is suspected. Clinical diagnosis of mediastinal nonfunctioning paragangliomas is challenging. Mediastinal paragangliomas can mimic intrathoracic goiters. If a clinical suspicion of paraganglioma is raised, 123I-MIBG can be useful. In case of a vascularized cervico-mediastinal mass, an angiography is recommended. Angiography can detect the blood supply and guide the surgical approach.
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Affiliation(s)
- Daniel Bianchi
- Division of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Adriana Scamporlino
- Division of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Costantini
- Department of Pathology, University Hospital of Modena, Modena, Italy.
| | | | - Uliano Morandi
- Division of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
| | - Alessandro Stefani
- Division of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
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16
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Chiang PL, Lin WC, Chen HL, Luo SD, Chen MH, Chen WC, Chang YH, Chou CK, Su YY, Tung YC, Chen WC, Chi SY, Baek JH. Efficacy and safety of single-session radiofrequency ablation for intrathoracic goiter: preliminary results and short-term evaluation. Int J Hyperthermia 2021; 38:976-984. [PMID: 34167409 DOI: 10.1080/02656736.2021.1942241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND An intrathoracic goiter (ITG) is defined as a thyroid extension below the sternal notch. Compared to cervical goiters, surgery for ITG is more challenging, with a higher risk of an extracervical approach. Ultrasound (US)-guided radiofrequency ablation (RFA) is a minimally invasive treatment modality. The purpose of this study was to prospectively evaluate the safety and efficacy of RFA in patients with ITG. METHODS From a total of 324 patients who underwent thyroid RFA at a single medical center, 15 patients (mean age 52.2 years; 73.3% female) with 16 ITGs were included and classified into three grades and three types using the cross-section imaging CT system. Clinical features and demographics, degree of extension, RFA details, goiter volume, and complications were analyzed. RESULTS Mean pre- and post-RFA goiter volumes as measured by US were 106.62 ± 61.82 and 25.09 ± 14.22 mL respectively, with a volume reduction rate (VRR) of 75.5% (p < 0.001) at 6 months. The VRR as measured by CT/MRI was 57.0 ± 10.0% (p < 0.001) at 6 months. The intrathoracic length reduction rate at 6 months was 44.9 ± 39.2% (p = 0.001). In addition, 4 (25%) ITGs had total regression of the intrathoracic extension, with a downgrade from grade 1 to cervical goiter. Mean pre- and post-RFA symptom and cosmetic scores were 1.53 and 0.15 (p = 0.001), and 2.67 and 2.00 (p = 0.001), respectively. One patient had transient vocal cord palsy and another had perithyroidal and mediastinal hemorrhage. CONCLUSION US-guided RFA is an effective treatment for ITG in terms of both cervical and intrathoracic reductions with an acceptable complication rate.
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Affiliation(s)
- Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, 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
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 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
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yan-Ye Su
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Cheng Tung
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chieh Chen
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Goiters tend to grow slowly and steadily over many years, occasionally reaching the mediastinum and extending through the thoracic inlet into the visceral compartment. In most cases, retrosternal goiters originate from the cervical portion of the thyroid. The incidence of retrosternal goiters varies considerably, ranging from 0.2 to 45% of all thyroidectomies, depending on the criteria used to define this type of goiter. Symptoms are generally related to the compressive nature of the mass on the adjacent structures, and most patients report some form of respiratory manifestation associated with the goiter. A diagnostic assessment usually includes an evaluation of thyroid function, chest radiography, and computed tomography. Fine-needle aspiration biopsy should be avoided in substernal areas of the goiter due to limited visibility and location of vital structures in this region. Treatment of retrosternal goiters is surgical, as medical therapy is generally unsuccessful in these cases.
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Affiliation(s)
- M Knobel
- Thyroid Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 155, 8th floor, bl 3, PAMb, São Paulo, 05403-900, Brazil.
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18
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Van Slycke S, Simons AS, Van Den Heede K, Van Crombrugge P, Tournoy K, Simons P, Vermeersch H, Brusselaers N. Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study. Updates Surg 2021; 73:1-10. [PMID: 33779950 PMCID: PMC8397680 DOI: 10.1007/s13304-021-01027-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
Objective Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy. Methods In a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500). Results An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%). Conclusion In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy. Level of evidence IV Supplementary Information The online version contains supplementary material available at 10.1007/s13304-021-01027-1.
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Affiliation(s)
- S Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
| | - A-S Simons
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Group of Biomedical Sciences, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - K Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - P Van Crombrugge
- Department of Endocrinology, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - K Tournoy
- Department of Pneumology, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Department of Internal Medicine and Paediatrics, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - P Simons
- Department of Radiology, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - H Vermeersch
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Plastic and Reconstructive Surgery, Department of Human Structure and Repair, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - N Brusselaers
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Department of Microbiology, Tumour and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Tomtebodavagen 16, 17165, Stockholm, Sweden. .,Global Health Institute, Antwerp University, Campus Drie Eiken, Gouverneur Kinsbergencentrum, Doornstraat 331, 2610, Wilrijk, Belgium.
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Cardiopulmonary Arrest Caused by Large Substernal Goiter-Treatment with Combined Cervical Approach and Median Mini-Sternotomy: Report of a Case. ACTA ACUST UNITED AC 2021; 57:medicina57040303. [PMID: 33804853 PMCID: PMC8063807 DOI: 10.3390/medicina57040303] [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: 02/05/2021] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Substernal goiter is usually defined as a goiter that extends below the thoracic inlet or a goiter with more than 50% of its mass lying below the thoracic inlet. Substernal goiters may compress adjacent anatomical structures causing a variety of symptoms. CASE REPORT Here we report a rare case of a 75-year-old woman presenting with cardiac arrest caused by acute respiratory failure due to tracheal compression by a substernal goiter. DISCUSSION Substernal goiters can be classified as primary or secondary depending on their site of origin. Symptoms are diverse and include a palpable neck mass, mild dyspnea to asphyxia, dysphagia, dysphonia, and superior vena cava syndrome. Diagnosis of substernal goiter is largely based on computed tomography imaging, which will show the location of the goiter and its extension in the thoracic cavity. Surgery is the treatment of choice for symptomatic patients with substernal goiter. The majority of substernal goiters are resected through a cervical approach. However, in approximately 5% of patients, a thoracic approach is required. The most important factor determining whether a thoracic approach should be used is the depth of the extension to the tracheal bifurcation on CT imaging. CONCLUSION Cardiac arrest appearing as the first symptom of a substernal goiter is a very rare condition and should be treated by emergency thyroidectomy via a cervical or thoracic approach depending on the CT imaging findings.
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20
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Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series. Ann Med Surg (Lond) 2021; 62:353-357. [PMID: 33552494 PMCID: PMC7848720 DOI: 10.1016/j.amsu.2021.01.081] [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: 12/25/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. Materiels and methods Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. Results 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. Conclusions With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality. In the literature, there is no consensus on the definition of cervico-mediastinal goiters. CMG is a challenging disease that needs proper clinical, biological and radiological assessment. Malignancy in a CMG is not higher than that of the cervical goiters and most of the foci in CMG were in the intrathoracic region. With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases.
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21
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Shioya N, Inoue N, Kawashima N, Tsukamoto Y, Nakayama M, Hazama K, Shichinohe Y, Suzuki F, Honma N. Enlargement of Intrathoracic Goiter with Unilateral Phrenic Nerve Paralysis Leading to Cardiopulmonary Arrest. Intern Med 2021; 60:91-97. [PMID: 32893229 PMCID: PMC7835477 DOI: 10.2169/internalmedicine.5075-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
As an intrathoracic goiter expands, it causes airway stenosis and phrenic nerve paralysis, and slight respiratory stimuli can trigger sudden life-threatening hypoventilation. A 78-year-old obese woman with a large intrathoracic goiter was found unconscious with agonal breathing in her room early in the morning. Cardiopulmonary resuscitation restored spontaneous circulation. She underwent surgical removal of the goiter; however, she required long-term mechanical ventilation because of atelectasis due to phrenic nerve paralysis. In patients with large intrathoracic goiters, difficulty breathing on exertion and diaphragm elevation on chest X-ray may be significant findings predicting future respiratory failure.
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Affiliation(s)
- Nobuki Shioya
- Critical Care and Emergency Center, National Hospital Organization Hokkaido Medical Center, Japan
| | - Nozomu Inoue
- Critical Care and Emergency Center, National Hospital Organization Hokkaido Medical Center, Japan
| | - Naonori Kawashima
- Critical Care and Emergency Center, National Hospital Organization Hokkaido Medical Center, Japan
| | - Yuki Tsukamoto
- Critical Care and Emergency Center, National Hospital Organization Hokkaido Medical Center, Japan
| | - Miyabi Nakayama
- Critical Care and Emergency Center, National Hospital Organization Hokkaido Medical Center, Japan
| | - Koji Hazama
- Critical Care and Emergency Center, National Hospital Organization Hokkaido Medical Center, Japan
| | - Yasuo Shichinohe
- Critical Care and Emergency Center, National Hospital Organization Hokkaido Medical Center, Japan
| | - Fumiyuki Suzuki
- Department of Otorhinolaryngology, National Hospital Organization Hokkaido Medical Center, Japan
| | - Naotake Honma
- Department of Respiratory Surgery, National Hospital Organization Hokkaido Medical Center, Japan
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22
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A Case of a Young Woman with Cervico-Mediastinal Malignant Goiter. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
The main treatment in nearly every case of thyroid cancer is surgery. The exception often refers to anaplastic carcinoma because this cancer is already widespread at the time of diagnosis. Most of the cases are treated with thyroidectomy, but small tumors that spread inside the thyroid gland might be treated by lobectomy. Intrathoracic goiter accounts for 5.8% of all mediastinal masses. On the other hand, the incidence of thyroid malignancy in cervico-mediastinal thyroid masses is 7,7%. In such cases, total thyroidectomy with en block removal of the mediastinal portion of the gland is the treatment of choice. We present a case of a 34-year-old woman with cervico-mediastinal malignant goiter.
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Karsan RB, Nanjaiah P, Hogan J, Mehta D, Stetchman M. Concomitant aortic valve replacement and retrosternal goitre resection via mini-sternotomy: a novel case. J Surg Case Rep 2020; 2020:rjaa066. [PMID: 32509262 PMCID: PMC7263760 DOI: 10.1093/jscr/rjaa066] [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: 01/26/2020] [Accepted: 03/10/2020] [Indexed: 11/12/2022] Open
Abstract
Median sternotomy has been used to aide thyroidectomies demonstrating good outcomes; however no cases have been documented to show the use of mini-sternotomy to perform simultaneous thyroidectomy and valve surgery. We present a novel case of an 83-year-old woman with severe aortic stenosis and retrosternal goitre extending to the aortic arch deemed unsuitable for TAVI. Due to co-morbid status and anatomical position preventing routine thyroidectomy, we elected to perform a combined procedure to excise the goitre and perform an aortic valve replacement through a mini-J sternotomy, utilizing 3D-reconstructed imaging to plan our approach. This case shows that mini-sternotomy is a safe and effective method to perform concomitant thyroidectomy and aortic valve surgery.
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Affiliation(s)
- Rickesh B Karsan
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Prakash Nanjaiah
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - John Hogan
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Dheeraj Mehta
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Michael Stetchman
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, UK
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24
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Abdelrahman H, Al-Thani H, Al-Sulaiti M, Tabeb A, El-Menyar A. Clinical Presentation and Surgical Treatment of Retrosternal Goiter: A Case Series Study. Qatar Med J 2020; 2020:13. [PMID: 32391249 PMCID: PMC7198470 DOI: 10.5339/qmj.2020.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/01/2019] [Indexed: 11/03/2022] Open
Abstract
Background: The retrosternal goiter (RSG) is a slow-growing mass often benign in nature; thyroidectomy remains the preferred standard curative treatment. This study aimed to explore the local experience of RSG with respect to the clinical presentation, classifications, management, and outcomes. Method: A retrospective chart review was conducted to include all cases diagnosed with RSG and underwent thyroidectomy between January 1998 and December 2013. Results: A total of 1210 patients underwent thyroidectomy; of which 30 (2.5%) patients were diagnosed to have RSG. The commonly reported symptoms were dyspnea (40%), pain and discomfort (30%), dysphagia (26.7%), and hoarseness (20%). Thirteen patients (43.3%) were completely asymptomatic. The fine-needle aspiration cytology was performed in 22 (73.3%) patients, of whom the majority was benign (77.3%). The grading classification showed that grade 1 is the most frequent (73.3%). Total bilateral thyroidectomy was the most prevailing procedure in 57% cases followed by partial thyroidectomy. All patients underwent retrosternal thyroidectomy through a cervical incision except for one case. Postoperative histopathology showed frequent benign multinodular goiter (83.3%), followed by papillary thyroid cancer (10%) and thyroiditis (6.7%). The most common complication after thyroidectomy was tracheomalacia (13.4%), transient hypocalcemia (10%), and hypoparathyroidism (6.7%). There was no intraoperative or perioperative mortality. Conclusion: RSG is a rare entity often presented with pressure symptoms, mostly involving anterior mediastinum and had a challenging surgical procedure. A large multicenter study is needed to include more cases in order to have a consensus on the definition and classification system for such important clinical goiter presentation.
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Affiliation(s)
| | - Hassan Al-Thani
- Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Abdelhakem Tabeb
- Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH), Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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25
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Casella C, Molfino S, Cappelli C, Salvoldi F, Benvenuti MR, Portolani N. Thyroiditis process as a predictive factor of sternotomy in the treatment of cervico-mediastinal goiter. BMC Surg 2019; 18:20. [PMID: 31074402 PMCID: PMC7402563 DOI: 10.1186/s12893-019-0474-z] [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: 11/20/2018] [Accepted: 01/07/2019] [Indexed: 11/11/2022] Open
Abstract
Background About 10% of cervico-mediastinal goiter need to associate cervicotomy with a total or partial sternotomy to allow a safe removal of the goiter. Aim of this study is to identify preoperative predictors of sternotomy for mediastinal goiter. Methods Between January 2008 and December 2015, 586 patients were submitted to total thyroidectomy at Surgical Clinic of Brescia, Italy. Among these, patients with cervico-mediastinal goiter have been divided in two groups based on the necessity of an associated sternotomy in the operating field: Group 1 (n = 40 patients) did not need sternotomy and Group 2 (n = 4 patients) underwent cervicotomy associated with sternotomy. Clinical and pathological characteristics of patients were retrospectivelly recorded. Results Among study group, 44 patients had cervico-mediastinal goiter. Thoracic CT was performed in all patients: an extension above aortic arch was found in 41 patients (93.18%) while an extention below aortic arch was found in 3 patients (6.82%). The extension of the goiter below the aortic arch resulted as a predictive value in the choice of surgical treatment (p = 0.0001). The thyroiditis process was found to be a significant predictive of the extention to a sternotomic approach (p = 0.029). The years of goiter’s presence were on average 8.40 years in Group 1 and 14.75 years in Group 2. These parameters proved to be predictive when choosing a cervicotomy with sternotomy. Conclusions: Our study, despite limitations posed by small sample and its retrospective analisys, highlights the role of goiter’s extention (below the aortic arch), disease length (for more than 14.75 years) and flogistic process (positivity of Tg Ab and anti-TPO-Ab) in the choice of combined (cervicotomic and sternotomic) approach to goiter’s removal.
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Affiliation(s)
- Claudio Casella
- Department of Molecular and Translational Medicine, Spedali Civili, 3rd Division of General Surgery, University of Brescia, P.zle Spedali Civili 1, 25123, Brescia, Italy.
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Medical Clinic, University of Brescia, Brescia, Italy
| | - Federica Salvoldi
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Medical Clinic, University of Brescia, Brescia, Italy
| | | | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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26
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Tikka T, Nixon IJ, Harrison-Phipps K, Simo R. Predictors of the need for an extracervical approach to intrathoracic goitre. BJS Open 2018; 3:174-179. [PMID: 30957064 PMCID: PMC6433325 DOI: 10.1002/bjs5.50123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/02/2018] [Indexed: 11/24/2022] Open
Abstract
Background Sternotomy and lateral thoracotomy are required infrequently to remove an intrathoracic goitre (ITG). As few studies have explored the need for an extracervical approach (ECA), the aim of this study was to examine this in a large cohort of patients. Methods A prospective database of all patients who had surgery for ITG between 2004 and 2016 was interrogated. Patient demographics, preoperative characteristics and type of operation were analysed to identify factors associated with an ECA. Results Of 237 patients who had surgery for ITG, 29 (12·2 per cent) required an ECA. ITGs below the aortic arch (odds ratio (OR) 10·84; P = 0·004), those with an iceberg shape (OR 59·30; P < 0·001) and revisional surgery (OR 4·83; P = 0·022) were significant preoperative predictors of an ECA. Conclusion The extent of intrathoracic extension in relation to the aortic arch, iceberg goitre shape and revisional surgery were independent risk factors for ECA. Careful preoperative assessment should take these factors into consideration when determining the optimal surgical approach to ITG.
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Affiliation(s)
- T Tikka
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital Glasgow UK.,School of Psychological Sciences and Health University of Strathclyde Glasgow UK
| | - I J Nixon
- Department of Otolaryngology - Head and Neck Surgery, NHS Lothian Edinburgh UK
| | - K Harrison-Phipps
- Department of Thoracic Surgery Guy's and St Thomas' NHS Foundation Trust London UK
| | - R Simo
- Department of Otolaryngology - Head and Neck Surgery Guy's and St Thomas' NHS Foundation Trust London UK
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27
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Surgical management of intrathoracic goitres. Eur Arch Otorhinolaryngol 2018; 276:305-314. [PMID: 30506185 DOI: 10.1007/s00405-018-5213-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intrathoracic goitres (ITG) often present with compressive symptoms and require specialised care by experienced surgical teams. Most ITG can be accessed by a transcervical approach (TCA) and only between 1 and 15% will require an extracervical approach (ECA). Many controversies exist regarding the clinical presentation, evaluation, selection of cases for ECA, surgical technique and outcomes. This paper reviews the recent literature on the management, outcomes and evidence-based treatment strategies of ITG. METHODS We conducted a review of the literature on the evaluation, management and outcomes of surgery for ITGs. RESULTS The incidence of cancer in the ITGs ranges between 4 and 20%. Multiplanar CT scanning offers the best preoperative evaluation and aids to determine the approach. Most ITG can be accessed by TCA and ECA are only needed in maximum 15% of cases. In experienced hands, the outcome of these surgeries is comparable to thyroid surgery for non-ITG. CONCLUSIONS Surgery for ITG is challenging. The experienced surgeon however, with few exceptions can address ITG via TCA, with outcomes comparable to those of uncomplicated thyroid surgery.
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Doulaptsi M, Karatzanis A, Prokopakis E, Velegrakis S, Loutsidi A, Trachalaki A, Velegrakis G. Substernal goiter: Treatment and challenges. Twenty-two years of experience in diagnosis and management of substernal goiters. Auris Nasus Larynx 2018; 46:246-251. [PMID: 30055961 DOI: 10.1016/j.anl.2018.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/24/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Descending goiter has been a focus of controversy in thyroid surgery until nowadays. This study aims to investigate the diagnosis and treatment options of thyroid goiters extending into the mediastinum and the thoracic cavity. METHODS AND MATERIALS A retrospective study was conducted assessing all cases of substernal goiter managed in a tertiary care referral center within 22 years. Demographics, clinical, operative, anatomical, and pathological data of the patients were recorded and analyzed. RESULTS Among 3.028 total thyroidectomies, 212 procedures for substernal goiters were studied. All cases underwent total thyroidectomy. The surgical approach was cervical in all but two cases. A very low rate of complications and zero mortality were noted. Incidence of malignancy on permanent histology was 16%. CONCLUSION Descending goiter constitutes a major indication for thyroid surgery. The overwhelming majority of descending goiters may be managed surgically through a neck incision. In experienced hands good results with low morbidity should be expected. Such cases should be considered as challenging, however, and therefore management in a referral center may be necessary in order to ensure optimal results.
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Affiliation(s)
- Maria Doulaptsi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Panepistimiou Avenue, 71500, Crete, Greece.
| | - Alexandros Karatzanis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Panepistimiou Avenue, 71500, Crete, Greece
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Panepistimiou Avenue, 71500, Crete, Greece
| | - Stylianos Velegrakis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Panepistimiou Avenue, 71500, Crete, Greece
| | - Alexia Loutsidi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Panepistimiou Avenue, 71500, Crete, Greece
| | - Athina Trachalaki
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Panepistimiou Avenue, 71500, Crete, Greece
| | - George Velegrakis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Panepistimiou Avenue, 71500, Crete, Greece
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Di Crescenzo VG, Napolitano F, Panico C, Di Crescenzo RM, Zeppa P, Vatrella A, Laperuta P. Surgical approach in thymectomy: Our experience and review of the literature. Int J Surg Case Rep 2017; 39:19-24. [PMID: 28787670 PMCID: PMC5545819 DOI: 10.1016/j.ijscr.2017.07.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022] Open
Abstract
Aim Thymectomy is the main treatment for thymoma and patients with myasthenia gravis (MG). The traditional approach is through a median sternotomy, but, recently, thymectomy through minimally invasive approaches is increasingly performed. Our purpose is an analysis and discussion of the clinical presentation, the diagnostic procedures and the surgical technique. We also consider post-operative complications and results, over a period of 5 years (May 2011–June 2016), in thymic masses admitted in our Thoracic Surgery Unit. Methods We analyzed 8 patients who underwent surgical treatment for thymic masses over a period of 5 years. 6 patients (75%) had thymoma, 2 patients (25%) had thymic carcinomas. 2 patients with thymoma (33%) had myasthenia gravis. We performed a complete surgical resection with median sternotomy as standard approach. Results One patient (12%) died in the postoperative period. The histological study revealed 6 (75%) thymoma and 2 (25%) thymic carcinomas. Post-operative morbidity occurred in 2 patients (25%) and were: pneumonia in 1 case (12%), atrial fibrillation and pleural effusion in 2 patients (25%). One patient with thymoma type A recurred at skeletal muscle 2-years after surgery. Conclusions Thymic malignancies are rare tumors. Surgical resection is the main treatment, but a multimodal approach is useful for many patients. Radical thymectomy is completed removing all the soft tissue in the anterior mediastinum between the two phrenic nerves and this is the most important factor in controlling myasthenia and influencing survival in patients with thymoma. Open (median sternotomy) approach has been the standard approach for thymectomy for the better visualization of the anatomical structures. Actually, video-assisted thoracoscopic surgery (VATS) thymectomy and robotic video-assisted thoracoscopic (R-VATS) approach versus open surgery has an equal if not superior oncological efficacy, better perioperative complications and survival outcomes.
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Affiliation(s)
| | - Filomena Napolitano
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
| | - Claudio Panico
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
| | - Rosa Maria Di Crescenzo
- Department of Medicine and Surgery, Pathology Unit, Federico II University of Naples, Italy.
| | - Pio Zeppa
- Department of Medicine and Surgery, Pathology Unit, University of Salerno, Italy.
| | - Alessandro Vatrella
- Department of Medicine and Surgery, Section of Respiratory Diseases, University of Salerno, Salerno, Italy.
| | - Paolo Laperuta
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
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30
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Mantke R. Komplexität von DRG‑Routinedaten erschwert auch bei der Schilddrüsenoperation die Interpretation. Chirurg 2017; 88:532-533. [DOI: 10.1007/s00104-017-0436-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Laperuta P, Napolitano F, Di Crescenzo RM, Zeppa P, Galderisi A, Selleri C, Vatrella A, Capunzo M, Di Crescenzo VG. Idiopathic pleural panniculitis with recurrent pleural effusion not associated with Weber-Christian disease. Open Med (Wars) 2017; 11:394-398. [PMID: 28352826 PMCID: PMC5329858 DOI: 10.1515/med-2016-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/19/2016] [Indexed: 01/03/2023] Open
Abstract
A 82-year-old patient with dyspnea and a recurrent history of pleural effusion was admitted into our unit. He performed a Chest computed tomography showing right pleural effusion. Video-assisted thoracoscopy (VATS) exploratory showed parietal pleural thickening of adipose tissue. The surgical procedure consisted, therefore, in the execution of multiple biopsies of the parietal pleura which appeared covered, on the whole surface, by islands of adipose tissue, without macroscopic pathological aspects. After the procedure was performed pleurodesis with talc. The definitive histological examination consisted of normal mesothelial cells surrounded by fatty tissue infiltrated by small lymphocytes in a patient without skin lesions or visceral or systemic signs of inflammatory involvement of the adipose tissue. We reported a rare case of idiopathic pleural panniculitis with recurrent pleural effusion not associated with Weber-Christian disease.
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Affiliation(s)
- Paolo Laperuta
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy
| | - Filomena Napolitano
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy
| | | | - Pio Zeppa
- Department of Medicine and Surgery, Pathology Unit, University of Salerno, Italy
| | - Antonio Galderisi
- Respiratory Disease Unit, A.O.U. “S. Giovanni di Dio & Ruggi D’Aragona”, Salerno, Italy
| | - Carmine Selleri
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alessandro Vatrella
- Department of Medicine and Surgery, Section of Respiratory Diseases, University of Salerno, Salerno, Italy
| | - Mario Capunzo
- Department of Medicine and Surgery, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Vincenzo Giuseppe Di Crescenzo
- Department of Medicine and Surgery, University of Salerno, Baronissi Campus, Via S. Allende, 84081 Baronissi, Salerno, Italy
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Giudice V, Rosamilio R, Serio B, Di Crescenzo RM, Rossi F, De Paulis A, Pilone V, Selleri C. Role of Laparoscopic Splenectomy in Elderly Immune Thrombocytopenia. Open Med (Wars) 2017; 11:361-368. [PMID: 28352821 PMCID: PMC5329853 DOI: 10.1515/med-2016-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/19/2016] [Indexed: 12/17/2022] Open
Abstract
The management of older patients with chronic primary immune thrombocytopenia (ITP) is still very challenging because of the fragility of older patients who frequently have severe comorbidities and/or disabilities. Corticosteroid-based first-line therapies fail in most of the cases and patients require a second-line treatment, choosing between rituximab, thrombopoietin-receptor agonists and splenectomy. The choice of the best treatment in elderly patients is a compromise between effectiveness and safety and laparoscopic splenectomy may be a good option with a complete remission rate of 67% at 60 months. But relapse and complication rates remain higher than in younger splenectomized ITP patients because elderly patients undergo splenectomy with unfavorable conditions (age >60 year-old, presence of comorbidities, or multiple previous treatments) which negatively influence the outcome, regardless the hematological response. For these reasons, a good management of concomitant diseases and the option to not use the splenectomy as the last possible treatment could improve the outcome of old splenectomized patients.
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Affiliation(s)
- Valentina Giudice
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Rosa Rosamilio
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Bianca Serio
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | | | - Francesca Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Pilone
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Carmine Selleri
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, 84131, Italy
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Tsilimigras DI, Patrini D, Antonopoulou A, Velissaris D, Koletsis E, Lawrence D, Panagiotopoulos N. Retrosternal goitre: the role of the thoracic surgeon. J Thorac Dis 2017; 9:860-863. [PMID: 28449497 DOI: 10.21037/jtd.2017.02.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose of this Mini-Review is to evaluate the role of a thoracic surgeon in the surgical management of retrosternal goitre. A cervical approach is sufficient in the majority of the cases. On the other hand, there are cases where a cervical approach is combined with sternotomy or thoracotomy, depending on the position of the goitre, in the anterior or posterior mediastinum. On top of that, different minimally invasive approaches including video-assisted thoracoscopic surgery (VATS) and robotic-assisted surgery (RATS) have been introduced, providing faster recovery, superior manoeuvrability and better aesthetic results.
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Affiliation(s)
- Diamantis I Tsilimigras
- Department of Cardiothoracic Surgery, University College London Hospitals (UCLH), London, UK
| | - Davide Patrini
- Department of Cardiothoracic Surgery, University College London Hospitals (UCLH), London, UK
| | - Aspasia Antonopoulou
- Department of Cardiothoracic Surgery, University College London Hospitals (UCLH), London, UK
| | | | | | - David Lawrence
- Department of Cardiothoracic Surgery, University College London Hospitals (UCLH), London, UK
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Cascone AM, Siano M, Angrisani B, Di Crescenzo RM, Vatrella A, Selleri C, Salzano F, Zeppa P. Fine-needle cytology in the follow-up of breast carcinoma. Aging Clin Exp Res 2017; 29:167-171. [PMID: 27873102 DOI: 10.1007/s40520-016-0645-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/12/2016] [Indexed: 11/26/2022]
Abstract
The postoperative follow-up strategies for breast carcinoma (BC) utilize different procedures; the aim of this study was to investigate the role of fine-needle cytology (FNC) in the follow-up of BC patients. Two hundred sixty-six FNC samples from 190 BC patients have been reviewed. The target anatomical sites were 190 breast including 155 ipsilateral and 145 contralateral breast lesions and 76 extra-mammary nodules. Extra-mammary lesions included lymph nodes, thyroidal nodules, soft tissue lesions, (subcutaneous and sub-scars), salivary glands and deep located masses. Diagnostic distribution of the breast lesions was as follows: 51 positive, 15 indeterminate/suspicious, 119 negative and 5 inadequate. Positive cases included 43 ipsilateral and 8 contralateral BC, 9 BC in different quadrants from those of onset of the first BC. Sensitivity, specificity and accuracy have been 90, 91 and 90&, respectively. FNC, in a correct setting, is a reliable and effective method for the follow-up management of BC patients.
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Affiliation(s)
- Anna Maria Cascone
- Department of Pathology, Azienda Ospedaliera Universitaria AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Largo Città d'Ippocrate n.1, 84100, Salerno, Italy
| | - Maria Siano
- Department of Pathology, Azienda Ospedaliera Universitaria AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Largo Città d'Ippocrate n.1, 84100, Salerno, Italy
| | - Basilio Angrisani
- Department of Pathology, Azienda Ospedaliera Universitaria AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Largo Città d'Ippocrate n.1, 84100, Salerno, Italy
| | - Rosa Maria Di Crescenzo
- Department of Pathology, Azienda Ospedaliera Universitaria AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Largo Città d'Ippocrate n.1, 84100, Salerno, Italy
| | - Alessandro Vatrella
- Department of Pathology, Azienda Ospedaliera Universitaria AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Largo Città d'Ippocrate n.1, 84100, Salerno, Italy
| | - Carmine Selleri
- Department of Pathology, Azienda Ospedaliera Universitaria AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Largo Città d'Ippocrate n.1, 84100, Salerno, Italy
| | - Francesco Salzano
- Department of Pathology, Azienda Ospedaliera Universitaria AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Largo Città d'Ippocrate n.1, 84100, Salerno, Italy
| | - Pio Zeppa
- Department of Pathology, Azienda Ospedaliera Universitaria AOU San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Largo Città d'Ippocrate n.1, 84100, Salerno, Italy.
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Vitale C, Galderisi A, Maglio A, Laperuta P, Di Crescenzo RM, Selleri C, Molino A, Vatrella A. Diagnostic yield and safety of C-TBNA in elderly patients with lung cancer. Open Med (Wars) 2016; 11:477-481. [PMID: 28352839 PMCID: PMC5329871 DOI: 10.1515/med-2016-0084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 01/14/2023] Open
Abstract
Conventional transbronchial needle aspiration (C-TBNA) is a minimally invasive technique used primarily in the diagnosis and staging of lung cancer. Currently lung cancer is mostly considered a disease of the elderly and the management of this disease in older patients is a growing concern. In this study we aimed to assess the diagnostic yield and safety of C-TBNA in elderly patients. A retrospective review of 88 consecutive C-TBNA procedures for nodal staging in suspected or confirmed primary lung cancer or pathological confirmation in suspected advanced lung cancer was performed. Patients were divided into less than 70 (<70yrs) or 70 and older (≥70yrs) age groups for analysis. There were no significant differences either in the diagnostic yield (69% in patients aged < 70 yrs and 74% patients aged ≥ 70 yrs (p=0.5) nor in the complication rate (respectively 8.8% in patients aged < 70 yrs and 6.9% in patients aged ≥ 70 yrs (p=0.7) between the two age groups. Reported complications were minor bleeding and poor tolerance; no major complications were observed. Based on our experience, C-TBNA represents a useful and safe alternative procedure for the diagnosis and staging of lung cancer in elderly patients.
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Affiliation(s)
| | - Antonio Galderisi
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Italy
| | - Paolo Laperuta
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Italy
| | - Rosa Maria Di Crescenzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Italy
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Italy
| | - Antonio Molino
- Respiratory Department, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’, Napoli, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Italy
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