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González-Sánchez C, Salvador-Egea MP, Glückmann-Maldonado E, Ríos A, Martín-Fernández J, Pérez-García JI, García-Lorenzo F, Flores-Pastor B, Gómez-Ramírez J, Ortega-Serrano J, Ros-López S, Villar-Del-Moral J, Morales-García D, Gutiérrez-Rodríguez MT, Domènech-Calvet J, Nuño-Vázquez-Garza JM, Franch-Arcas G. Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study. Langenbecks Arch Surg 2023; 408:206. [PMID: 37221304 DOI: 10.1007/s00423-023-02945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/14/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.
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Affiliation(s)
- C González-Sánchez
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente, 88-132, 37007, Salamanca, Spain.
- Instituto de Investigación Biomédica de Salamanca IBSAL, Salamanca, Spain.
| | - M P Salvador-Egea
- Department of Surgery, Complejo Hospitalario de Navarra B, Pamplona, Spain
| | | | - A Ríos
- Department of Surgery, Hospital Clínico Universitario Arrixaca, Murcia, Spain
| | - J Martín-Fernández
- Department of Surgery, Complejo Hospitalario de Ciudad Real, Ciudad Real, Spain
| | - J I Pérez-García
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - F García-Lorenzo
- Department of Surgery, Hospital Alvaro Cunqueiro de Vigo, Vigo, Spain
| | - B Flores-Pastor
- Department of Surgery, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - J Gómez-Ramírez
- Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - J Ortega-Serrano
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - S Ros-López
- Department of Surgery, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J Villar-Del-Moral
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria IBS de Granada, Granada, Spain
| | - D Morales-García
- Department of Surgery, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - J Domènech-Calvet
- Department of Surgery, Hospital Universitario Sant Joan de Reus, Reus, Spain
| | | | - G Franch-Arcas
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente, 88-132, 37007, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca IBSAL, Salamanca, Spain
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Villodre C, Taccogna L, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F, Afonso N, Aguilella V, Aguiló J, Alados JC, Alberich M, Apio AB, Balongo R, Bra E, Bravo-Gutiérrez A, Briceño FJ, Cabañas J, Cánovas G, Caravaca I, Carbonell S, Carrera-Dacosta E, Castro EE, Caula C, Choolani-Bhojwani E, Codina A, Corral S, Cuenca C, Curbelo-Peña Y, Delgado-Morales MM, Delgado-Plasencia L, Doménech E, Estévez AM, Feria AM, Gascón-Domínguez MA, Gianchandani R, González C, Hevia RJ, González MA, Hidalgo JM, Lainez M, Lluís N, López F, López-Fernández J, López-Ruíz JA, Lora-Cumplido P, Madrazo Z, Marchena J, de la Cuadra MB, Martín S, Casas MI, Martínez P, Mena-Mateos A, Morales-García D, Mulas C, Muñoz-Forner E, Naranjo A, Navarro-Sánchez A, Oliver I, Ortega I, Ortega-Higueruelo R, Ortega-Ruiz S, Osorio J, Padín MH, Pamies JJ, Paredes M, Pareja-Ciuró F, Parra J, Pérez-Guarinós CV, Pérez-Saborido B, Pintor-Tortolero J, Plua-Muñiz K, Rey M, Rodríguez I, Ruiz C, Ruíz R, Ruiz S, Sánchez A, Sánchez D, Sánchez R, Sánchez-Cabezudo F, Sánchez-Santos R, Santos J, Serrano-Paz MP, Soria-Aledo V, Tallón-Aguilar L, Valdivia-Risco JH, Vallverdú-Cartié H, Varela C, Villar-Del-Moral J, Zambudio N. Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. Int J Surg 2022; 97:106168. [PMID: 34785344 DOI: 10.1016/j.ijsu.2021.106168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
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Affiliation(s)
- C Villodre
- Hospital Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain Hospital Lluís Alcanyís de Xàtiva, Valencia, Spain Hospital Universitario de Badajoz, Badajoz, Spain Hospital Universitario de Bellvitge, Barcelona, Spain Hospital Marina Baixa, Alicante, Spain Hospital Juan Ramón Jiménez, Infanta Elena, Huelva, Spain Hospital Infanta Cristina, Parla, Madrid, Spain Hospital Universitario de Canarias, Tenerife, Spain Hospital Reina Sofía de Córdoba, Córdoba, Spain H. Ramón y Cajal, Madrid, Spain Hospital Parc Taulí de Sabadell, Barcelona, Spain Hospital General Universitario de Alicante, Alicante, Spain Complejo Hospitalario Universitario de Vigo, Hospital Pontevedra, Spain Hospital Trueta de Girona, Girona, Spain Hospital Universitario Rio Hortega, Valladolid, Spain Hospital Mutua Terrassa, Barcelona, Spain Consorci Hospitalari de Vic, Barcelona, Spain POVISA, Pontevedra, Spain Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain Hospital Universitario Basurto, Bizkaia, Spain Hospital Universitario Marqués de Valdecilla, Santander, Spain Hospital de Viladecans, Barcelona, Spain Hospital Clínico de Valencia, Valencia, Spain Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain Hospital Vírgen de la Macarena, Sevilla, Spain Hospital Cabueñes, Gijón, Spain Complejo Hospitalario de Jaén, Jaén, Spain Hospital Universitari Sant Joan de Reus, Tarragona, Spain Hospital Universitario Infanta Sofía, Madrid, Spain Complejo Hospitalario Torrecárdenas, Almería, Spain Hospital Sant Pau i Santa Tecla, Tarragona, Spain Hospital General Rafael Méndez de Lorca, Murcia, Spain Hospital Vírgen del Rocío, Sevilla, Spain Hospital Morales Meseguer, Murcia, Spain Hospital del Vinalopó, Alicante, Spain Hospital Universitario del Vinalopó, Alicante, Spain Hospital Universitario Virgen de las Nieves, Granada, Spain Department of Surgery, General University Hospital of Alicante, Alicante, Spain Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain Computing, BomhardIP, Alicante, Spain Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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Moreno P, de la Quintana Basarrate A, Musholt TJ, Paunovic I, Puccini M, Vidal O, Ortega J, Kraimps JL, Bollo Arocena E, Rodríguez JM, González López O, Del Pozo CD, Iacobone M, Veloso E, Del Pino JM, García Sanz I, Scott-Coombes D, Villar-Del-Moral J, Rodríguez JI, Vázquez Echarri J, González Sánchez C, Gutiérrez Rodríguez MT, Escoresca I, Nuño Vázquez-Garza J, Tobalina Aguirrezábal E, Martín J, Candel Arenas MF, Lorenz K, Martos JM, Ramia JM. Adrenalectomy for solid tumor metastases: results of a multicenter European study. Surgery 2013; 154:1215-22; discussion 1222-3. [PMID: 24238044 DOI: 10.1016/j.surg.2013.06.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/21/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND We assessed the results of adrenalectomy for solid tumor metastases in 317 patients recruited from 30 European centers. METHODS Patients with histologically proven adrenal metastatic disease and undergoing complete removal(s) of the affected gland(s) were eligible. RESULTS Non-small cell lung cancer (NSCLC) was the most frequent tumor type followed by colorectal and renal cell carcinoma. Adrenal metastases were synchronous (≤6 months) in 73 (23%) patients and isolated in 213 (67%). The median disease-free interval was 18.5 months. Laparoscopic resection was used in 46% of patients. Surgery was limited to the adrenal gland in 73% of patients and R0 resection was achieved in 86% of cases. The median overall survival was 29 months (95% confidence interval, 24.69-33.30). The survival rates at 1, 2, 3, and 5 years were 80%, 61%, 42%, and 35%, respectively. Patients with renal cancer showed a median survival of 84 months, patients with NSCLC 26 months, and patients with colorectal cancer 29 months (P = .017). Differences in survival between metachronous and synchronous lesions were also significant (30 vs. 23 months; P = .038). CONCLUSION Surgical removal of adrenal metastasis is associated with long-term survival in selected patients.
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Affiliation(s)
- Pablo Moreno
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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