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Choi WK, Shin HY, Park YJ, Lee SH, Lee AY, Hong JS. Analysis of trends and status of evaluation methods in thyroid scar. Heliyon 2024; 10:e29301. [PMID: 38720695 PMCID: PMC11076647 DOI: 10.1016/j.heliyon.2024.e29301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Background The incidence of thyroid cancer has increased over the decades, and patients prefer short thin scars after thyroidectomy due to their cosmetic visibility. Several scar assessment methods have been used to determine the most cosmetically optimal surgical method, but a widely accepted measurement tool is still lacking. This study investigates the usage status in the thyroid scar scale according to time, region, and study method. Methods The authors searched for articles on thyroid scars published between January 2000 and September 2022 in the PubMed database. The study included clinical studies that mentioned thyroid scar and scar scale, excluding articles that did not evaluate neck scars. Statistical analysis was performed using IBM SPSS Statistics 29. Results A total of 35 studies were included. Among them, 17 used the Vancouver Scar Scale (VSS), 17 used the Patient and Observer Scar Assessment Scale (POSAS), four used the Manchester Scar Scale (MSS), and four used the Stony Brook Scar Evaluation Scale (SBSES). VSS and POSAS were the most commonly used scar evaluation methods. VSS tended to be used frequently in Asia, while POSAS was used frequently in Europe and in randomized controlled trials. Conclusion VSS and POSAS are popular thyroid scar assessment methods, with regional variations. Standardization is needed for meaningful comparisons. Patient's subjective evaluations should be considered, given the cosmetic importance of thyroid scars.
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Affiliation(s)
- Woo Kyoung Choi
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Hui Young Shin
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Yu Jeong Park
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Seung Ho Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Jong Soo Hong
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
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Spinos D, Geropoulos G, Vavoulis G, Georgountzos G, Papageorgakopoulou M, Karela NR, Varoutis P, Evangelou K, Cho WS. The Association Between Obesity and Spontaneous Temporal Bone CSF Leak Outcomes: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:2012-2018. [PMID: 38400793 DOI: 10.1002/lary.31349] [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: 10/27/2023] [Revised: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE We undertook a systematic review of the literature with meta-analysis to identify the role of obesity (BMI ≥30) in the patient characteristics presenting with spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base and the outcomes of their repair. DATA SOURCES A Systematic Review of English Articles using MEDLINE, EMBASE, and Cochrane Library. REVIEW METHODS The research algorithm included the following keywords: "spontaneous CSF leak," "lateral skull base," "temporal bone," "meningocele," "encephalocele," and "otorrhea." We also manually searched the references of included studies, to identify possible studies missed during our literature search. RESULTS More than two-thirds of the patients were female (69.2%) and often were obese (mean BMI 36.5 kg/m2) with a mean age of 57. Most common presenting symptoms were otorrhea and hearing loss. Most authors did not report a routine use of a post-operative lumbar drain. Most patients had a single skull base defect and encephaloceles prolapsing through, across obese and non-obese groups. Median length of stay in hospital was 3.2 days, and the majority of patients did not have any recurrence during their follow-up (89.6%), which was not affected by obesity. CONCLUSION Obesity does not affect length of hospital stay or recurrence rate following surgical repair of lateral skull base sCSF leaks. Surgical repair is a safe and viable approach in the management of obese patients with sCSF leaks in the temporal bone. LEVEL OF EVIDENCE NA Laryngoscope, 134:2012-2018, 2024.
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Affiliation(s)
- Dimitrios Spinos
- Department of Otorhinolaryngology, Head and Neck Surgery, South Warwickshire University NHS Foundation Trust, Warwick, UK
| | - Georgios Geropoulos
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Panagiotis Varoutis
- Department of Neurosurgery, General Hospital of Thessaloniki Ippokratio, Thessaloniki, Greece
| | | | - Wai Sum Cho
- Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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3
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Qian L, Tang J, Jiang F, Sun S, Zhang S, Yue X, Yao T. The impact of body mass index on operative time in transoral endoscopic thyroidectomy vestibular approach for thyroid cancer. Endocrine 2024; 84:179-184. [PMID: 38091199 DOI: 10.1007/s12020-023-03616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/13/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND The impact of body mass index (BMI) on operative time in transoral endoscopic thyroidectomy vestibular approach (TOETVA) for thyroid cancer is still a subject of debate. This study assessed the impact of BMI on operative time and postoperative complications in patients undergoing TOETVA. METHODS The study has been conducted to compare the outcomes of TOETVA in patients with high BMI (≥25) and those with normal BMI (<25). Postoperative outcomes, including operative time, blood lost, recurrent laryngeal nerve (RLN) palsy, hypocalcemia and postoperative pain score, were evaluated. RESULTS A total of 62 patients who underwent TOETVA were included in the study. The high BMI group consisted of 39 patients, while the normal BMI group included 23 patients. No significant differences were observed between the two groups regarding operative time, blood loss, postoperative pain score, and postoperative complications such as recurrent laryngeal nerve (RLN) palsy and hypocalcemia. CONCLUSIONS BMI was not significantly associated with operative time and postoperative complications in patients undergoing TOETVA, indicating its safety and feasibility for elevated BMI patients.
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Affiliation(s)
- Liyu Qian
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Jie Tang
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Fangqian Jiang
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Siyu Sun
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Song Zhang
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Xicheng Yue
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Tingjing Yao
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China.
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Armstrong VL, Funkhouser A, Memeh K, Heidel E, Mancini M, Vaghaiwalla T. Thyroidectomy Outcomes in Obese Patients. J Surg Res 2024; 295:717-722. [PMID: 38142574 DOI: 10.1016/j.jss.2023.11.071] [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: 03/01/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Obese patients often have higher complication rates after elective general surgeries; however, few studies have examined the outcomes after thyroidectomy. This study examines whether increased body mass index (BMI) is associated with poor postoperative outcomes after thyroid surgery. METHODS A retrospective review of patients who underwent thyroidectomy from 2015 to 2018 was performed. Demographics, comorbidities, pathology, and extent of resection (total versus hemithyroidectomy) were examined. Patients were classified into BMI groups according to the WHO definitions, and the incidence of surgical outcomes was determined in each group. Surgical outcomes of interest included readmission rates (RRs), length of stay, average operating room time, return to the operating room, hypocalcemia, postop infections, hematomas, and recurrent laryngeal nerve injury. Between-subjects statistics including independent samples t-test, ANOVA, and chi-square analyses were performed. RESULTS There were n = 465 patients included with a mean BMI 32.35 (standard deviation = 8.55) and median BMI 30.78 (Q1 = 26.26, Q3 = 36.73). There were no differences between BMI groups in age, gender, smoking, heart disease. There was a positive association between increased BMI and postoperative infection (P < 0.001), pneumonia (P = 0.018), and surgical site infection (P = 0.04), which were highest for BMI > 40. Increased BMI was associated with a higher 30-d RR (P = 0.008), particularly for BMI >40 versus BMI <40 (6.2% versus 1.05%; P = 0.003). There were no significant differences between surgical outcomes for patients with increased BMI who underwent total thyroidectomy or hemithyroidectomy. CONCLUSIONS Excellent postoperative outcomes were observed in all BMI categories. Higher postoperative infection and 30-d RRs were observed in the morbidly obese. Contrary to previous studies, operating room times were similar regardless of BMI.
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Affiliation(s)
| | - Alex Funkhouser
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Kelvin Memeh
- Department of Surgery, Methodist University Hospital, Memphis, Tennessee
| | - Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Matt Mancini
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Tanaz Vaghaiwalla
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
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Rossi L, Becucci C, Iachini M, Ambrosini CE, Renieri F, Morganti R, Pignatelli F, Materazzi G. The impact of obesity on thyroidectomy outcomes: a case-matched study. Updates Surg 2024; 76:219-225. [PMID: 37989908 PMCID: PMC10806022 DOI: 10.1007/s13304-023-01687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
Obesity is a well-known public health concern in Western World. Accordingly, an elevated number of obese patients undergo thyroidectomy every year. We aim to assess the impact of obesity on intraoperative and postoperative outcomes of patients who undergo thyroidectomy. 1228 patients underwent thyroidectomy at our department between January 2021 and September 2021. We divided patients into two groups according to body mass index (BMI): non-obese (BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). A propensity score approach was performed to create 1:1 matched pairs (matching according to age, gender, diagnosis, nodule size and type of operation). After matching, the final population included 522 patients, equally divided between each group: non-obese group (Group A; n = 261) and obese group (Group B; n = 261). The primary endpoint of the study was the overall rate of postoperative complications; secondary endpoints of the study were operative time, use of energy device and length of hospital stay. The duration of hospital stay resulted longer in Group B (p = 0.002). No statistically significant differences were documented in terms of operative time (p = 0.206), use of energy devices (p = 0.855) and surgical complications (p = 0.429). Moreover, no statistically significant differences were documented considering each specific complication: transient and permanent hypocalcemia (p = 0.336; p = 0.813, respectively), transient and permanent recurrent laryngeal nerve palsy (p = 0.483; p = 0.523, respectively), hematoma (p = 0.779), bleeding (p = 0.178), wound infection (p = 0.313) and cheloid formation (p = 0.412). Thyroidectomy can safely be performed in obese patients. Outcomes resulted comparable; nonetheless, obesity correlates to longer hospital stay.
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Affiliation(s)
- Leonardo Rossi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
| | - Chiara Becucci
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Mattia Iachini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Carlo Enrico Ambrosini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Federica Renieri
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Francesco Pignatelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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Park Y, Yu HW, Lee JK, Choi JH, Kim W, Kwak J, Kim SJ, Chai YJ, Suh H, Choi JY, Lee KE. Effect of body habitus on surgical outcomes following bilateral axillo-breast approach robotic thyroidectomy: a retrospective cohort study. Int J Surg 2023; 109:1257-1263. [PMID: 36999794 PMCID: PMC10389347 DOI: 10.1097/js9.0000000000000279] [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: 11/17/2022] [Accepted: 02/10/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION BMI has been shown to predict perioperative outcomes in patients undergoing surgery. Most studies assessing the role of body habitus in thyroid surgery have focused on open surgery, with few studies assessing patients undergoing robotic surgery. The present study evaluated the effects of BMI on surgical outcomes in patients undergoing bilateral axillo-breast approach (BABA) robotic thyroidectomy. MATERIALS AND METHODS This study included patients who underwent BABA robotic thyroidectomy between January 2013 and September 2021 at Seoul National University Bundang Hospital. Patients were categorized into six groups based on the WHO classification of overweight and obesity. Clinicopathological characteristics, postoperative complications, and surgical outcomes were evaluated. RESULTS A total of 1921 patients were included. Comparisons of the six BMI groups showed no statistically significant differences in postoperative stay, resection margin involvement, postoperative complications, and recurrence. Subgroup analysis showed that hypocalcemia rates differed among BMI groups in patients who underwent lobectomy, with underweight and class II obese patients being at the highest risk ( P =0.006). However, the actual number of complications was relatively small and similar among the groups. In patients who underwent total thyroidectomy and isthmectomy, BMI was not correlated with postoperative complications, including hypocalcemia, recurrent laryngeal nerve palsy, postoperative bleeding, and chyle leakage. CONCLUSION Body habitus was not significantly associated with operative time and postoperative complications in patients undergoing BABA robotic thyroidectomy, indicating that this approach is safe and feasible in obese patients.
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Affiliation(s)
- Yeshong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Seoul National University College of Medicine
| | - Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Jee-Hye Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - JungHak Kwak
- Department of Surgery, Seoul National University Hospital, Jongno-gu
| | - Su-jin Kim
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Hospital, Jongno-gu
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea
| | - Hyunsuk Suh
- Suh Scarless Thyroid Surgery Center, Tampa, Florida, USA
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Seoul National University College of Medicine
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Hospital, Jongno-gu
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Li Y, Liu Z, Song Z, Wang Y, Yu X, Wang P. Comparison of the endoscopic thyroidectomy via areola approach and open thyroidectomy: A propensity score matched cohort study of 302 patients in the treatment of papillary thyroid non-microcarcinoma. Front Oncol 2023; 13:1081835. [PMID: 36925920 PMCID: PMC10012860 DOI: 10.3389/fonc.2023.1081835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/13/2023] [Indexed: 03/04/2023] Open
Abstract
Background The endoscopic thyroidectomy via areola approach (ETAA) is widely used in patients with benign thyroid tumors and papillary thyroid microcarcinoma (PTMC). Its safety and complication rates are reported to be similar to open thyroidectomy (OT). This study aimed to evaluate the safety and feasibility of ETAA, compared with OT, in patients with papillary thyroid non-microcarcinoma (PTNMC). Methods We retrospectively reviewed all patients with PTNMC who underwent ETAA or OT in our hospital from January 2017 to December 2021. A total of 302 patients were matched at a ratio of 1:1 by the propensity score matching (PSM) analysis and surgical outcomes. Safety and feasibility were analyzed between two groups. Results Before PSM, patients in the ETAA group were younger (p < 0.001) and had a larger proportion of female patients (p < 0.001) with a lower BMI (p < 0.001) compared with the OT group. The ETAA group also had a higher proportion of unilateral thyroidectomy (p = 0.002). PSM was used to create a highly comparable control group. After PSM, the ETAA group had a longer operative time (p < 0.001), larger blood loss (p = 0.046) and total drainage amount (p = 0.035), with higher C-reactive protein (p = 0.023) and better cosmetic outcomes (p < 0.001). There were no significant differences in the following clinicopathologic characteristics: number of dissected positive lymph nodes, rate of recurrent laryngeal nerve signal weakened, parathyroid autotransplantation, postoperative pain, hospital stay, complications, and oncologic completeness. There was no patient converted to OT in the ETAA group and two patients suffered from persistence/recurrence in the follow-up. Conclusion ETAA is a safe and feasible surgical approach for patients with PTNMC.
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Affiliation(s)
- Yujun Li
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaodi Liu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zhuolin Song
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Xing Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
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Association of BMI with Clinicopathological Features of Papillary Thyroid Cancer: A Systematic Review and Meta-Analysis. World J Surg 2021; 45:2805-2815. [PMID: 34136926 DOI: 10.1007/s00268-021-06193-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is the most common subtype of thyroid cancer. The incidence of PTC is rising in tandem with an obesity epidemic. Associations have been demonstrated between increased body mass index (BMI) and worse oncological outcomes in a number of malignancies. However, research on this topic in PTC to date has been inconsistent, often due to limited data. This study aimed to measure the association between BMI and potentially adverse clinicopathological features of PTC. METHODS A meta-analysis of studies reporting outcomes after surgical treatment of PTC was performed. PubMed, Embase and the Cochrane Library were searched systematically to identify studies which provided data on BMI and clinicopathologic features of PTC. Relevant data were extracted and synthesis performed using adjusted odds ratios where available and crude values when not. Data were analysed by inverse variance using random and fixed effects models. RESULTS Data on 35,237 patients from 15 studies met the criteria for inclusion. Obesity was associated with larger tumour size (MD = 0.17 cm [0.05, 0.29]), increased rates of multifocality (OR = 1.41 [1.16, 1.70]), extrathyroidal extension (OR = 1.70 [1.39, 2.07]) and nodal spread (OR = 1.18 [1.07, 1.30]). Associations were more pronounced as BMI increased. There was no association between BMI and bilaterality, vascular invasion or metastatic spread. CONCLUSION Increased BMI is significantly associated with multiple potentially adverse features of PTC. The effect on long-term oncological outcomes requires further evaluation.
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Zhou Y, Yang Y, Zhou T, Li B, Wang Z. Adiponectin and Thyroid Cancer: Insight into the Association between Adiponectin and Obesity. Aging Dis 2021; 12:597-613. [PMID: 33815885 PMCID: PMC7990371 DOI: 10.14336/ad.2020.0919] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/13/2020] [Indexed: 12/14/2022] Open
Abstract
In recent decades, the incidence and diagnosis of thyroid cancer have risen dramatically, and thyroid cancer has now become the most common endocrine cancer in the world. The onset of thyroid cancer is insidious, and its progression is slow and difficult to detect. Therefore, early prevention and treatment have important strategic significance. Moreover, an in-depth exploration of the pathogenesis of thyroid cancer is key to early prevention and treatment. Substantial evidence supports obesity as an independent risk factor for thyroid cancer. Adipose tissue dysfunction in the obese state is accompanied by dysregulation of a variety of adipocytokines. Adiponectin (APN) is one of the most pivotal adipocytokines, and its connection with obesity and obesity-related disease has gradually become a hot topic in research. Recently, the association between APN and thyroid cancer has received increasing attention. The purpose of this review is to systematically review previous studies, give prominence to APN, focus on the relationship between APN, obesity and thyroid cancer, and uncover the underlying pathogenic mechanisms.
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Affiliation(s)
- Yuanyuan Zhou
- 1Department of Endocrinology and Metabolism, The Second People's Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China.,2Department of Endocrinology and Metabolism, Sixth Affiliated Hospital of Kunming Medical University, The People's Hospital of Yuxi City, Yuxi, China
| | - Ying Yang
- 1Department of Endocrinology and Metabolism, The Second People's Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Taicheng Zhou
- 1Department of Endocrinology and Metabolism, The Second People's Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bai Li
- 3School of Medicine, Yunnan University, Kunming, China
| | - Zhanjian Wang
- 4Department of Endocrinology and Metabolism, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Canu GL, Medas F, Cappellacci F, Podda MG, Romano G, Erdas E, Calò PG. Can thyroidectomy be considered safe in obese patients? A retrospective cohort study. BMC Surg 2020; 20:275. [PMID: 33160350 PMCID: PMC7648980 DOI: 10.1186/s12893-020-00939-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity is a growing public health concern in most western countries. More and more patients with high body mass index (BMI) are undergoing surgical procedures of all kinds and, in this context, obese patients are undergoing thyroid surgery more than ever before. The aim of the present study was to evaluate whether thyroidectomy can be considered safe in obese patients. METHODS Patients undergoing thyroidectomy in our Unit between January 2014 and December 2018 were retrospectively analysed. Patients were divided into two groups: those with BMI < 30 kg/m2 were included in Group A, while those with BMI ≥ 30 kg/m2 in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analyses were performed to evaluate whether the BMI value (considered in this case as a continuous variable) had a significant role in the development of each individual postoperative complication. RESULTS A total of 813 patients were included in this study: 31 (3.81%) were underweight, 361 (44.40%) normal-weight, 286 (35.18%) overweight, 94 (11.57%) obese and 41 (5.04%) morbidly obese. Six hundred and seventy-eight patients were included in Group A and 135 in Group B. At univariate analysis, the comparison between the two groups, in terms of operative time and thyroid weight resulted in statistically significant results (P = 0.001, P = 0.008; respectively). These features were significantly higher in Group B than in Group A. About postoperative stay and complications, no statistically significant difference was found between the two groups. At multivariate analyses, only the development of cervical haematoma was statistically significantly correlated to the BMI value. Patients with high BMI had a lower risk of cervical haematoma (P = 0.045, OR 0.797, 95% CI 0.638-0.995). CONCLUSIONS This study showed that obesity, in the field of thyroid surgery, is not associated with any increase of postoperative complications. Thus, it is possible to conclude that thyroidectomy can be performed safely in obese patients. Our result about operative times had no clinical significance.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy.
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Michele Guido Podda
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, 90127, Palermo, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
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Sun N, Zhang D, Zheng S, Fu L, Li L, Liu S, Li H, Qiu X. Incidence and Risk Factors of Postoperative Bleeding in Patients Undergoing Total Thyroidectomy. Front Oncol 2020; 10:1075. [PMID: 32850311 PMCID: PMC7396519 DOI: 10.3389/fonc.2020.01075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/29/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose: Our goal was to analyze postoperative bleeding in patients undergoing total thyroidectomy and to explore the possible risk factors. Materials and Methods: Patients undergoing total thyroidectomy were retrospectively enrolled, and the main study outcomes were postoperative bleeding and 30-day mortality. Univariate and multivariate analyses were used to determine the independent risk factors for postoperative bleeding. Results: A total of 31,706 patients were enrolled for analysis during January 2010 and December 2018 from the Affiliated First Hospital of Zhengzhou University. Benign and malignant disease was reported in 4,521 and 27,185 patients, respectively. Postoperative bleeding occurred in 48 patients with benign disease and in 263 patients with malignant disease. There was one bleeding site in 243 patients. The branch of the superior thyroid artery was the most common arterial bleeding site, occurring in 124 patients, and the anterior jugular vein was the most common venous bleeding site, occurring in 85 patients. Multivariable analysis confirmed that hypertension, diabetes, BMI, and disease pathology were independent factors affecting postoperative bleeding in patients with benign disease and that hypertension, diabetes, BMI, operation time, tumor stage, and tracheotomy were independent factors affecting postoperative bleeding in patients with malignant disease. In patients with postoperative bleeding, there were 5 deaths; in patients without postoperative bleeding, there were 42 deaths, and the difference was significant (p < 0.001). Conclusions: Compared with malignant disease patients, benign disease patients have a similar postoperative bleeding rate. A previous history of chemotherapy or radiotherapy has no significant effect on postoperative bleeding.
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Affiliation(s)
- Ning Sun
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Danhua Zhang
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shouhua Zheng
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijun Fu
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liwen Li
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Senyuan Liu
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongting Li
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinguang Qiu
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Bioinformatic Analysis Reveals an Immune/Inflammatory-Related Risk Signature for Oral Cavity Squamous Cell Carcinoma. JOURNAL OF ONCOLOGY 2019; 2019:3865279. [PMID: 31911802 PMCID: PMC6930791 DOI: 10.1155/2019/3865279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/06/2019] [Accepted: 11/05/2019] [Indexed: 12/26/2022]
Abstract
High-throughput gene expression profiling has recently emerged as a promising technique that provides insight into cancer subtype classification and improved prediction of prognoses. Immune/inflammatory-related mRNAs may potentially enrich genes to allow researchers to better illustrate cancer microenvironments. Oral cavity squamous cell carcinoma (OC-SCC) exhibits high morbidity and poor prognosis compared to that of other types of head and neck squamous cell carcinoma (HNSCC), and these differences may be partially due to differences within the tumor microenvironments. Based on this, we designed an immune-related signature to improve the prognostic prediction of OC-SCC. A cohort of 314 OC-SCC samples possessing whole genome expression data that were sourced from The Cancer Genome Atlas (TCGA) database was included for discovery. The GSE41613 database was used for validation. A risk score was established using immune/inflammatory signatures acquired from the training dataset. Principal components analysis, GO analysis, and gene set enrichment analysis were used to explore the bioinformatic implications. When grouped by the dichotomized risk score based on the signature, this classifier could successfully discriminate patients with distinct prognoses within the training and validation cohorts (P < 0.05 in both cohorts) and within different clinicopathological subgroups. Similar somatic mutation patterns were observed between high and low risk score groups, and different copy number variation patterns were also identified. Further bioinformatic analyses suggested that the lower risk score group was significantly correlated with immune/inflammatory-related biological processes, while the higher risk score group was highly associated with cell cycle-related processes. The analysis indicated that the risk score was a robust predictor of patient survival, and its functional annotation was well established. Therefore, this bioinformatic-based immune-related signature suggested that the microenvironment of OC-SCC could distinguish among patients with different underlying biological processes and clinical outcomes, and the use of this signature may shed light on future OC-SCC classification and therapeutic design.
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