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Balch CM. The Surgical Legacy of Randolph Lee Clark, Jr, MD: First Director and Surgeon-in-Chief of University of Texas MD Anderson Cancer Center II. Surgical Practice and Leadership at University of Texas MD Anderson Cancer Center (1946-1978). Ann Surg Oncol 2021; 28:4794-4804. [PMID: 33515334 DOI: 10.1245/s10434-020-09514-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022]
Abstract
Dr. R. Lee Clark Jr brought a broad-based cancer surgery experience to MD Anderson Hospital for Cancer Research when he became its first Surgeon-in-Chief and full-time salaried physician in 1946. He performed major surgery until 1971 including major head and neck operations, thyroidectomy, mastectomy, radical melanoma and sarcoma surgery, gastric and abdominal-perineal resection, and even hemipelvectomy. He initiated major programs in radiation therapy and mammography breast screening, and organized teams of specialists in a group practice providing multidisciplinary cancer care. Dr. Clark was elected into membership by the James Ewing Society (currently the Society of Surgical Oncology), the Southern Surgical Association, and the American Surgical Association, and was a founding member of the Society of Head and Neck Surgery. The Society of Surgical Oncology honored him with the Lucy Wortham James Award in 1965 and the James Ewing Lecture Award in 1977. Dr. Clark also provided invaluable leadership in the American College of Surgeons, leading a fledgling Committee on Cancer into a robust organization that became the Commission on Cancer. The College of Surgeons honored him with their Distinguished Service Award in 1969. Dr. Clark recruited major surgical leaders and personally designed the new hospital that opened in 1954, described in Time magazine as "the most modern, most ingeniously designed hospital in the U.S." R. Lee Clark, Jr. was an accomplished and busy clinical surgeon, a visionary and charismatic leader, and an organizational genius. Indeed, he was one of the first pioneers in the specialty of surgical oncology.
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Affiliation(s)
- Charles M Balch
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ballarati U, Marinoni U, Puricelli G, Spreafico G. Clinico-statistical Considerations on Thyroid Cancer in the Youth. TUMORI JOURNAL 2018; 52:201-29. [PMID: 5962249 DOI: 10.1177/030089166605200305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
On a series of 220 patients with carcinoma of the thyroid, 17 (10 females and 7 males) were under the 24th year of age. In four cases the tumor was diagnosed between the 5th and the 14th year of age and in 13 cases between the 15th and the 24th year; there were 13 cases of papillary adenocarcinoma, 2 cases of follicular adenocarcinoma, and 2 cases of solid carcinoma. In 7 cases the tumor was preceded by the appearance of goiter; only one patient had been previously irradiated. The first clinical sign of disease was a thyroid nodule in 10 cases, metastases to cervical lymph nodes in 7 cases; in 3 of these last cases primary neoplasia of the thyroid remained clinically occult. Scanning with I181 was used in 13 cases for the diagnosis of thyroid cancer. Surgical and radiological therapies were associated in all cases; the enucleation of the tumor was performed in one case, emithyroidectomy in 7 cases, total thyroidectomy in 6 cases. Surgery was limited to dissection of the neck in 3 cases. In addition, thyroidectomy was associated to radical neck dissection in 9 cases with metastases. In all cases I181 was administered; in 7 cases it was associated to X-therapy and in 8 cases to telecobaltotherapy. One patient is alive 3 months after the beginning of the treatment, 6 patients from 1 to 3 years, 3 patients from 5 to 6 years, 2 patients after 8 years and 5 patients from 10 to 15 years.
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La Greca A, Xu B, Ghossein R, Tuttle RM, Sabra MM. Patients with Multifocal Macroscopic Papillary Thyroid Carcinoma Have a Low Risk of Recurrence at Early Follow-Up after Total Thyroidectomy and Radioactive Iodine Treatment. Eur Thyroid J 2017; 6:31-39. [PMID: 28611946 PMCID: PMC5465646 DOI: 10.1159/000448752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multifocal thyroid cancer involvement is a common presentation in papillary thyroid cancer. The risk of recurrence of intrathyroidal multifocal papillary microcarcinoma (<1 cm) is documented to be low. However, the risk of recurrence of multifocal macroscopic thyroid cancer is not known. Prior studies have suggested that both the number of foci and the presence of nodal involvement at diagnosis are important predictors of recurrence in multifocal papillary thyroid carcinoma (PTC). OBJECTIVES In this retrospective review of 99 patients presenting with multifocal macroscopic PTC (with 2 tumor foci >1 cm) without gross extrathyroidal extension, we examined the clinical outcomes of patients in the first 2 years after the initial therapy and at the end of the follow-up period (median: 5 years). RESULTS Half of the patients presenting with multifocal macroscopic PTC had nodal involvement at diagnosis. Only 4 patients had a recurrence on long-term follow-up, all with classic or tall-cell variant PTC with bulky nodal involvement at diagnosis. The number of tumor foci did not influence the risk of recurrence in this cohort. The median time to recurrence in these 4 patients was 11 years, with all patients having a recurrence after 9 years of follow-up. None of patients developed distant metastasis or died from thyroid cancer. CONCLUSIONS Patients presenting with multifocal macroscopic papillary thyroid cancer without bulky nodal involvement or gross extrathyroidal extension have a low risk of thyroid cancer recurrence.
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Affiliation(s)
- Amanda La Greca
- Department of Pathology, Endocrinology Service, Department of Medicine, N.Y., USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center and Weill-Cornell College of Medicine, New York, N.Y., USA
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center and Weill-Cornell College of Medicine, New York, N.Y., USA
| | - R. Michael Tuttle
- Department of Pathology, Endocrinology Service, Department of Medicine, N.Y., USA
| | - Mona M. Sabra
- Department of Pathology, Endocrinology Service, Department of Medicine, N.Y., USA
- *Mona M. Sabra, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (USA), E-Mail
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Thyroid Lobectomy for Papillary Thyroid Cancer: Long-term Follow-up Study of 1,088 Cases. World J Surg 2013; 38:68-79. [DOI: 10.1007/s00268-013-2224-1] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Džepina D, Zurak K, Petric V, Čupić H. Pathological characteristics and clinical perspectives of papillary thyroid cancer: study of 714 patients. Eur Arch Otorhinolaryngol 2013; 271:141-8. [PMID: 23568042 DOI: 10.1007/s00405-013-2472-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/26/2013] [Indexed: 01/23/2023]
Abstract
Papillary thyroid cancer belongs to most commonly diagnosed well-differentiated malignant tumor of the thyroid gland, with only minority of cases being more aggressive, recurring locoregionally and developing distant metastatic foci. The aim of this study was to determine the clinical relationship between parameters of age, gender, size of primary tumor, intraglandular dissemination and regional metastatic spread and evaluate the importance of each parameter; analyze other major aggressive factors (tumor border, thyroid capsule invasion, perivascular, perilymphatic spread) on prevalence and extent of intraglandular dissemination and relation to metastatic spread in neck. This study is a retrospective analysis of clinical and pathological data from 714 patients with papillary thyroid cancer, presented and operated at the Department of ENT/Head and Neck surgery, Sisters of Charity University Hospital, Zagreb, in the period from 1980 to 2008. All patients were operated upon with total thyroidectomy and some type of neck lymphonode dissection (paratracheal or lateral). In results, we found 46.9% tumors were aggressive; 34.7% tumors were multicentric, with foci in the contralateral lobe nearly twice as often as in the ipsilateral lobe; 27.8% were regionally metastatic, with equal distribution between paratracheal and lateral regions. In conclusion, we revealed contralateral lobe multicentricity and male gender as independent risk factors for regional metastatic dissemination. Nodular goiter has been identified as a protective parameter.
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Affiliation(s)
- Davor Džepina
- Department of ENT, Head and Neck Surgery, University Clinical Hospital Center Sisters of Charity, Vinogradska 29, 10000, Zagreb, Croatia,
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Uludag M, Yetkin G, Citgez B, Isgor A, Atay M, Kebudi A, Akgun I. Contribution of gamma probe-guided surgery to lateral approach completion thyroidectomy. Endocr Pract 2009; 15:213-9. [PMID: 19364688 DOI: 10.4158/ep.15.3.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of gamma probe performed with technetium Tc 99m-labeled pertechnetate in patients who underwent completion thyroidectomy after pathologic detection of incidental thyroid cancer following subtotal thyroidectomy. METHODS In this prospective study, we evaluated findings from patients with multinodular goiter who underwent gamma probe-guided lateral approach completion thyroidectomy after the pathologic detection of incidental thyroid cancer following subtotal thyroidectomy where partial thyroid tissue was left unilaterally or bilaterally. Patients who underwent the procedure between January 2003 and January 2007 were included. Thyroid scintigraphy; thyroid and neck ultrasonography examinations; and concentrations of thyroid hormones, thyrotropin (TSH), thyroglobulin, and thyroglobulin antibodies were evaluated before the second operation. Patients were administered 3 mCi technetium Tc 99m pertechnetate during anaesthetic induction, and we extracted suspicious thyroid tissue and tissue with activity above background activity levels according to gamma probe. Extracted tissues were evaluated pathologically. RESULTS Completion thyroidectomy was performed in 23 patients. Seventy-nine tissue samples were extracted; 49 were thyroid tissue and 30 were nonthyroid tissue. Mean thyroid tissue to background activity ratio (T:B) was 6.4 +/- 3.9 (range, 2-14.3), and mean thyroid bed (after excision) to background activity ratio (Tbed:B) was 1.2 +/- 0.2 (range, 0.8-1.7) (P = .001). Mean T:B and Tbed:B ratios of the nonthyroid tissue were 1.2 +/- 0.3 (range, 0.2-1.7) and 1.1 +/- 0.2 (range, 0.4-1.4), respectively (P = .001). The thyroid tissue T:B ratio was significantly higher than that of non-thyroid tissue (P<.001). Gamma probe labeling contributed to extraction of small amounts of thyroid tissue that could not be viewed by scintigraphy in 43% of patients. CONCLUSIONS Using gamma labeling, thyroid tissue shows significantly more activity than nonthyroid tissue. Gamma probe helps detect small, residual thyroid tissue that is buried in the scar tissue that cannot be distinguished by scintigraphy; therefore, it assists in the extraction of the maximum amount of thyroid tissue.
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Affiliation(s)
- Mehmet Uludag
- Department of Second General Surgery, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey.
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Woodrum DT, Gauger PG. Role of131I in the treatment of well differentiated thyroid cancer. J Surg Oncol 2005; 89:114-21. [PMID: 15719384 DOI: 10.1002/jso.20185] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
(131)I is an integral component in postsurgical management of well-differentiated thyroid cancer (WDTC), which includes papillary and follicular types. (131)I is used postsurgically to either destroy remaining thyroid tissue (thyroid ablation) or to treat recurrence and metastases (radioiodine therapy). (131)I is no longer a routine diagnostic modality, but it is widely used for remnant ablation after thyroidectomy for WDTC > 1 cm, under conditions of thyroxine withdrawal. It is generally-though not unanimously-accepted that postsurgical radioiodine is the most powerful method by which to lengthen disease-free survival. (131)I cannot be used if the residual thyroid remnant is large; many surgeons therefore perform near-total or total thyroidectomy for all WDTC > 1 cm. Since 1997, radioiodine treatment has been performed in outpatient settings, where side effects are common, but mild and transient. Secondary screening is by physical exam, thyroglobulin measurements, and (131)I diagnostic whole-body scans. This is performed under conditions of thyrotropin stimulation, which is accomplished either by thyroxine withdrawal or administration of recombinant human thyrotropin. While most cancers are well treated with radioiodine, some advanced cancers may no longer take up radioiodine, rendering them resistant to treatment. For these cancers, redifferentiation therapy and molecular target-specific medicines hold future promise for improved treatment.
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Affiliation(s)
- Derek T Woodrum
- Division of Endocrine Surgery, University of Michigan Department of Surgery, Ann Arbor, Michigan, USA
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Kupferman ME, Mandel SJ, DiDonato L, Wolf P, Weber RS. Safety of completion thyroidectomy following unilateral lobectomy for well-differentiated thyroid cancer. Laryngoscope 2002; 112:1209-12. [PMID: 12169901 DOI: 10.1097/00005537-200207000-00013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES When a diagnosis of thyroid cancer is returned following unilateral lobectomy, removal of the contralateral lobe is frequently necessary. Morbidity for completion thyroidectomy includes a reported 2% to 5% risk of recurrent laryngeal nerve (RLN) injury and an 8% to 15% incidence of hypoparathyroidism. In this study, to determine morbidity following completion thyroidectomy, we reviewed our results of reoperative surgery among patients with thyroid cancer. STUDY DESIGN Retrospective chart review. METHODS Between 1997 and 2000, 36 consecutive patients, 32 females and 4 males, with a mean age of 43.6 years (range, 19-59 y), underwent completion thyroidectomy. Preoperative fine-needle aspiration revealed follicular derived neoplasm in 32 patients (88.9%), indeterminate in 3 patients (8.3%), and Hürthle cell neoplasm in 1 patient (2.8%). The interval between the first and second operation was a mean of 43.3 days (range, 2-103 d). RESULTS At the primary surgery, 29 patients (80.6%) had a follicular variant of papillary carcinoma, 6 (16.7%) had follicular carcinoma, and 1 (2.8%) had Hürthle cell carcinoma. Of these, 14 had multifocal disease. In the completion lobe, 20 patients (55.6%) had evidence of thyroid carcinoma. There was a 0% incidence of RLN injury, and the mean pre- and post-completion thyroidectomy serum calcium was 8.9 mg/dL and 8.6 mg/dL, respectively. There was one postoperative hematoma, requiring re-exploration. Five patients (13.9%) had a transient postoperative serum calcium (Ca) <8.0 mg/dL, with one being symptomatic. None required vitamin D or prolonged calcium supplementation. CONCLUSIONS When completion thyroidectomy is necessary for the treatment of thyroid malignancy, the procedure can be performed safely with low morbidity and is effective for diagnosing and removing occult disease in the remaining thyroid.
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Affiliation(s)
- Michael E Kupferman
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, U.S.A
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Abstract
Fewer than 5% of all adults will have a palpable thyroid nodule, but this is still a large number of individuals who require evaluation. Although most thyroid nodules are a result of a benign disease process (more than 95%), the possibility of thyroid cancer is always a consideration. Important aspects of history taking with a patient in whom a thyroid nodule has been noted include age, gender, family history of thyroid or endocrine disease, prior low dosage head and neck radiation, recent hoarseness, dysphagia, and symptoms of hypermetabolism. Key features of evaluation by physical examination are the size and location of the thyroid abnormality, the degree of firmness of the nodule, the presence of other nodules in the thyroid, palpable cervical lymph nodes, vocal cord paresis or paralysis, and tachycardia and/or tremor. The major categories of thyroid abnormality in such patients include cysts, adenomas, thyroiditis, and cancer. Although radionuclide scans, ultrasound examination and computer tomography have all been employed in the assessment of thyroid nodules, and thyroid stimulating hormone assay is useful for confirming a euthyroid state, fine needle aspiration biopsy (FNAB) has proved to be the most efficient diagnostic tool. The findings from FNAB allow avoidance of operative treatment for a large portion of these patients with palpable thyroid nodules, but a diagnosis of "follicular neoplasm" on FNAB usually requires operation, despite the fact that many such patients do ultimately prove to have a benign lesion. The extent of operation in patients undergoing surgery will depend on the diagnostic findings before operation, but unilateral thyroid lobectomy is the minimum procedure when surgery is required.
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Affiliation(s)
- Walter Lawrence
- Division of Surgical Oncology, Medical College of Virginia, Richmond, Virginia 23298, USA.
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Alzahrani AS, Al Mandil M, Chaudhary MA, Ahmed M, Mohammed GE. Frequency and predictive factors of malignancy in residual thyroid tissue and cervical lymph nodes after partial thyroidectomy for differentiated thyroid cancer. Surgery 2002; 131:443-9. [PMID: 11935135 DOI: 10.1067/msy.2002.122377] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The extent of surgery in differentiated thyroid cancer (DTC) has been a controversial issue. Total thyroidectomy potentially carries a higher operative risk, whereas partial thyroidectomy has the risk of leaving significant residual malignancy. The aim of this study was to assess the frequency and potential predictive factors of malignancy in the residual thyroid tissue and the cervical lymph nodes (CLN) in patients with DTC who had partial thyroid surgery and subsequently underwent completion thyroidectomy and/or modified neck dissection. Age, gender, pressure symptoms, duration of symptoms, size of the original tumor, tumor multifocality, perithyroidal tumor extension, soft tissue invasion, and serum thyroglobulin (Tg) level after first surgery were analyzed as potential predictive factors for the presence of malignancy in the thyroid remnant and the CLN. METHODS We retrospectively reviewed the medical and pathologic data of 101 cases of DTC; 97 had papillary and 4 had follicular thyroid cancer. On the initial surgery, the median tumor size was 2.5 cm (range, 0.5 to 8.5 cm). Tumor multifocality occurred in 28 cases, perithyroidal tumor extension in 26 cases, and soft tissue invasion in 9 cases. Completion thyroidectomy was performed in 100 cases and modified neck dissection in 90 cases. RESULTS On completion neck surgery, 39 patients had evidence of malignancy in the residual thyroid tissue and 36 patients in the CLN. In 23 (22.7%) cases, malignancy was present in both CLN and residual thyroid tissue. Only tumor multifocality and Tg level greater than 20 ng/mL after first surgery were predictive of the presence of malignancy in the thyroid remnant, whereas age older than 40 years, soft tissue invasion, perithyroidal tumor extension, and Tg level greater than 20 ng/mL were predictive of malignancy in CLN. CONCLUSIONS Residual malignancy is common after partial thyroid surgery for DTC. Tumor multifocality and Tg level may be predictive of its presence in residual thyroid tissue. Age, perithyroidal tumor extension, soft tissue invasion, and Tg level are predictive of the presence of lymph node metastases.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia
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Hundahl SA, Cady B, Cunningham MP, Mazzaferri E, McKee RF, Rosai J, Shah JP, Fremgen AM, Stewart AK, Hölzer S. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer 2000; 89:202-17. [PMID: 10897019 DOI: 10.1002/1097-0142(20000701)89:1<202::aid-cncr27>3.0.co;2-a] [Citation(s) in RCA: 308] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The American College of Surgeons Commission on Cancer (CoC) has conducted national Patient Care Evaluation (PCE) studies since 1976. METHODS Over 1500 hospitals with CoC-approved cancer programs were invited to participate in this prospective cohort study of U.S. thyroid carcinoma cases treated in 1996. Follow-up will be conducted through the National Cancer Data Base. RESULTS Of the 5584 cases of thyroid carcinoma, 81% were papillary, 10% follicular, 3.6% Hürthle cell, 0.5% familial medullary, 2.7% sporadic medullary, and 1.7% undifferentiated/anaplastic. Demographics and suspected risk factors were analyzed. Fine-needle aspiration of the thyroid gland (53%) or a neck lymph node (7%), thyroid nuclear scan (39%), and ultrasound (38%) constituted the most frequently utilized diagnostic modalities. The vast majority of patients with differentiated thyroid carcinoma presented with American Joint Committee on Cancer Stage I and II disease and relatively small tumors. For all histologies, near-total or total thyroidectomy constituted the dominant surgical treatment. No lymph nodes were examined in a substantial proportion of cases. Residual tumor after the surgical event could be documented in 11% of cases, hypocalcemia in 10% of cases, and recurrent laryngeal nerve injury in 1.3% of cases. Complications were most frequently associated with total thyroidectomy combined with lymph node dissection. Thirty-day mortality was 0.3%; when undifferentiated/anaplastic cancer cases were eliminated, it decreased to 0.2%. Adjuvant treatment, probably underreported in this study, consisted of hormonal suppression (50% overall) and radioiodine (50% overall). CONCLUSIONS In addition to offering information concerning risk factors and symptoms, the current PCE study compliments the survival information from previous NCDB reports and offers a surveillance snapshot of current management of thyroid carcinoma in the U.S. Identified opportunities for improvement of care include 1) more frequent use of fine-needle aspiration cytology in making a diagnosis; 2) more frequent use of laryngoscopy in evaluating patients preoperatively, especially those with voice change; and 3) improved lymph node resection and analysis to improve staging and, in some situations, outcomes.
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Affiliation(s)
- S A Hundahl
- Queen's Cancer Institute, Honolulu, Hawaii, USA
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Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns]. Cancer 1998; 83:2638-48. [PMID: 9874472 DOI: 10.1002/(sici)1097-0142(19981215)83:12<2638::aid-cncr31>3.0.co;2-1] [Citation(s) in RCA: 1169] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The National Cancer Data Base (NCDB) represents a national electronic registry system now capturing nearly 60% of incident cancers in the U. S. In combination with other Commission on Cancer programs, the NCDB offers a working example of voluntary, accurate, cost-effective "outcomes management" on a both a local and national scale. In addition, it is of particular value in capturing clinical information concerning rare cancers, such as those of the thyroid. METHODS For the accession years 1985-1995, NCDB captured demographic, patterns-of-care, stage, treatment, and outcome information for a convenience sample of 53,856 thyroid carcinoma cases (1% of total NCDB cases). This article focuses on overall 10-year relative survival and American Joint Committee on Cancer (AJCC) (3rd/4th edition) stage-stratified 5-year relative survival for each histologic type of thyroid carcinoma. Care patterns also are discussed. RESULTS The 10-year overall relative survival rates for U. S. patients with papillary, follicular, Hürthle cell, medullary, and undifferentiated/anaplastic carcinoma was 93%, 85%, 76%, 75%, and 14%, respectively. For papillary and follicular neoplasms, current AJCC staging failed to discriminate between patients with Stage I and II disease at 5 years. Total thyroidectomy +/- lymph node sampling/dissection represented the dominant method of surgical treatment rendered to patients with papillary and follicular neoplasms. Approximately 38% of such patients receive adjuvant iodine-131 ablation/therapy. At 5 years, variation in surgical treatment (i.e., lobectomy vs. more extensive surgery) failed to translate into compelling differences in survival for any subgroup with papillary or follicular carcinoma, but longer follow-up is required to evaluate this. NCDB data appeared to validate the AMES prognostic system, as applied to papillary cases. Younger age appeared to influence prognosis favorably for all thyroid neoplasms, including medullary and undifferentiated/anaplastic carcinoma. NCDB data also revealed that unusual patients diagnosed with undifferentiated/anaplastic carcinoma before age of 45 years have better survival. CONCLUSIONS The NCDB system permits analysis of care patterns and survival for large numbers of contemporaneous U. S. patients with relatively rare neoplasms, such as thyroid carcinoma. In this context, it represents an unsurpassed clinical tool for analyzing care, evaluating prognostic models, generating new hypotheses, and overcoming the volume-related drawbacks inherent in the study of such neoplasms. [See editorial on pages 2434-6, this issue.]
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MESH Headings
- Adenocarcinoma/epidemiology
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/mortality
- Adenocarcinoma, Follicular/pathology
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma/epidemiology
- Carcinoma/mortality
- Carcinoma/pathology
- Carcinoma, Medullary/epidemiology
- Carcinoma, Medullary/mortality
- Carcinoma, Medullary/pathology
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Child
- Child, Preschool
- Cohort Studies
- Databases as Topic/statistics & numerical data
- Humans
- Infant
- Infant, Newborn
- Middle Aged
- Neoplasm Staging
- Registries/statistics & numerical data
- Survival Rate
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
- United States/epidemiology
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Affiliation(s)
- S A Hundahl
- Department of Surgery, The Queen's Medical Center, Honolulu, Hawaii, USA
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Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer 1998. [DOI: 10.1002/(sici)1097-0142(19981215)83:12%3c2638::aid-cncr31%3e3.0.co;2-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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BURN JI, TAYLOR SF. Natural history of thyroid carcinoma. A study of 152 treated patients. BRITISH MEDICAL JOURNAL 1998; 2:1218-23. [PMID: 14017111 PMCID: PMC1926216 DOI: 10.1136/bmj.2.5314.1218] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND Thyroid carcinoma in young patients under the age of 20 years is uncommon. Because of the slow progression of this disease, there is still a great deal of debate as to which operation strategy is best. METHODS We undertook a retrospective study of 61 patients under 20 years of age with thyroid cancer treated at our institute between 1952 and 1995. They constitute 6.6% of the 921 thyroid cancer patients treated by us during the same period. Factors examined were: symptoms, metastases, treatment, complications, and survival. RESULTS Total or near-total thyroidectomy was performed in 51 patients. Regional lymph node dissection was performed in 17 patients and modified radical neck dissection in 13. Fifty-one patients underwent pretracheal and paratracheal lymph node dissection. During the 43 years of this study, two patients died of thyroid cancer. CONCLUSIONS Although most children are initially seen with more extensive disease than adults, the overall prognosis is excellent. The excellent prognosis is the product of initial aggressive treatment: near-total or total thyroidectomy and at least pre- and paratracheal lymph node dissection, followed by radioactive iodine therapy.
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Affiliation(s)
- K Segal
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
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Gimm O, Dralle H. Surgical strategies in papillary thyroid carcinoma. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1997; 91:51-64. [PMID: 9018916 DOI: 10.1007/978-3-642-60531-4_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- O Gimm
- Chirurgische Klinik, Martin-Luther-Universität, University of Halle/Saale, Germany
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Agarwal A, Mishra SK. Completion total thyroidectomy in the management of differentiated thyroid carcinoma. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:358-60. [PMID: 8678852 DOI: 10.1111/j.1445-2197.1996.tb01210.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Completion thyroidectomy is the removal of any thyroid tissue that remains after a less than total thyroidectomy. This procedure has been commonly performed when the final histopathology of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Complete thyroidectomy carries little morbidity if performed by experienced surgeons using a lateral approach. The purpose of this study is to reinforce the usefulness of a lateral approach. METHODS A retrospective analysis over a 5 year period at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) yielded 19 patients who underwent completion thyroidectomy. This group represents 23% of 82 patients who underwent total thyroidectomy for differentiated thyroid cancer (DTC) during that period. The residual thyroid tissue was excised through a lateral approach and could be resected safely, preserving the recurrent laryngeal nerve (RLN) and the parathyroid glands. RESULTS A lateral approach dissection could be performed with ease in a virgin area. Excision of residual thyroid tissue could be performed safely even in cases with prior partial lobectomy or bilateral subtotal resection. Tumour was found in 52% of the re-operative specimens: in three out of four of those after a previous partial lobectomy, in six out of 12 of those after a total lobectomy, and in one out of three of those after a prior bilateral (although incomplete) thyroid resection. Postoperative complications included transient RLN palsy (n = 2) and transient hypoparathyroidism (n = 4). CONCLUSIONS Completion thyroidectomy using a lateral approach is safe in re-operative thyroid surgery.
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Affiliation(s)
- A Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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19
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Segal K, Friedental R, Lubin E, Shvero J, Sulkes J, Feinmesser R. Papillary Carcinoma of the Thyroid. Otolaryngol Head Neck Surg 1995; 113:356-63. [PMID: 7567004 DOI: 10.1016/s0194-59989570068-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Between 1954 and 1993 503 patients with papillary carcinoma of the thyroid were treated at the Department of Otolaryngology–Head and Neck Surgery of the Beilinson Medical Center. Two thirds of these patients were women. The median follow-up period was 10.3 years. In more than 30% of cases the tumor was discovered because of the presence of an enlarged lymph node and/or invasion to adjacent structures. Total or near-total thyroidectomy was performed in 381 patients. The 48 patients in whom it was necessary to perform a reoperation had a significantly higher complication rate. Multicentricity was found in 65% of those cases in which both thyroid lobes were available for histologic examination. Nineteen patients were found to have a “tail” cell variant, 223 had a pure papillary variant, and 261 a follicular variant. The mortality rate was 6.2% 15 years after Initial therapy. A number of factors–age, size of tumor, presence of distant metastases, “tall” cell variant, and type of surgery–were found to be significant predictors of survival. After almost 40 years of experience in treating more than 500 cases of papillary cancer, we have come to the conclusion that the surgical approach should be aggressive.
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MESH Headings
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/mortality
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/secondary
- Adolescent
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/secondary
- Child
- Female
- Follow-Up Studies
- Forecasting
- Humans
- Israel/epidemiology
- Lymphatic Metastasis
- Male
- Middle Aged
- Neck Dissection/statistics & numerical data
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local
- Reoperation
- Survival Rate
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
- Thyroidectomy/methods
- Thyroidectomy/statistics & numerical data
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Affiliation(s)
- K Segal
- Department of Otolaryngology-Head and Neck Surgery, Beilinson Medical Center, Petah Tikva, Israel
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20
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Eroğlu A, Berberoğlu U, Buruk F, Yildirim E. Completion thyroidectomy for differentiated thyroid carcinoma. J Surg Oncol 1995; 59:261-6; discussion 266-7. [PMID: 7630175 DOI: 10.1002/jso.2930590413] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures less than total or near-total thyroidectomy. The extent of surgical management for differentiated thyroid carcinoma (DTC) is controversial. Although some authors advocate subtotal thyroidectomy with lower complication rates, total or near-total thyroidectomy and completion thyroidectomy have been defended by others because of the improved survival and lower morbidity that is comparable with subtotal thyroidectomy. In this study, the incidence of residual tumor and surgical complication rates in patients who underwent completion thyroidectomy were investigated. The medical records of 165 patients undergoing completion thyroidectomy for DTC were reviewed. Seventy-seven (46.6%) of these patients were found to have residual tumor in the remaining thyroid tissue. Anaplastic transformation developed in two of these patients. Permanent bilateral recurrent laryngeal nerve palsy occurred in three patients, and permanent hypoparathyroidism was seen in one patient. We recommend completion thyroidectomy as an efficient and safe method of surgical treatment with a low complication rate for DTC.
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Affiliation(s)
- A Eroğlu
- Department of Surgery, Ankara Oncology Hospital, Demetevler, Turkey
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21
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Walker RP, Paloyan E, Kelley TF, Gopalsami C, Jarosz H. Parathyroid autotransplantation in patients undergoing a total thyroidectomy: a review of 261 patients. Otolaryngol Head Neck Surg 1994; 111:258-64. [PMID: 8084634 DOI: 10.1177/01945998941113p115] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Parathyroid autotransplantation was first described in 1907 by Halsted. However, this simple and effective method of preserving parathyroid function has been used with increasing frequency only during the past 25 years. Beginning in the late 1960s, our group has transplanted normal parathyroid tissue into the ipsilateral sternocleidomastoid muscle whenever these glands could not be preserved in situ with adequate blood supply. In addition, if the blood supply of all four parathyroid glands appeared compromised, cryopreservation of parathyroid tissue was performed in case the autotransplanted tissue did not function after surgery. Since 1970, 393 patients underwent a total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and then autotransplanted. Of the 393 patients who underwent a total thyroidectomy, 261 patients required transplantation of one or more glands. Among those 261 patients who underwent selective parathyroid autotransplantation, 33 (13%) required temporary calcium and vitamin D supplementation. Of these 33 patients, 2 (less than 1%) had permanent hypoparathyroidism and are receiving long-term vitamin D therapy.
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Affiliation(s)
- R P Walker
- Department of Otolaryngology, Loyola University Medical Center, Maywood, IL 60153
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22
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Hatada T, Sakanoue Y, Kusunoki M, Kobayashi A, Utsunomiya J. Variable activity of protein tyrosine kinase in apparently normal thyroid glands. Cancer Invest 1994; 12:26-32. [PMID: 8281463 DOI: 10.3109/07357909409021390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We examined protein tyrosine kinase (PTK) activity in apparently normal thyroid tissue (n = 22) obtained from patients undergoing thyroid surgery for papillary thyroid cancer or benign disease. The PTK activity in apparently normal thyroid tissue from patients with papillary thyroid cancer progressively was elevated in the cytosolic fraction compared with that from patients without cancer (p < 0.05). The cytosolic proportion of PTK activity was also significantly increased in the normal thyroid tissue of patients with cancer (62% vs. 51%, p < 0.05). These findings suggest that alterations in PTK activity may indicate apparently normal thyroid tissue at increased risk of developing malignancy.
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Affiliation(s)
- T Hatada
- Second Department of Surgery, Hyogo College of Medicine, Japan
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23
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Pasieka JL, Thompson NW, McLeod MK, Burney RE, Macha M. The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J Surg 1992; 16:711-6; discussion 716-7. [PMID: 1413840 DOI: 10.1007/bf02067365] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of this study was to evaluate the surgical outcome of completion thyroidectomy in patients with presumed unilateral well-differentiated thyroid cancer (WDTC). The medical records of all patients having had unilateral thyroid lobectomy for WDTC, who subsequently underwent completion thyroidectomy, were reviewed. From 1980 to 1991, 60 patients with WDTC underwent completion thyroidectomy. Forty-seven patients had presumed unilateral WDTC, with no evidence of residual disease prior to their completion thyroidectomy. Twenty-five (53%) of these patients were found to have residual neoplastic disease in the neck. In 20 (43%) of 47 patients, a focus of cancer was found in the remaining thyroid lobe and in 5 additional patients no cancer was found in the contralateral lobe, however, unsuspected nodal disease was found. The remaining 13 of the 60 patients presented with either regional recurrence (n = 12) or distant metastases (n = 1) at the time of their completion thyroidectomy. All (92%) but 1 of these 13 patients had cancer in the remaining thyroid lobe. Multifocal disease in the primary lobe was associated with bilateral thyroid cancer (p less than 0.01). Complications were infrequent; transient hypocalcemia occurred in 5 (8%) patients, permanent hypoparathyroidism occurred in 1 (1.7%) patient, and transient recurrent laryngeal nerve palsy occurred in 3 (5%) patients. Residual WDTC was found in 37 (62%) of 60 patients undergoing completion thyroidectomy. Multifocal disease in the primary resected lobe was associated with a high incidence of contralateral thyroid cancer. Completion thyroidectomy is a safe procedure and may prevent the development of regional recurrence by eliminating an unsuspected focus of cancer.
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Affiliation(s)
- J L Pasieka
- Department of Surgery, University of Michigan, Ann Arbor
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24
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Abstract
The primary role of iodine deficiency in goitrogenesis and the prevention and treatment of endemic goiter by iodine supplementation is firmly established. Unfortunately, implementation of iodine prophylaxis programs has met with considerable technical and socioeconomic difficulties. Besides, lack of knowledge concerning some of the other causative factors of endemic goiter has prevented development of appropriate measures for its complete eradication in those areas where goiter persists in spite of prolonged and adequate iodine supplementation. At present, no less than 5% of the world's population have goiters and associated disorders, resulting in a public health and socioeconomic problem of major proportions. Seventy-five percent of people with goiter live in less developed countries where iodine deficiency is prevalent. Goiter prevalence rates of more than 50% and the highest frequency of severe cases of iodine deficiency disorders, namely, cretinism, congenital hypothyroidism, and various degrees of impairment of growth and mental development are found in endemic areas with extreme iodine deficiency. Goiters are usually multinodular and of very large size, producing, on occasion, signs of compression that require surgery. Recurrence rates are as high as 25-30% and second surgery accounts for 16% of all thyroidectomies. Unfortunately, most of these goiters occur in areas with highly restricted medical and surgical facilities. Twenty-five percent of people with goiters live in more developed countries where goiter continues to occur in certain areas despite iodine prophylaxis. Iodine-sufficient goiters are associated with autoimmune thyroiditis, hypothyroidism, hyperthyroidism, and thyroid carcinoma. Goiter is of considerable surgical significance in iodine-sufficient endemic areas and, to a lesser degree, in nonendemic areas where it is called "sporadic" goiter. Recurrence rates of iodine-sufficient goiter are 10-19% following thyroidectomy. Since most of these goiters grow by mechanisms other than increased thyrotropin (TSH) stimulation, treatment with suppressive doses of L-thyroxine is inefficient and, because of possible complications, not recommended. Although Graves' hyperthyroidism is not directly related to endemic goiter, it does relate adversely with ingestion or administration of iodine. At present, Graves' disease is treated with 131I or antithyroid drugs in more than 90% of the cases. The incidence rates of papillary, follicular, and anaplastic thyroid carcinomas appear to be related to endemic goiter and iodine supplementation, with surgery being required in essentially all of these cases.
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Affiliation(s)
- E Gaitan
- University of Mississippi School of Medicine, Jackson
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25
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Abstract
Of 238 thyroid cancer patients, 24 exhibited a lateral neck mass as the initial presentation. Twenty four (77.4%) of 31 metastatic masses were located at the midjugular and lower jugular lymph chains. The average number of histologically proven metastatic nodes was 6.5. Histologically, 22 cases were diagnosed as papillary carcinoma, 1 as follicular carcinoma, and the remaining case as medullary carcinoma. Fifteen thyroid glands were found to have a single primary focus, while 9 others had multiple foci. The mean diameter of the primary foci was 1.2 cm. The rates of detection of primary foci by thyroid scan and ultrasonography were 60% and 37.5%, respectively. Surgical procedures for the thyroid lesions included total or near-total thyroidectomy in 18 cases and lobectomy in 6 cases; for metastatic neck nodes, 13 were treated by modified neck dissection, 5 by standard radical neck dissection, and six by partial neck dissection. All 24 patients were followed for a mean duration of 4.5 years with a range of 2.0 to 7.5 years, and all except 1 are still living. In the presence of a lateral neck mass as the initial manifestation of thyroid carcinoma, no matter what size the primary tumor foci, a total or near-total thyroidectomy appears to be justified in addition to an appropriate neck dissection.
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Affiliation(s)
- C S Park
- Department of Surgery, Yonsei University College of Medicine, Korea
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26
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Granberg PO, Bäckdahl M, Cedermark B, Hamberger B, Lundell G, Löwhagen T, Wallin G. Thyroid and Parathyroid Carcinoma. Surg Oncol 1989. [DOI: 10.1007/978-3-642-72646-0_68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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27
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Abstract
There is controversy about the most appropriate treatment for patients with thyroid cancer. This study analyses our experience with 206 cases of thyroid cancer from an endemic goiterous area. There were 100 males and 106 females; patients presented at an earlier age with a short history. Thyroid cancers demonstrated an aggressive biological behaviour with an advanced stage at presentation (overt cancers in 51 per cent) and a relentless course with a mortality rate of 24.2 per cent for the well-differentiated tumours. Near-total thyroidectomy was performed in 126 patients. Multicentric foci of tumour were seen in 17.2 per cent of the well-differentiated cancers and 25.2 per cent of the cases of well-differentiated cancers who underwent near-total thyroidectomy developed loco-regional recurrence. Hemithyroidectomy was performed in 35 patients who refused completion total thyroidectomy at a second stage; 16.7 per cent of these patients developed a recurrence in the remaining contralateral lobe. Thus in our patients from an endemic goiterous area, near-total thyroidectomy is the treatment of choice particularly because of the frequent occurrence of follicular and anaplastic cancers (in 44.2 per cent) and because the course of the disease is more virulent.
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Affiliation(s)
- A K Sarda
- Department of Surgery, All India Institute of Medical Sciences, New Delhi
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28
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Dor P. Invited commentary. World J Surg 1988. [DOI: 10.1007/bf01655488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Lennquist S, Persliden J, Smeds S. The value of intraoperative scintigraphy as a routine procedure in thyroid carcinoma. World J Surg 1988; 12:586-92. [PMID: 3245213 DOI: 10.1007/bf01655856] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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30
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Høie J, Stenwig AE, Brennhovd IO. Surgery in papillary thyroid carcinoma: a review of 730 patients. J Surg Oncol 1988; 37:147-51. [PMID: 3352268 DOI: 10.1002/jso.2930370302] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Between 1956 and 1978, 1143 patients with thyroid cancer, nearly half of all patients with thyroid carcinomas in Norway in this period, were seen in our hospital. Of 730 papillary cancer patients, 447 were operated with total thyroidectomy (TT), 179 with hemi-thyroidectomy (HT), while 104 patients had minor thyroid resections (RT). Survival and recurrence rates were similar in the TT- and HT-groups. Local recurrences were seen in 15.2% of the patients following total thyroidectomy and in 16.2% following hemi-thyroidectomy; distant metastases were seen in 10.7% and 11.2%, respectively. Beyond the seventh year of follow-up the cumulative survival was similar following total thyroidectomies, hemi-thyroidectomies, and thyroid resections. Unless grossly malignant residues were left behind, the impact of the surgical procedure on prognosis in papillary thyroid cancer seems minor.
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Affiliation(s)
- J Høie
- Department of Surgical Oncology, Norweigian Radium Hospital, Oslo
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31
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Abstract
A definitive evaluation of different therapeutic approaches to patients with papillary and follicular thyroid carcinomas requires a prospective multicenter long-term study, with careful documentation of variations in histologic classification and all other factors that can possibly influence prognosis. Until such information is available, every patient with a thyroid nodule should be given the treatment that offers the best prospect for cure to the greatest possible number of patients; this treatment appears to be hemithyroidectomy for benign unilateral thyroid tumors and total thyroidectomy for carcinomas. These operations can be done safely by experienced surgeons without exceeding the morbidity or complication rate of less extensive treatments.
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32
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Abstract
The authors conducted a retrospective analysis with 5- to 30-year follow-up on 109 patients in order to determine the optimum management of nonmedullary thyroid cancer. Results of total thyroidectomy were compared to partial thyroidectomy, among patients well matched for prognostic indicators. No differences in cancer mortality or recurrence rates were evident. However, there were significantly more complications when total thyroidectomy was employed. In view of these results, partial thyroidectomy is recommended as the treatment of choice for nonmedullary thyroid cancer.
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33
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Lennquist S, Persliden J, Smeds S. Intraoperative scintigraphy in surgical treatment of thyroid carcinoma: evaluation of a new technique. World J Surg 1986; 10:711-7. [PMID: 3751096 DOI: 10.1007/bf01655564] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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34
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Rossi RL, Cady B, Silverman ML, Wool MS, Horner TA. Current results of conservative surgery for differentiated thyroid carcinoma. World J Surg 1986; 10:612-22. [PMID: 3751088 DOI: 10.1007/bf01655538] [Citation(s) in RCA: 139] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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35
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Segal K, Levy R, Sidi J, Abraham A. Thyroid Carcinoma in Children and Adolescents. Ann Otol Rhinol Laryngol 1985. [DOI: 10.1177/000348948509400404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Carcinoma of the thyroid gland, although fairly common in young adults, is uncommon in the first two decades of life. Because therapy is controversial, it is important to study a relatively large group of patients treated in a single department. This report records the findings and responses to treatment in 40 cases of thyroid gland carcinoma in children and adolescents treated from 1953 to 1982.
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36
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Freitas JE, Gross MD, Ripley S, Shapiro B. Radionuclide diagnosis and therapy of thyroid cancer: current status report. Semin Nucl Med 1985; 15:106-31. [PMID: 2988129 DOI: 10.1016/s0001-2998(85)80021-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Thyroid cancer is uncommon, with an incidence of 10,300 new patients each year and a mortality of 1,100 patients each year. Patient survival correlates with many factors, including tumor pathology, age, primary lesion size, distant metastases, extent of surgery, and radioiodine therapy. Deaths from thyroid cancer may occur many years after diagnosis, and such an indolent course has hampered the analysis of the multiple treatment programs advocated. Thyroid imaging continues to play an important role in the initial detection and follow-up management of thyroid cancer, but the search for a specific tracer for the primary lesion continues. The complementary role of serum thyroglobulin and radioiodine in the follow-up of the thyroidectomized patient is discussed. Radioiodine therapy has proven effectiveness in those patients with radioiodine-avid distant metastases and/or regional metastases. Whether radioiodine ablation of residual thyroid bed activity is beneficial remains controversial.
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37
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Abstract
The cases of thyroid carcinoma treated at this hospital during the period 1948 to 1981 were reviewed retrospectively. Nine hundred eighty-six patients with thyroid nodules were operated on. One hundred fifty-two were thyroid carcinoma (59 papillary, 36 mixed papillary-follicular, 30 follicular, 20 anaplastic, 5 medullary, and 2 Hurthle cell tumors). There was a 92% follow-up for a mean of 10 years. In the last decade, patients presented at a younger age, the female predominance was diminished, and 15% had had previous neck irradiation. Surgery consisted of total (27) or subtotal thyroidectomy (89), lobectomy or nodulectomy (24), and biopsy (12). Total thyroidectomy had an incidence of postoperative complications that was 20 times higher than that with partial thyroidectomy (P less than 0.001). Disease-related death, recurrence, and survivor status were discussed. There was no significant difference between total versus subtotal thyroidectomy. This study reaffirms the usefulness of subtotal resection and the avoidance of morbidity of more radical total thyroidectomy surgery.
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38
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Segal RL, Cobin RH, Futterweit W, Fiedler RP, Sirota DK. Thyroid nodules in the irradiated patient--an indication for total thyroidectomy. J Surg Oncol 1985; 28:126-30. [PMID: 3968896 DOI: 10.1002/jso.2930280212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Eight patients who received radiation therapy to the head, neck, or chest during infancy, childhood, or adolescence are reported. In these individuals, the presenting abnormality was a nodule of the thyroid gland, which was found to be benign at surgery. All patients were subsequently found to harbor a malignant lesion of the contralateral lobe. On the basis of this study and the discussion presented, we feel that a total thyroidectomy is the indicated therapeutic procedure in previously radiated patients presenting with a cold nodule.
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39
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Auguste LJ, Sako K. Radiation and thyroid carcinoma: radiotherapy, head and neck regions, thyroid carcinoma. HEAD & NECK SURGERY 1985; 7:217-24. [PMID: 3882633 DOI: 10.1002/hed.2890070306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Radiotherapy for benign conditions of the head and neck area was first linked to thyroid carcinoma in 1950. All the salivary glands, the parathyroids, and the facial skin can also develop neoplastic lesions in this setting. Thyroid carcinoma is most commonly papillary or mixed papillary and follicular. It is very often multifocal and can be detected by hand palpation, nuclear scanning, high resolution sonography, and needle aspiration. Each test has its limitations and appropriate protocols for screening and detection should be adapted to different medical centers. The surgical management is controversial and ranges from simple lobectomy to total thyroidectomy with adjuvant 131I treatment and thyroid suppression. We prefer total thyroidectomy if it can be performed safely. With adequate treatment the survival should be good. Prevention by administration of iodine at the time of exposure to radiation seems feasible and deserves further clinical trial.
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40
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Cohn K, Bäckdahl M, Forsslund G, Auer G, Lundell G, Löwhagen T, Tallroth E, Willems JS, Zetterberg A, Granberg PO. Prognostic value of nuclear DNA content in papillary thyroid carcinoma. World J Surg 1984; 8:474-80. [PMID: 6485347 DOI: 10.1007/bf01654917] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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41
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42
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43
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Christensen SB, Ljungberg O, Tibblin S. Surgical treatment of thyroid carcinoma in a defined population: 1960 to 1977. Evaluation of the results after a conservative surgical approach. Am J Surg 1983; 146:349-54. [PMID: 6614326 DOI: 10.1016/0002-9610(83)90414-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Ninety patients from a demographically well-defined area of, on an average, 243,000 inhabitants were surgically treated for thyroid carcinoma during an 18 year period. Sixty-five of the patients had papillary carcinoma, 20 follicular carcinoma, 4 medullary carcinoma, and 1 anaplastic carcinoma. Seventy-eight patients were operated on for cure, and among them, 23 had total thyroidectomy and 55 partial thyroidectomy. Additional therapy with thyroxine was given to all patients postoperatively. None of the patients treated for cure died from thyroid carcinoma at follow-up 2 to 20 years after diagnosis. One of 42 patients (2.4 percent) primarily treated for cure with lobectomy for papillary carcinoma had local recurrence in the thyroid bed which was excised successfully. No patient treated for cure of follicular carcinoma had local recurrence. All verified recurrences except one were diagnosed within 5 years of primary operation. We conclude that local recurrence after procedures less than total thyroidectomy that are considered to be curative is unusual provided that thyroxine is given postoperatively. Thus it seems that the reported high rates of microscopic carcinoma in the contralateral lobe in patients with unilateral cancer have little clinical significance. A conservative approach in most patients with localized thyroid carcinoma is indicated because it reduces the risk of postoperative complications.
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44
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45
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Abstract
During a 10.5-year period ending in June 1982, total thyroidectomy was performed on 213 patients at the Vanderbilt University Medical Center. A nonfunctioning nodule on technetium scan was the primary indication for operation. Twenty-one of 213 patients had undergone previous partial thyroidectomy. The pathologic changes in the excised thyroids were carcinoma (81 patients), thyroiditis (27 patients), multiple benign adenoma (16 patients), thyrotoxicosis (27 patients), multinodular goiter (56 patients), and C-cell hyperplasia (three patients). Three total thyroidectomies were performed in search of a parathyroid adenoma. Fourteen patients had coexistent primary hyperparathyroidism. Excluding 12 patients with medullary carcinoma, 25% of all other patients with carcinoma would have had unrecognized tumor left in the remaining lobe had a total thyroidectomy not been performed. Calcium supplements were required in 59 patients during hospitalization, but only 2.8% of the patients developed permanent hypoparathyroidism. Since the adoption of Thompson's technique of total thyroidectomy, only one of the 128 patients (0.8%) has sustained permanent hypoparathyroidism. Two patients exhibited transient recurrent laryngeal nerve palsies without permanent nerve damage. There were no operative deaths. The low morbidity of total thyroidectomy appears to justify its use in all patients with differentiated thyroid malignancy. With surgeons experienced in this technique, total thyroidectomy should also be considered as the primary treatment for many other patients requiring thyroidectomy.
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46
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Abstract
A rare case of a papillary thyroid cancer in a young boy is reported. At the age of 8 years a rapidly growing tumour of the right antero-lateral neck region was detected. Biopsy revealed a cervical lymph node metastasis of a papillary thyroid carcinoma. Any adequate therapy was rejected by the patient's father. After two years of delay, at the age of ten, a severe dyspnoea urged to an emergency tracheotomy. The further investigations revealed a bilateral partly papillary, partly follicular and partly anaplastic thyroid carcinoma with infiltration and compression of the cervical trachea and the cricoid and with right recurrent nerve paralysis. The thyroid cancer was classified as T3N2bM0. To save the boy's life an extensive operation was performed with total extirpation of the thyroid gland and the adjacent tissues, total laryngectomy and resection of the cervical trachea, combined with bilateral neck dissection. The patient has been given no other treatment than hormone substitution during 16 years after surgery. The patient grew up normally and stayed recurrence-free. As far as we could find in world literature, this is the youngest patient with total laryngectomy, partial resection of the trachea, total thyroidectomy and bilateral neck dissection.
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Abstract
While few solitary thyroid nodules are carcinomatous, it is essential to identify and preferentially select those that are for surgery. Clinical, biochemical, serologic, radiographic, scintigraphic, sonographic, biopsy, and even therapeutic evaluation may be necessary to choose those patients with the greatest probability of malignancy. The benefits and limitations of each diagnostic modality are discussed, and the importance of fine-needle aspiration is stressed. After the operative confirmation of malignancy, the prognosis in any given case depends on 1) the histologic type of the neoplasm, 2) its size and extent, 3) the presence of angioinvasiveness, 4) the tendency toward multicentricity of the lesion, 5) the age and sex of the patient, and 6) whether distant metastases are present. These factors influence the extent of surgery required for well-differentiated carcinomas. Meticulous dissection and preservation of the recurrent laryngeal nerves and the parathyroid glands along with their blood supply are important if total thyroidectomy for papillary carcinoma is to be employed with an acceptable operative morbidity to optimize survival. The value of the adjunctive use of thyroid hormone and radioactive iodine is also discussed. Finally, the clinical behaviors and treatments of undifferentiated carcinomas, sarcomas, lymphomas, and neoplasms metastatic to the thyroid gland are reviewed.
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Mazzaferri EL, Young RL. Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 1981; 70:511-8. [PMID: 7211893 DOI: 10.1016/0002-9343(81)90573-8] [Citation(s) in RCA: 401] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Data from 576 patients with papillary thyroid cancer were retrospectively analyzed. With a median follow-up of 10 years and three months, there were six deaths from, and 84 recurrences of, thyroid cancer. Of the latter, 16 (19 percent) could not be eradicated. Death from thyroid cancer occurred only in those 30 years of age or over at the time of diagnosis and only in patients with primary tumors larger than 1.5 cm in diameter. Locally invasive tumor was associated with a poor prognosis. Cervical lymph node metastases found at initial surgery were associated with higher recurrence rates but not higher mortality rates. Treatment with total thyroidectomy, postoperative radioiodine and thyroid hormone resulted in the lowest recurrence and mortality rates except in those patients with small primary tumors (less than 1.5 cm diameter) in whom less than total thyroidectomy and postoperative therapy with thyroid hormone alone gave results which did not differ statistically from those achieved with more aggressive therapy. No important differences in outcome were observed when cervical lymph node metastases were simply excised or more aggressively treated by neck dissection. External radiation and as initial adjunctive therapy adversely influenced outcome.
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Abstract
The clinical outcome in 155 patients with papillary or follicular carcinoma of the thyroid gland operated on over a 25-year period demonstrated no difference in survival rates or incidence of recurrent tumor between those treated by total thyroidectomy and those undergoing less than total thyroidectomy. However, the complication rate was statistically significantly higher in those undergoing total thyroidectomy. Partial thyroidectomy with lobectomy on the side of the tumor, resection of the thyroid isthmus, and simple excision of enlarged cervical lymph nodes, if present, appears to be equally effective and safer.
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