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Raffaelli M, Voloudakis N, Barczynski M, Brauckhoff K, Durante C, Gomez-Ramirez J, Koutelidakis I, Lorenz K, Makay O, Materazzi G, Pandev R, Randolph GW, Tolley N, Vriens M, Musholt T. European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. Br J Surg 2024; 111:znae199. [PMID: 39158073 PMCID: PMC11331340 DOI: 10.1093/bjs/znae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità (CREO), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joaquin Gomez-Ramirez
- Endocrine Surgery Unit, General Surgery Department, Hospital Universitario La Paz, IdiPaz Madrid, Madrid, Spain
| | - Ioannis Koutelidakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ozer Makay
- Centre for Endocrine Surgery, Ozel Saglik Hospital, Izmir, Turkey
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Rumen Pandev
- Department of General Surgery, University Hospital St Marina, Medical University Pleven, Pleven, Bulgaria
| | - Gregory W Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Tolley
- Endocrine Surgery Service, Imperial College NHS Healthcare Trust, London, UK
| | - Menno Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thomas Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Mainz, Germany
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Deo S, Bansal B, Bhoriwal S, Bal CS, Mishra A, Sharma J, Singh S, Jayakumar P, Agarwal S, Bhatnagar S, Mishra S, Bharati SJ, Kumar V, Thulkar S. Re-operative surgery for differentiated thyroid cancer: A single institutional experience of 182 cases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107042. [PMID: 37634301 DOI: 10.1016/j.ejso.2023.107042] [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: 04/14/2023] [Revised: 07/24/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Re-operative thyroid surgery (RTS) is performed in patients of differentiated thyroid cancer (DTC) with residual or recurrent disease. However, there is a paucity of literature discussing experience and technique of RTS. This study aims to address this gap by providing a comprehensive review of RTS for DTC, utilizing experiences from a dedicated complex thyroid surgical oncology program at the apex hospital in a developing country. METHODS A retrospective analysis was conducted using data from the Department of Surgical Oncology's thyroid cancer database. The study period spanned from 2006 to 2022. Clinical presentation, prior surgical history, operative details of RTS, and post-operative outcomes were assessed. Descriptive analysis was performed. RESULTS During the study period, a total of 182 patients underwent re-operative thyroid surgery (RTS). The primary surgeries performed prior to RTS included near-total or total thyroidectomy in most cases (69.2%), and approximately half of the patients (48.4%) had prior neck node interventions. The RTS procedures consisted of completion total thyroidectomy in 30.8% of cases and surgery for thyroid bed recurrence in 9.9% of cases, while central node dissection was performed in 46.2% of patients and unilateral or bilateral template neck dissection was performed in 41.8% of cases. Extended resections were required in 9.3% of patients. Post-operative complications included permanent hypoparathyroidism (2.7%) and unilateral recurrent laryngeal nerve palsy (1.6%). CONCLUSIONS RTS is a complex procedure with high rates of post-operative morbidity reported in literature. Optimal outcomes require a multidisciplinary approach, thorough assessment, and skilled surgeons.
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Affiliation(s)
- Svs Deo
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - Babul Bansal
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - C S Bal
- Department of Nuclear Medicine, AIIMS, New Delhi, India.
| | - Ashutosh Mishra
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - Jyoti Sharma
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - Seema Singh
- Department of Surgical Oncology, RGCIRC, New Delhi, India.
| | - P Jayakumar
- Department of Surgical Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | | | - Sushma Bhatnagar
- Department of Onco-anesthesia and Palliative Medicine, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - Seema Mishra
- Department of Onco-anesthesia and Palliative Medicine, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - Sachidanand Jee Bharati
- Department of Onco-anesthesia and Palliative Medicine, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - Vinod Kumar
- Department of Onco-anesthesia and Palliative Medicine, Dr. BRA-IRCH, AIIMS, New Delhi, India.
| | - Sanjay Thulkar
- Department of Radiology, Dr. BRA-IRCH, AIIMS, New Delhi, India.
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Coca-Pelaz A, Rodrigo JP, Shah JP, Nixon IJ, Hartl DM, Robbins KT, Kowalski LP, Mäkitie AA, Hamoir M, López F, Saba NF, Nuyts S, Rinaldo A, Ferlito A. Recurrent Differentiated Thyroid Cancer: The Current Treatment Options. Cancers (Basel) 2023; 15:2692. [PMID: 37345029 PMCID: PMC10216352 DOI: 10.3390/cancers15102692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
Differentiated thyroid carcinomas (DTC) have an excellent prognosis, but this is sometimes overshadowed by tumor recurrences following initial treatment (approximately 15% of cases during follow-up), due to unrecognized disease extent at initial diagnosis or a more aggressive tumor biology, which are the usual risk factors. The possible sites of recurrence are local, regional, or distant. Local and regional recurrences can usually be successfully managed with surgery and radioiodine therapy, as are some isolated distant recurrences, such as bone metastases. If these treatments are not possible, other therapeutic options such as external beam radiation therapy or systemic treatments should be considered. Major advances in systemic treatments have led to improved progression-free survival in patients previously considered for palliative treatments; among these treatments, the most promising results have been achieved with tyrosine kinase inhibitors (TKI). This review attempts to give a comprehensive overview of the current treatment options suited for recurrences and the new treatments that are available in cases where salvage surgery is not possible or in cases resistant to radioiodine.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Jatin P. Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Iain J. Nixon
- Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh EH3 9YL, UK;
| | - Dana M. Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, CEDEX, 94805 Villejuif, France;
- Laboratoire de Phonétique et de Phonologie, 75005 Paris, France
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 32952, USA;
| | - Luiz P. Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, São Paulo 01509-001, Brazil;
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland;
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium;
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Nabil F. Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA;
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy;
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Management of Recurrent Well-Differentiated Thyroid Carcinoma in the Neck: A Comprehensive Review. Cancers (Basel) 2023; 15:cancers15030923. [PMID: 36765880 PMCID: PMC9913047 DOI: 10.3390/cancers15030923] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Surgery has been historically the preferred primary treatment for patients with well-differentiated thyroid carcinoma and for selected locoregional recurrences. Adjuvant therapy with radioactive iodine is typically recommended for patients with an intermediate to high risk of recurrence. Despite these treatments, locally advanced disease and locoregional relapses are not infrequent. These patients have a prolonged overall survival that may result in long periods of active disease and the possibility of requiring subsequent treatments. Recently, many new options have emerged as salvage therapies. This review offers a comprehensive discussion and considerations regarding surgery, active surveillance, radioactive iodine therapy, ultrasonography-guided percutaneous ablation, external beam radiotherapy, and systemic therapy for well-differentiated thyroid cancer based on relevant publications and current reference guidelines. We feel that the surgical member of the thyroid cancer management team is empowered by being aware and facile with all management options.
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Sharanappa V, Pradhan S, Mishra A, Pradhan PK. Neoadjuvant Multikinase Inhibitor Therapy in Locally Advanced Unresectable Differentiated Thyroid Carcinoma: a Case Report. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Abuduwaili M, Su A, Xing Z, Xia B, Wu Z, Fei Y, Zhu J, Chen Z. Clinical significance of extrathyroidal extension to major vessels in papillary thyroid carcinoma. J Endocrinol Invest 2022; 46:1155-1167. [PMID: 36427135 DOI: 10.1007/s40618-022-01966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 11/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Gross extrathyroidal extension (gETE) into major vessel is considered the most advanced stage of the locally advanced papillary thyroid cancer (PTC). Surgical intervention may not benefit some patients at this disease stage or even result in intraoperative death due to massive hemorrhage; however, it is still considered an effective strategy for most cases. The lack of description for this challenging invasion in PTC warrants detailed characterization of its pattern, risk factors, optimal surgical method, and prognostic value. METHODS In total, 3127 patients diagnosed as having PTC were enrolled and categorized into two the following groups, namely the major vessel invasion (MVI) group (n = 30) and the control group (n = 3097). Data regarding clinicopathological and demographic characteristics, vascular invasion sites, postoperative complications, locoregional recurrence, distant metastasis, and surgical strategies were collected. Predictive disease-free survival (DFS) was also compared between the two groups. RESULTS MVI was independently associated with invasion of the esophageal extension, age < 55 years, tumor size > 1 cm, lateral lymph node metastasis, and distant metastasis (P = 0.00; P = 0.01; 0.05; P = 0.00; P = 0.00, respectively). The difference in the predictive DFS between the two groups was significant (P = 0.00), and the difference remained significant even in patients with ETE when compared with patients without ETE (P = 0.00). Additionally, predictive DFS did not differ significantly between patients who received vessel repairment and those who received vessel resection (P = 0.28). CONCLUSIONS This study first characterized the gross MVI pattern exhibited by PTC and the risk factors for MVI. Additionally, it demonstrated the DFS of patients with PTC. Extensive gross MVI significantly worsened the biological characteristics of PTC. Regardless of the high risk and difficulty of the operation, patients still benefited from the surgical intervention, and vessel repairment may be the optimal surgical strategy.
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Affiliation(s)
- M Abuduwaili
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - A Su
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Z Xing
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - B Xia
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Z Wu
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Y Fei
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - J Zhu
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Z Chen
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
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Dahan A, Al Ghuzlan A, Chehab R, Guerlain J, Breuskin I, Garcia C, Lamartina L, Hadoux J, Baudin E, Hartl DM. Pathological Analysis of Encased Resected Recurrent Nerves in Locally Invasive Thyroid Cancer. Cancers (Basel) 2022; 14:cancers14122961. [PMID: 35740626 PMCID: PMC9221102 DOI: 10.3390/cancers14122961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Thyroid cancer encasing the recurrent nerve is rare, and the decision to resect or preserve the nerve is multifactorial. The aim of this retrospective study was to evaluate the rate of actual invasion of the nerve beyond the nerve sheath in cancers encasing the nerve. Fifty-two patients were included: 7 cases of medullary thyroid carcinoma, 8 papillary thyroid carcinomas in children and 37 follicular derived cancers in adults. Tumor-related vocal fold paralysis was present in 30% of cases. The nerve was invaded in 82% of follicular cell-derived tumors, 88% of pediatric cases, and 100% of medullary carcinomas. Only agressive histology was a risk factor for nerve invasion. Vocal fold paralysis was not predictive. To our knowledge, this is one of the largest series with pathologic analysis of resected recurrent nerves, showing a high rate of nerve invasion in these rare cases of cancer encasing the reucrrent nerve. Abstract Objective: Thyroid cancer encasing the recurrent nerve is rare, and the decision to resect or preserve the nerve is multifactorial. The objective of this study was to histopathologically analyze resected encased nerves to assess the rate of nerve invasion and risk factors. Materials and Methods: A retrospective study was carried out on consecutive patients with resection of the recurrent nerve for primary or recurrent follicular cell-derived or medullary thyroid carcinoma from 2005 to 2020. Demographics, pathology, locoregional invasion, metastases, recurrences and survival were analyzed. Slides were reviewed blindly by two specialized pathologists (AAG, RC) for diagnosis of invasion deep to the epineurium. Results: Fifty-two patients were included: 25 females; average age, 55 (range 8–87). In total, 87% percent (45/52) were follicular cell-derived with 17/45 (37.8%) aggressive variants; 13% (7/52) were medullary carcinoma. Preoperative vocal fold (VF) paralysis was present in 16/52 (30.7%). Pathologically, the nerve was invaded in 44/52 cases (85%): 82% of follicular cell-derived tumors (37/45), 88% of pediatric cases, and 100% of medullary carcinomas (7/7). Nerve invasion was observed in 11/16 (69%) with preoperative VF paralysis and 33/36 (92%) with normal VF function. Only aggressive histology was correlated with nerve invasion in follicular cell-derived tumors (p = 0.019). Conclusions: The encased nerves were pathologically invaded in 82% of follicular cell-derived tumors and in 100% of medullary carcinomas. Nerve invasion was statistically correlated with aggressive histopathological subtypes and was observed in the absence of VF paralysis in 92% of cases.
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Affiliation(s)
- Alexandre Dahan
- Thyroid Surgery Unit, Department of Anesthesia, Surgery, and Interventional Radiology, Institute Gustave Roussy, 94805 Villejuif, France; (A.D.); (J.G.); (I.B.)
| | - Abir Al Ghuzlan
- Department of Biology and Pathology, Institute Gustave Roussy, 94805 Villejuif, France; (A.A.G.); (R.C.)
| | - Randa Chehab
- Department of Biology and Pathology, Institute Gustave Roussy, 94805 Villejuif, France; (A.A.G.); (R.C.)
| | - Joanne Guerlain
- Thyroid Surgery Unit, Department of Anesthesia, Surgery, and Interventional Radiology, Institute Gustave Roussy, 94805 Villejuif, France; (A.D.); (J.G.); (I.B.)
| | - Ingrid Breuskin
- Thyroid Surgery Unit, Department of Anesthesia, Surgery, and Interventional Radiology, Institute Gustave Roussy, 94805 Villejuif, France; (A.D.); (J.G.); (I.B.)
| | - Camilo Garcia
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, 94805 Villejuif, France; (C.G.); (L.L.); (J.H.); (E.B.)
| | - Livia Lamartina
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, 94805 Villejuif, France; (C.G.); (L.L.); (J.H.); (E.B.)
| | - Julien Hadoux
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, 94805 Villejuif, France; (C.G.); (L.L.); (J.H.); (E.B.)
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, 94805 Villejuif, France; (C.G.); (L.L.); (J.H.); (E.B.)
| | - Dana M. Hartl
- Thyroid Surgery Unit, Department of Anesthesia, Surgery, and Interventional Radiology, Institute Gustave Roussy, 94805 Villejuif, France; (A.D.); (J.G.); (I.B.)
- Correspondence:
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Dell’Aquila M, Tralongo P, De Ruggieri G, Curatolo M, Revelli L, Lombardi CP, Pontecorvi A, Fadda G, Larocca LM, Raffaelli M, Pantanowitz L, Rossi ED. Does Locally Advanced Thyroid Cancer Have Different Features? Results from a Single Academic Center. J Pers Med 2022; 12:221. [PMID: 35207709 PMCID: PMC8879437 DOI: 10.3390/jpm12020221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite the fact that the majority of thyroid cancers are indolent, 15% of patients with well-differentiated carcinoma including papillary thyroid carcinoma (PTC) present with locally advanced thyroid cancer (LATC) at diagnosis. The current study analyzes a cohort of patients with LATC focusing on their risk for local recurrence, distant metastases, and overall survival. MATERIALS AND METHODS From January 2010 to December 2020, 65 patients with LATC were retrieved, including 42 cases with preoperative cytological samples. BRAFV600E and TERT mutations were performed on both cytology and histopathology specimens in this cohort. RESULTS Among the 65 cases, 42 (65%) were women. The median age was 60.1 years. Histological diagnoses included 25 (38.4%) with classic PTC and 30 (46.1%) aggressive variants of PTC, mostly tall cell variant (17 cases, 26.1%). Multifocality was seen in 33 cases (50.8%). All patients had nodal metastases. The most common site of extrathyroidal extension was the recurrent laryngeal nerve (69.2%). Staging revealed 21 cases were stage I, none were stage II, 33 were stage III, and 7 were stage IVa and 4 stage IVb. No differences were found between well and poorly/undifferentiated thyroid cancers. CONCLUSION These data suggest that locally advanced thyroid cancers, including variants of PTC, exhibit a more aggressive biological course and should accordingly be more assertively managed.
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Affiliation(s)
- Marco Dell’Aquila
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Giuseppe De Ruggieri
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (G.D.R.); (L.R.); (C.P.L.); (M.R.)
| | - Mariangela Curatolo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Luca Revelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (G.D.R.); (L.R.); (C.P.L.); (M.R.)
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (G.D.R.); (L.R.); (C.P.L.); (M.R.)
| | - Alfredo Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy;
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Marco Raffaelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (G.D.R.); (L.R.); (C.P.L.); (M.R.)
| | - Liron Pantanowitz
- Department of Pathology& Clinical Labs, University of Michigan, Ann Arbor, MI 48103, USA;
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
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9
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Alshehri K, Alqurashi Y, Merdad M, Samargandy S, Daghistani R, Marzouki H. Neoadjuvant lenvatinib for inoperable thyroid cancer: A case report and literature review. Cancer Rep (Hoboken) 2021; 5:e1466. [PMID: 34105309 PMCID: PMC8842697 DOI: 10.1002/cnr2.1466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Poorly differentiated thyroid cancer (PDTC) is now classified as a separate thyroid tumor entity. It has male predominance and poor prognosis compared to differentiated TC. Case We report a case of a patient with PDTC who was previously deemed inoperable. A trial of neoadjuvant lenvatinib therapy was given to the patient after that the tumor become operable and the surgery went successfully. Conclusions Lenvatinib is a feasible option in patients with inoperable TC and can stabilize the lesion size or even reduce it, leading to a more favorable surgical outcome.
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Affiliation(s)
- Khalid Alshehri
- Department of Otorhinolaryngology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Yousuf Alqurashi
- Department of Otorhinolaryngology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mazin Merdad
- Department of Otorhinolaryngology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Shaza Samargandy
- Endocrine Unite, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Razan Daghistani
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hani Marzouki
- Department of Otorhinolaryngology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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10
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Russell MD, Kamani D, Randolph GW. Modern surgery for advanced thyroid cancer: a tailored approach. Gland Surg 2020; 9:S105-S119. [PMID: 32175251 DOI: 10.21037/gs.2019.12.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Surgical treatment of advanced thyroid malignancy can be morbid, compromising normal functions of the upper aerodigestive tract. There is a paucity of guidelines dedicated to the management of advanced disease. In fact, there is not even a uniform definition for advanced thyroid cancer currently. The presence of local invasion, bulky cervical nodes, distant metastases or recurrent disease should prompt careful preoperative evaluation and planning. Surgical strategy should evolve from multidisciplinary discussion that integrates individual disease characteristics and patient preference. Intraoperative neuromonitoring has important applications in surgery for advanced disease and should be used to guide surgical strategy and intraoperative decision-making. Recent paradigm shifts, including staged surgery and use of neoadjuvant targeted therapy hold potential for decreasing surgical morbidity and improving clinical outcomes. Modern surgical planning provides optimal treatment for each patient through a tailored approach based on exact extent and type of disease as well as incorporating appreciation of surgical complications, patient preferences and intraoperative findings.
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Affiliation(s)
- Marika D Russell
- Department of Otolaryngology & Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Hakeem AH, Javaid H, Hakeem IH, Wani FJ. Near-Total Laryngectomy for Extranodal Infiltration from Papillary Cancer to Larynx and Hypopharynx. Indian J Surg Oncol 2019; 10:614-617. [DOI: 10.1007/s13193-019-00932-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/02/2019] [Indexed: 11/28/2022] Open
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12
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Tam S, Amit M, Boonsripitayanon M, Cabanillas ME, Busaidy NL, Gunn GB, Lai SY, Gross ND, Sturgis EM, Zafereo ME. Adjuvant External Beam Radiotherapy in Locally Advanced Differentiated Thyroid Cancer. JAMA Otolaryngol Head Neck Surg 2019; 143:1244-1251. [PMID: 29098272 DOI: 10.1001/jamaoto.2017.2077] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Samantha Tam
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Moran Amit
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Mongkol Boonsripitayanon
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Maria E Cabanillas
- Division of Internal Medicine, Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston
| | - Naifa L Busaidy
- Division of Internal Medicine, Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston
| | - G Brandon Gunn
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Stephen Y Lai
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Neil D Gross
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Erich M Sturgis
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston.,Division of Cancer Prevention and Population Studies, Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mark E Zafereo
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
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13
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Xu MS, Li J, Wiseman SM. Major vessel invasion by thyroid cancer: a comprehensive review. Expert Rev Anticancer Ther 2018; 19:191-203. [DOI: 10.1080/14737140.2019.1559059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Michael S. Xu
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Li
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M. Wiseman
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
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14
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Kim BY, Choi JE, Lee E, Son YI, Baek CH, Kim SW, Chung MK. Prognostic factors for recurrence of locally advanced differentiated thyroid cancer. J Surg Oncol 2017. [PMID: 28650576 DOI: 10.1002/jso.24740] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background and Objectives To present treatment outcomes and prognostic factors for surgical management of locally advanced differentiated thyroid cancer (DTC). METHODS Retrospective review of 70 patients in a single, tertiary referral institution was done. Clinical pathology characteristics were analyzed to investigate prognosticators, based on primary endpoints; locoregional recurrence alone (LRR), total recurrence (LRR or distant metastasis (DM)), and recurrence-free survival. RESULTS Recurrent laryngeal nerve (n = 31) and trachea (n = 30) were most commonly invaded organs by tumor. At the mean follow-up of 81.7 months, LRR occurred in 15 patients and/or DM was detected in 15 patients (10 developed LRR and DM). By multivariate analysis, R1 resection (positive margin) and pN1b stage increased risk of LRR with a fold of 3.16 [95%CI 1.08-9.24, P = 0.03] and 5.92 [1.61-21.7, P = 0.007], respectively. Also, they increased risk of total recurrence with a fold of 3.04 [95%CI 1.26-7.31, P = 0.01] and 3.42 [95%CI 1.16-10.0, P = 0.02], respectively. Patients with pN1b stage showed better LRR-free survival than pN0/N1a stage (P = 0.03). Conclusions Along with careful preoperative evaluation of the extent of primary and neck disease, obtaining negative resection margin and aggressive neck management is critical to improve oncologic outcomes of locally advanced DTC.
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Affiliation(s)
- Bo-Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Eun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eunkyu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Woo Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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15
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Amini K, Frank DK. True Vocal Fold Immobility in the Setting of Well-Differentiated Thyroid Carcinoma: Unusual Illustrative Cases and Recommendations for Operative Strategy. Ann Otol Rhinol Laryngol 2016; 116:324-8. [PMID: 17561759 DOI: 10.1177/000348940711600502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We present cases of transient true vocal fold (TVF) immobility caused by well-differentiated thyroid carcinoma (WDTC), and review the literature concerning management of WDTC invading the recurrent laryngeal nerve (RLN). Methods: A description of the clinical course of 2 patients with WDTC and transient TVF immobility is presented in the context of a review of the literature concerning locally advanced WDTC with extrathyroidal extension and RLN involvement. Results: Both patients had papillary thyroid carcinoma with ipsilateral TVF paralysis that resolved completely before operation. During the operation, the RLN was found to be grossly involved with disease and inseparable from the tumor, necessitating resection. Review of the literature revealed the following points that should be considered when confronting an RLN invaded by WDTC. 1) Benign disease can mimic invasive WDTC and must be ruled out. 2) RLN invasion does not carry the same prognostic implications as other categories of extrathyroidal extension of WDTC. 3) RLN sacrifice does not increase the overall survival rate. 4) There is no evidence that a paralyzed RLN will regain function when preserved. 5) The majority of RLNs that function before operation can be expected to function after the operation if preserved. Conclusions: Resolution of TVF paralysis should not reduce suspicion of RLN involvement by WDTC. When RLN involvement is discovered during operation, every attempt should be made to preserve a functioning RLN.
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Affiliation(s)
- Kamyar Amini
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
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Krishnatreya M, Rahman T, Kataki AC, Sharma JD, Nandy P, Baishya N. Pre-treatment performance status and stage at diagnosis in patients with head and neck cancers. Asian Pac J Cancer Prev 2015; 15:8479-82. [PMID: 25339050 DOI: 10.7314/apjcp.2014.15.19.8479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Performance status (PS) is a key factor in the selection of treatment in head and neck cancer patients (HNC). There is a probability in the development of an unfavorable PS with HNC advancing stages. This retrospective study was done on data of patients registered during the period from January 2010 to December 2012 at a cancer registry in the North Eastern India. PS was recorded according to the WHO scale. Multinomial logistic regression analysis was conducted to assess the probability of poor performance status with advancing stage. Out of 3,593 patients, there were 78.9% (2,836) males and 21.1% (757) females. Average PS0 was seen in 57.4% of all HNCs, less than 1% of all cases in HNCs with poor PS3-4 except in cases with thyroid, parotid and nose and PNS cancers, 0.7% stage IV (±M1) HNC with PS4, favorable PS0-1 was seen in 84% to 100% of cases, RR=57.1 (CI=21.2-154.1) in M1 for PS4 and with advancing stages the probability of worsening of PS0 to PS4 was 3 times (P=0.021, 95% CI= 1.187-8.474). In HNC, the majority of patients presents with a favorable PS0- 1 with different odds of worsening of PS with advancing stages and the presence of metastasis in stage IV is significantly associated with a poor PS.
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Affiliation(s)
- Manigreeva Krishnatreya
- Department of Cancer Registry, Epidemiology and Biostatistics, Dr.B Borooah Cancer Institute, Guwahati, India E-mail :
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Moritani S. Impact of lymph node metastases with recurrent laryngeal nerve invasion on patients with papillary thyroid carcinoma. Thyroid 2015; 25:107-11. [PMID: 25317601 DOI: 10.1089/thy.2014.0152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although rare, invasion by papillary thyroid carcinoma (PTC) of the upper aerodigestive tract significantly affects patients' prognosis and quality of life. Within the central compartment, the recurrent laryngeal nerve (RLN) is most frequently invaded by lymph node metastases (LNM). However, such an invasion has not been described in the literature, although reports on RLN invasion by primary tumors have been published. The present study aimed to characterize LNM with RLN invasion in patients with PTC. METHODS The participants of this retrospective investigation were selected from 629 PTC patients who received initial surgical treatment at our institution between January 1981 and December 2012. They included 38 (6%) patients with 40 cases of RLN invasion by LNM (LNM invasion group) and 112 (17.8%) patients with 117 cases of RLN invasion by the primary tumor (primary invasion group). RESULTS In the LNM invasion group, 70% of the RLN invasion cases occurred on the right side, whereas those in the primary invasion group were almost equally distributed. RLN invasion caused vocal cord paralysis, affecting 13 nerves (32.5%) in the LNM invasion group and 68 nerves (58%) in the primary invasion group. Significant differences in laterality and preoperative vocal cord paralysis were observed between the two groups. In the LNM invasion group, the longest diameter of metastatic lymph nodes (mean±standard deviation) of patients with RLN paralysis was 21±8 mm, whereas it was significantly different at 14±7 mm in those without RLN paralysis. CONCLUSIONS Our results indicate that most patients with RLN invasion by LNM did not experience preoperative vocal cord paralysis. LNM invasion of the RLN (70%) more often occurred on the right side as expected given the complexity and three-dimensional anatomy of the RLN in the right paratracheal region compared to the left. RLN invasion by LNM should be considered if preoperative paratracheal nodal disease, especially when bulky, is noted in the right paratracheal region.
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Affiliation(s)
- Sueyoshi Moritani
- Center for Head and Neck Surgery, Kusatsu General Hospital , Kusatsu, Japan
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18
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Shindo ML, Caruana SM, Kandil E, McCaffrey JC, Orloff LA, Porterfield JR, Shaha A, Shin J, Terris D, Randolph G. Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement. Head Neck 2014; 36:1379-90. [PMID: 24470171 DOI: 10.1002/hed.23619] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/24/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Invasive differentiated thyroid cancer (DTC) is relatively frequent, yet there is a paucity of specific guidelines devoted to its management. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to provide clinical consensus statements based on review of the literature, synthesized with the expert opinion of the group. METHODS An expert panel, selected from membership of the AHNS, constructed the manuscript and recommendations for management of DTC with invasion of recurrent laryngeal nerve, trachea, esophagus, larynx, and major vessels based on current best evidence. A Modified Delphi survey was then constructed by another expert panelist utilizing 9 anchor points, 1 = strongly disagree to 9 = strongly agree. Results of the survey were utilized to determine which statements achieved consensus, near-consensus, or non-consensus. RESULTS After endorsement by the AHNS Endocrine Committee and Quality of Care Committee, it received final approval from the AHNS Council.
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Affiliation(s)
- Maisie L Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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Lin S, Huang H, Liu X, Li Q, Yang A, Zhang Q, Guo Z, Chen Y. Treatments for complications of tracheal sleeve resection for papillary thyroid carcinoma with tracheal invasion. Eur J Surg Oncol 2014; 40:176-81. [DOI: 10.1016/j.ejso.2013.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/11/2013] [Accepted: 12/12/2013] [Indexed: 12/16/2022] Open
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20
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Airtight Tracheocutaneostomy After Window Resection of the Trachea for Invasive Papillary Thyroid Carcinoma: Experience of 109 Cases. World J Surg 2013; 38:660-6. [DOI: 10.1007/s00268-013-2197-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Iyer NG, Shaha AR. Management of thyroid nodules and surgery for differentiated thyroid cancer. Clin Oncol (R Coll Radiol) 2010; 22:405-12. [PMID: 20381323 DOI: 10.1016/j.clon.2010.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 03/16/2010] [Indexed: 11/19/2022]
Abstract
The incidence of well-differentiated thyroid cancer has seen a worldwide increase in the last three decades. Whether this is due to a 'true increase' in incidence or simply increased detection of otherwise subclinical disease remains unclear. The treatment of thyroid cancer revolves around appropriate surgical intervention, minimising complications and the use of adjuvant therapy in select circumstances. Prognostic features and risk stratification are crucial in determining the appropriate treatment. There continues to be considerable debate in several aspects of management in these patients. Level 1 evidence is lacking, and there are limited prospective data to direct therapy, hence limiting decision-making to retrospective analyses, treatment guidelines based on expert opinion and personal philosophies. This overview focuses on the major issues associated with the investigation of thyroid nodules and the extent of surgery. As overall survival in well-differentiated thyroid cancer exceeds 95%, it is important to reduce over-treating the large majority of patients, and focus limited resources on high-risk patients who require aggressive treatment and closer attention. The onus is on the physician to avoid treatment-related complications from thyroid surgery and to offer the most efficient and cost-effective therapeutic option.
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Affiliation(s)
- N G Iyer
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York 10065, USA
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23
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Controversies and challenges in the management of well-differentiated thyroid cancer. Indian J Surg 2009; 71:299-307. [PMID: 23133181 DOI: 10.1007/s12262-009-0084-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 11/24/2009] [Indexed: 12/11/2022] Open
Abstract
The incidence of well-differentiated thyroid cancer has seen a worldwide increase in the last three decades, although whether this is due to a 'true increase' in incidence or simply increased detection of otherwise subclinical disease remains undetermined. Nonetheless, this rising incidence has fuelled an interest in early diagnosis, treatment and follow-up of thyroid cancer along with greater public awareness. The treatment of thyroid cancer revolves around appropriate surgical intervention, minimising complications and the use of adjuvant therapy in select circumstances. Prognostic features and risk stratification are crucial in determining the appropriate treatment. There continues to be considerable debate in several aspects of management in these patients, and there is limited prospective data to direct therapy, hence limiting decision-making to retrospective analyses, treatment guidelines based on expert opinion and personal philosophies. The major controversies are related to diagnostic work-up, extent of surgery and postoperative management including the role of radioactive iodine. There are also differences in opinion regarding management of nodal metastases and follow-up protocols. As overall survival in well-differentiated thyroid cancer exceeds 95%, it is important to reduce over-treating the large majority of patients, and focus limited resources on high-risk patients who require aggressive treatment and closer attention. There needs to be a concerted effort on the part of a multidisciplinary team to recognise the nuances in treating well-differentiated thyroid cancer.
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Matsuyama H, Sugitani I, Fujimoto Y, Kawabata K. Indications for thyroid cancer surgery in elderly patients. Surg Today 2009; 39:652-7. [DOI: 10.1007/s00595-008-3951-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 08/12/2008] [Indexed: 11/24/2022]
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Ito Y, Fukushima M, Yabuta T, Tomoda C, Inoue H, Kihara M, Higashiyama T, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Miyauchi A. Local Prognosis of Patients with Papillary Thyroid Carcinoma who were Intra-operatively Diagnosed as Having Minimal Invasion of the Trachea: A 17-year Experience in a Single Institute. Asian J Surg 2009; 32:102-8. [DOI: 10.1016/s1015-9584(09)60019-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Goldenberg D, Zagon IS, Fedok F, Crist HS, McLaughlin PJ. Expression of opioid growth factor (OGF)-OGF receptor (OGFr) axis in human nonmedullary thyroid cancer. Thyroid 2008; 18:1165-70. [PMID: 19014324 DOI: 10.1089/thy.2008.0112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although thyroid cancers are readily treatable with surgery and radioactive iodine, there are problems in managing recurring, as well as locally advanced, thyroid cancer. The opioid growth factor (OGF) and its receptor, OGF receptor (OGFr), form a tonically active, autocrine-paracrine loop that serves to inhibit cell proliferation in a wide variety of normal and abnormal cells and tissues. In the present study we examined the presence and distribution of OGF and OGFr in nonmedullary thyroid cancer, including papillary, follicular, and anaplastic, as well as thyroid tissue from patients with nonmalignant disease. METHODS Patient samples of thyroid cancers and goiter were collected at the time of resection and processed for immunohistochemistry of OGF and OGFr, as well as pharmacological binding assays for OGFr. RESULTS Both peptide and receptor were detected in the cytoplasm and nucleus of all nonmedullary thyroid cancers, as well as in goiter. Specific and saturable binding of OGFr was found in all thyroid samples. CONCLUSIONS The finding that a potent negative growth regulator and its receptor are present in nonmedullary thyroid cancers and thyroid tissues from patients with nonmalignant disease lead us to suggest that the OGF-OGFr axis serves as a regulator of cell proliferation in these tissues. Moreover, modulation of this biological system may be used to treat progression of nonmedullary thyroid neoplasias.
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Affiliation(s)
- David Goldenberg
- Division of Otolaryngology, Department of Surgery, H091, College of Medicine, The Penn State University, Hershey, Pennsylvania 17033, USA.
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Abstract
There has been a rapid rise in the incidence of thyroid cancer in the United States, along with more incidentalomas of the thyroid. Treatment of thyroid cancer revolves around appropriate surgical intervention, minimizing complications, and the use of adjuvant therapy in select circumstances. Prognostic features and risk-group analysis are crucial in determining the appropriate treatment. Thyroid cancers are divided into low-, intermediate-, and high-risk groups. Surgical treatment should adhere to the risk-group analysis. The prognostic features in thyroid cancer are age, gender, size and grade of the tumor, extrathyroidal extension, and completeness of resection. The patient presenting with extrathyroidal extension needs extra attention in the operating room to remove all gross tumor during the initial surgical procedure to avoid future recurrences. Nodal metastasis generally has minimal implications; however, in older patients and those with poorly differentiated histology, it has major implications. Grading of the tumor is important, especially for understanding the poorly differentiated varieties of thyroid cancer, such as tall cell and insular. These patients do not respond well to RAI and are best followed with a PET scan. Overall survival in patients with well-differentiated thyroid cancer exceeds 95%.
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Affiliation(s)
- Ashok Shaha
- Attending Surgeon, Memorial Sloan-Kettering Cancer Center, Head and Neck Service, New York, New York, USA.
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Affiliation(s)
| | - David M. Brams
- From Endocrine Surgery, Lahey Clinic, Burlington, Massachusetts
| | - John P. Wei
- From Endocrine Surgery, Lahey Clinic, Burlington, Massachusetts
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Miyauchi A, Ito Y, Miya A, Higashiyama T, Tomoda C, Takamura Y, Kobayashi K, Matsuzuka F. Lateral Mobilization of the Recurrent Laryngeal Nerve to Facilitate Tracheal Surgery in Patients with Thyroid Cancer Invading the Trachea Near Berry’s Ligament. World J Surg 2007; 31:2081-4. [PMID: 17876665 DOI: 10.1007/s00268-007-9180-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Thyroid cancer often invades the trachea and the recurrent laryngeal nerve (RLN) at or near Berry's ligament, which fixes the thyroid gland to the trachea. In patients with thyroid cancer invading the trachea near the ligament, preservation of the RLN is very difficult. Regardless of whether the nerve is preserved or is resected and reconstructed, the presence of the nerve interferes with tracheal resection and repair. We proposed a new technique to solve this problem. METHODS Before tracheal surgery, the inferior pharyngeal constrictor muscle was divided along the lateral edge of the thyroid cartilage, and the RLN was mobilized and retracted laterally. We applied this technique in 11 patients with papillary thyroid carcinoma invading the trachea. Two patients demonstrated vocal cord paralysis preoperatively. The procedures used for tracheal surgery in this series were partial resection of the trachea with creation of a tracheocutaneostomy, that with direct suture, and shaving off the tumor in 7, 2, and 2 patients, respectively. RESULTS The RLN could be preserved and mobilized laterally in eight patients. While three patients demonstrated transient vocal cord paralysis, the remaining five had functioning cords postoperatively. In three patients the RLN was resected, and the remaining distal stump was mobilized and anastomosed with the ansa cervicalis. These patients recovered their voices and maximum phonation time increased to the normal level. The tracheocutaneous stoma was closed with local skin flap about four months later in all patients. CONCLUSION Lateral mobilization of the RLN facilitates the preservation of the nerve and the performance of tracheal surgery in patients with thyroid cancer invading the trachea at or near Berry's ligament.
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Affiliation(s)
- Akira Miyauchi
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe 650-0011, Japan.
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Morton RP, Ahmad Z. Thyroid cancer invasion of neck structures: epidemiology, evaluation, staging and management. Curr Opin Otolaryngol Head Neck Surg 2007; 15:89-94. [PMID: 17413408 DOI: 10.1097/moo.0b013e3280147348] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW This review addresses the issue of direct extra-capsular invasion of thyroid cancer; this may occur in several ways and to varying degrees. The evidence regarding the prognostic and treatment implications of extra-thyroidal spread is examined. The phenomenon is most common in papillary carcinoma of the thyroid and that is the focus for this review. Less common, but more aggressive tumours (medullary and anaplastic carcinoma) are not considered here. RECENT FINDINGS Overall, around 15% of thyroid cancers exhibit extra-thyroid spread but the rate is much higher in specific subgroups. The presence of invasive disease affects the staging of the tumour, and the implications for surgery can be substantial if complete tumour extirpation is to be achieved. No particular examination is completely accurate in detecting extra-thyroid spread preoperatively. Invasion posteriorly carries greater morbidity and mortality than anterior spread. The presence of extra-thyroid spread usually warrants adjuvant radiotherapy (radioiodine or external beam). SUMMARY Histologic assessment is the gold standard for detecting invasive thyroid cancer. Thyroidectomy is effectively a staging procedure by which the presence and extent of invasive disease can be established and subsequent management determined. Extra-thyroidal spread influences morbidity and mortality.
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Affiliation(s)
- Randall P Morton
- Department of Otolaryngology-Head and Neck Surgery, Manukau City, Auckland, New Zealand.
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Jeong HS, Chung M, Baek CH, Ko YH, Choi JY, Son YI. Can [18F]-Fluorodeoxyglucose Standardized Uptake Values of PET Imaging Predict Pathologic Extrathyroid Invasion of Thyroid Papillary Microcarcinomas? Laryngoscope 2006; 116:2133-7. [PMID: 17146385 DOI: 10.1097/01.mlg.0000243043.65560.3f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the hypothesis that the [F]-fluorodeoxyglucose (FDG) standardized uptake values (SUVs) of positron emission tomographic (PET) imaging can predict pathologic extrathyroid invasion of thyroid papillary microcarcinomas (TPMC) DESIGN: Prospective clinical study. METHOD From 2004 to 2005, 44 consecutive patients with TPMC (< or =1 cm), confirmed by ultrasonography and aspiration cytology, had FDG PET scans performed. Among them, 66 tumor foci in 41 patients were confirmed to be of less than 1 cm in diameter by the final surgical pathology report. According to the microcarcinoma tumor focus, prediction of pathologic extrathyroid invasion, by clinical variables including sonographic findings and SUVs from PET imaging, was evaluated by the univariate and multivariate logistic regression analysis. RESULTS : Univariate analysis showed that the tumor site attached to the thyroid capsule and the SUVs of PET imaging could predict pathologic extrathyroid invasion. However, the tumor site attached to thyroid capsule and an age older than 45 were significant predictors by multivariate analysis (P = .001 and P = .036). SUVs from PET imaging were only correlated with the size of tumor (P < 0.001). CONCLUSION The SUVs from FDG PET imaging alone cannot predict the pathologic extrathyroid invasion in patients with TPMC. However, the ultrasonographic findings, such as tumor site, provide better information about the extrathyroid invasion of TPMC tumor foci.
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Affiliation(s)
- Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Spanknebel K, Chabot JA, DiGiorgi M, Cheung K, Curty J, Allendorf J, LoGerfo P. Thyroidectomy using monitored local or conventional general anesthesia: an analysis of outpatient surgery, outcome and cost in 1,194 consecutive cases. World J Surg 2006; 30:813-24. [PMID: 16547617 DOI: 10.1007/s00268-005-0384-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Critical appraisal of safety, feasibility, and economic impact of thyroidectomy procedures using local (LA) or general anesthesia (GA) is performed. METHODS Consecutive patients undergoing thyroidectomy procedures were selected from a prospective database from January 1996 to June 2003 of a single-surgeon practice at a tertiary center. Statistical analyses determined differences in patient characteristics, outcomes, operative data, and length of stay (LOS) between groups. A cohort of consecutive patients treated in 2002-2003 by all endocrine surgeons at the institution was selected for cost analysis. RESULTS A total of 1,194 patients underwent thyroidectomy, the majority using LA (n = 939) and outpatient surgery (65%). Female gender (76%), body mass index > or = 30 kg/m2 (29%), median age (49 years), and cancer diagnosis (45%) were similar between groups. Extent of thyroidectomy (59% total) and concomitant parathyroidectomy (13%) were similarly performed. GA was more commonly utilized for patients with comorbidity [15% vs. 10%, Anesthesia Society of America (ASA) > or = 3; P < 0.001], symptomatic goiter (13% vs. 7%; P = 0.004), reoperative cases (10% vs. 6%; P = 0.01), and concomitant lymphadenectomy procedures (15% vs. 3%; P < 0.001). GA was associated with significant increase in LOS > or = 24 hours (17 % vs. 4%) or overnight observation (49 % vs. 14%), P < 0.001. Operative room utilization was significantly associated with type of anesthesia (180 min vs. 120 min, GA vs. LA, P < .001) and impacted to a lesser degree by surgeon operative time (89 minutes vs. 76 minutes, GA vs. LA; P = .089). Overall morbidity rates were similar between groups (GA 5.8 % vs. LA 3.2%). The actual total cost (ATC) per case for GA was 48% higher than for LA and 30% higher than the ATC for all procedures (P = 0.006), with the combined weighted average impacted by more LA cases (n = 217 vs. 85). CONCLUSION These data from a large, unselected group of thyroidectomy patients suggest LA results in similar outcomes and morbidity rates to GA. It is likely that associated LA costs are lower.
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Affiliation(s)
- Kathryn Spanknebel
- Division of General Surgery, The New York Thyroid Center, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB-7SK, New York, NY 10032, USA.
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