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Makay Ö, Agcaoglu O, Nominé-Criqui C, Van Den Heede K, Staubitz-Vernazza JI, Pennestrì F, Brunaud L, Raffaelli M, Iacobone M, Van Slycke S, Musholt TJ, Villar-Del-Moral J. Consensus statement of the European Society of Endocrine Surgeons (ESES) on advanced parathyroid cancer: definitions and management. Br J Surg 2024; 111:znae108. [PMID: 38713608 DOI: 10.1093/bjs/znae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/19/2024] [Accepted: 04/07/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Özer Makay
- Ozel Saglik Hospital, Centre for Endocrine Surgery, Izmir, Turkey
| | - Orhan Agcaoglu
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Claire Nominé-Criqui
- Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery, University of Lorraine, CHU Nancy-Hospital Brabois Adultes, Nancy, France
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital, Aalst, Belgium
| | - Julia I Staubitz-Vernazza
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University Medicine Mainz, Johannes-Gutenberg University, Mainz, Germany
| | - Francesco Pennestrì
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Chirurgia Endocrina e Metabolica, Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Rome, Italy
| | - Laurent Brunaud
- Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery, University of Lorraine, CHU Nancy-Hospital Brabois Adultes, Nancy, France
| | - Marco Raffaelli
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Chirurgia Endocrina e Metabolica, Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Rome, Italy
| | - Maurizio Iacobone
- Department of Surgery, Oncology and Gastroenterology, Endocrine Surgery Unit, University of Padova, Padua, Italy
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
| | - Thomas J Musholt
- Clinic for General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University Medical Centre Mainz, Mainz, Germany
| | - Jesús Villar-Del-Moral
- Department of General Surgery, University of Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Van Den Heede K, van Beek DJ, Van Slycke S, Borel Rinkes I, Norlén O, Stålberg P, Nordenström E. Surgery for advanced neuroendocrine tumours of the small bowel: recommendations based on a consensus meeting of the European Society of Endocrine Surgeons (ESES). Br J Surg 2024; 111:znae082. [PMID: 38626261 DOI: 10.1093/bjs/znae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/10/2023] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Small bowel neuroendocrine tumours often present with locally advanced or metastatic disease. The aim of this paper is to provide evidence-based recommendations regarding (controversial) topics in the surgical management of advanced small bowel neuroendocrine tumours. METHODS A working group of experts was formed by the European Society of Endocrine Surgeons. The group addressed 11 clinically relevant questions regarding surgery for advanced disease, including the benefit of primary tumour resection, the role of cytoreduction, the extent of lymph node clearance, and the management of an unknown primary tumour. A systematic literature search was performed in MEDLINE to identify papers addressing the research questions. Final recommendations were presented and voted upon by European Society of Endocrine Surgeons members at the European Society of Endocrine Surgeons Conference in Mainz in 2023. RESULTS The literature review yielded 1223 papers, of which 84 were included. There were no randomized controlled trials to address any of the research questions and therefore conclusions were based on the available case series, cohort studies, and systematic reviews/meta-analyses of the available non-randomized studies. The proposed recommendations were scored by 38-51 members and rated 'strongly agree' or 'agree' by 64-96% of participants. CONCLUSION This paper provides recommendations based on the best available evidence and expert opinion on the surgical management of locally advanced and metastatic small bowel neuroendocrine tumours.
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Affiliation(s)
- Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Dirk-Jan van Beek
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
| | - Inne Borel Rinkes
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olov Norlén
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Stålberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Erik Nordenström
- Department of Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Kinet S, Cornette H, Van Den Heede K, Brusselaers N, Van Slycke S. Accuracy and diagnostic performance of the Bethesda system for reporting thyroid cytopathology in a tertiary endocrine surgical referral center in Belgium. World J Surg 2024; 48:386-392. [PMID: 38686788 DOI: 10.1002/wjs.12052] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/13/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology is a commonly used classification for fine needle aspiration (FNA) cytology of suspicious thyroid nodules. The risk of malignancy (ROM) for each category has recently been analyzed in three international databases. This paper compares the diagnostic performance of the Bethesda classification in a high-volume referral center in Belgium. METHODS All consecutive thyroid procedures were registered in a prospective database from January 2010 till August 2022. Patient and surgical characteristics, preoperative Bethesda categories, and postoperative pathology results were analyzed. RESULTS Out of 2219 consecutive thyroid procedures, 1226 patients underwent preoperative FNA. Papillary thyroid cancer was the most prevalent malignancy (N = 119, 70.4%), followed by follicular (N = 17, 10.1%) and medullary thyroid cancer (N = 15, 8.9%). Micropapillary thyroid cancer was incidentally found in 46 (3.8%) patients. Bethesda categories I, II, III, IV, V, and VI, respectively, represented 250 (20.4%; ROM 4.4%), 546 (44.5%; ROM 3.8%), 96 (7.8%; ROM 20.8%), 231 (18.8%; ROM 15.2%), 62 (5.1%; ROM 72.6%), and 41 (3.3%; ROM 90.2%) patients. Overall ROM was 13.8%. An negative predictive value (NPV) of 96.2% was found. Overall specificity was 64.2% with a positive predictive value (PPV) of 31.9%. Diagnostic accuracy was 67.8%. Compared to international databases (CESQIP, EUROCRINE, and UKRETS), ROM in this study appeared lower for Bethesda category IV (15.2 vs. 26.7% and p = 0.612). CONCLUSION Despite being validated in numerous studies, ROM based on preoperative FNA cytology classified according to the Bethesda classification may vary among surgical centers and countries as this study reveals a higher NPV and lower PPV.
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Affiliation(s)
- Sam Kinet
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Hendrik Cornette
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Nele Brusselaers
- Department of Microbiology, Tumour and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
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Van Beek DJ, Van Den Heede K, Borel Rinkes I, Norlén O, Van Slycke S, Stålberg P, Nordenström E. Surgery for advanced pancreatic neuroendocrine neoplasms: recommendations based on a consensus meeting of the European Society of Endocrine Surgeons (ESES). Br J Surg 2024; 111:znae017. [PMID: 38364061 DOI: 10.1093/bjs/znae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/06/2023] [Revised: 11/16/2023] [Accepted: 01/06/2024] [Indexed: 02/18/2024]
Abstract
This European Society of Endocrine Surgeons (ESES) guideline provides evidence-based recommendations based on the surgical management for locally advanced pancreatic neuroendocrine neoplasms, indications for neoadjuvant therapy, primary tumor resections in the setting of metastatic disease and surgical indications for Grade 3 pancreatic neuroendocrine tumours and pancreatic neuroendocrine carcinoma.
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Affiliation(s)
- Dirk-Jan Van Beek
- Department of Endocrine Surgical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Inne Borel Rinkes
- Department of Endocrine Surgical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Olov Norlén
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
| | - Peter Stålberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Erik Nordenström
- Department of Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Nomine-Criqui C, Nguyen-Thi PL, Van Slycke S, Makay O, Brunaud L, Bergenfelz A. Role of hospital and patient factors in the outcome of reoperations for primary hyperparathyroidism: a retrospective multicenter cohort study. Int J Surg 2023; 109:3441-3449. [PMID: 37578454 PMCID: PMC10651301 DOI: 10.1097/js9.0000000000000613] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There are few data on outcomes after reintervention for persistent or recurrent primary hyperparathyroidism (PHPT). The authors hypothesized that the variation in outcomes at the hospital level after reoperation would be significant. After accounting for this variability, some patient-level clinical criteria could be identified to help inform treatment decisions in this patient population. The aim of this study was to determine whether there is significant variation in outcomes after reoperation for PHPT between hospitals (hospital-level analysis) and identify clinical factors (patient-level analysis) that influence postoperative outcomes. MATERIALS AND METHODS This retrospective multicenter cohort study was performed using the Eurocrine registry. Data from 11 countries and 76 hospitals from January 2015 to October 2020 were extracted. A generalized linear mixed model was used to assess the variation in outcomes at the hospital level and to identify risk factors of postoperative outcomes at the patient level. The primary endpoint (textbook outcome) was achieved when all six of the following postoperative conditions were met: no hypocalcemia or persistent hypercalcemia, no laryngeal nerve injury, no negative exploration, no normal parathyroid gland only on histopathology, and no postoperative death. RESULTS Among 13 593 patients who underwent parathyroidectomy for PHPT, 617 (4.5%) underwent reoperative parathyroidectomy. At follow-up, 231 patients (37.4%) were hypocalcemic, 346 (56.1%) were normocalcemic without treatment, and 40 (6.5%) had persistent hypercalcemia. Textbook outcomes were achieved in 321 (52.0%) patients. The hospital-level variation in textbook outcome rates was significant ( P <0.001), and this variation could explain 29.1% of the observed outcomes. The criterion that remained significant after controlling for inter-hospital variation was 'a single lesion on sestamibi scan or positron emission tomography (PET) imaging' (odds ratio 2.08, 95% confidence interval 1.24-3.48; P =0.005). CONCLUSION Outcomes after reoperation are significantly associated with hospital-related factors. A 'single lesion observed on preoperative sestamibi scan or PET' appears relevant to select patients before reoperation.
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Affiliation(s)
- Claire Nomine-Criqui
- Department of Gastrointestinal and Metabolic Surgery (CVMC), University of Lorraine, CHRU Nancy – Hospital Brabois Adultes, and Faculty of Medicine, INSERM NGERE, «Nutrition, Genetics, Environmental Risks», Vandoeuvre-les-Nancy
| | - Phi-Linh Nguyen-Thi
- Department of Medical Informatics and Evaluation, University of Lorraine, CHU Nancy, Nancy, France
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Ozer Makay
- Department of Surgery, Ege University Hospital, Izmir, Turkey
| | - Laurent Brunaud
- Department of Gastrointestinal and Metabolic Surgery (CVMC), University of Lorraine, CHRU Nancy – Hospital Brabois Adultes, and Faculty of Medicine, INSERM NGERE, «Nutrition, Genetics, Environmental Risks», Vandoeuvre-les-Nancy
| | - Anders Bergenfelz
- Department of Clinical Sciences, Lund University, and Department of Surgery and Gastroenterology, Skane University Hospital, Lund, Sweden
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Van den Eynde F, Van Den Heede K, Brusselaers N, Van Slycke S. Thyroid surgery in the elderly: a surgical cohort. Langenbecks Arch Surg 2023; 408:254. [PMID: 37386199 DOI: 10.1007/s00423-023-02982-6] [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: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE The need for thyroid surgery in the elderly is rising due to an ageing population, the liberal use of imaging studies, and the increasing prevalence of thyroid nodules and cancer with age. Data on surgical outcomes in this population are scarce and conflicting, but essential to assess safety of short-stay surgery. This study aims to compare surgical outcomes by age. METHODS All consecutive patients undergoing thyroid surgery from January 2010 to July 2021 in a large tertiary referral centre for endocrine surgery were included in this surgical cohort. The indication for surgery, surgical morbidity (hypocalcaemia, bleeding, recurrent laryngeal nerve (RLN) palsy), and length of hospital stay were assessed in three age groups (young: 18-64y, older: 65-74y, and the elderly: 75 years and older). RESULTS A total of 2,030 patients (1,499 young, 370 older, and 161 elderly) were included. The indication for surgery was significantly different, with the main indications in the elderly being multinodular goitre (70.2% vs. 47.7% in young patients) and thyroid cancer (9.9% vs. 7.0%). Reintervention for bleeding was more often required in the older (4.6%) and the elderly (2.5%) patients (vs. 1.4%). There was no difference in the proportion of hypocalcaemia or RLN palsy. The length of hospital stay was significantly longer in the elderly (length of stay longer than one day 43.5% vs. 9.8%). CONCLUSION Thyroid surgery in patients aged 75 years and older is a safe procedure with morbidity comparable to younger patients. However, the risk of reintervention for bleeding is higher, rendering ambulatory surgery not advisable. TRIAL REGISTRATION Researchregistry6182 on October 29th 2020, retrospectively registered.
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Affiliation(s)
- Fien Van den Eynde
- Group of Biomedical Sciences, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium.
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institute, Tomtebodavagen 16, 17165, Stockholm, Sweden
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
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Van Den Heede K, Vatansever S, Girgin T, Van Slycke S, Makay Ö. Posterior retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adults: results from the EUROCRINE® surgical registry. Langenbecks Arch Surg 2023; 408:241. [PMID: 37349535 DOI: 10.1007/s00423-023-02975-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE This study aims to compare posterior retroperitoneal laparoscopic adrenalectomy (PRLA) and laparoscopic transperitoneal adrenalectomy (LTA) in adults using pan-European data as conflicting results have been published regarding length of hospital stay, institutional volume, and morbidity. METHODS This retrospective cohort study analyzed data from the surgical registry EUROCRINE®. All patients undergoing PRLA and TLA for adrenal tumours and registered between 2015 and 2020 were included and compared for morbidity, length of hospital stay, and conversion to open surgery. RESULTS A total of 2660 patients from 11 different countries and 69 different hospitals were analyzed and 1696 LTA were compared to 964 PRLA. Length of hospital stay was shorter after RPLA, with less patients (N = 434, 45.5%, vs N = 1094, 65.0%, p < 0.001) staying more than 2 days. In total, 96 patients (3.6%) developed a complication Clavien-Dindo grade 2 or higher. No statistical difference was found between both study groups. After propensity score matching, length of hospital stay was shorter after PRLA (> 2 days 45.2% vs 63.0%, p < 0.001). After multivariable logistic regression, factors associated with morbidity were age (OR 1.03), male sex (OR 1.52), and conversion to open surgery (OR 5.73). CONCLUSION This study presents the largest retrospective observational analysis comparing LTA and PRLA. Our findings confirm the shorter length of hospital stay after PRLA. Both techniques are safe leading to comparable morbidity and conversion rates.
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Affiliation(s)
- Klaas Van Den Heede
- Department of General and Endocrine Surgery, Pitié Salpêtrière University Hospital, APHP, Sorbonne University, 47-83 Boulevard de L'Hôpital, Paris, France.
- Department of General and Endocrine Surgery, OLV Hospital Aalst, Aalst, Belgium.
| | - Safa Vatansever
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
| | - Tolga Girgin
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Hospital Aalst, Aalst, Belgium
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
| | - Özer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
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Najah H, Donatini G, Van Slycke S, Bizard JP, Triponez F, Sebag F. Place of laryngoscopy and neuromonitoring in thyroid surgery. Recommendations of the AFCE (Association francophone de chirurgie endocrinienne) with the SFE (Société française d'endocrinologie) and the SFMN (Société française de médecine nucléaire). J Visc Surg 2023:S1878-7886(23)00069-3. [PMID: 37210345 DOI: 10.1016/j.jviscsurg.2023.04.004] [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] [Indexed: 05/22/2023]
Abstract
Preoperative laryngoscopy is mandatory when there is a history of cervical or thoracic surgery, dysphonia, posteriorly developed thyroid carcinoma, or significant lymph node involvement in the central compartment. Postoperative laryngoscopy should be performed for any postoperative dysphonia, swallowing difficulties, respiratory symptoms, or loss of signal during neuromonitoring of the recurrent and/or vagus nerve. Neuromonitoring can be useful in thyroid surgery because it lowers the rate of transient recurrent palsy (RP), although no impact on permanent RP has been demonstrated. It facilitates location of the recurrent nerve. Continuous neuromonitoring of the vagus nerve can, in some situations, allow early detection of a signal drop during dissection near the recurrent nerve.
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Affiliation(s)
- Haythem Najah
- Department of Digestive and Endocrine Surgery, Haut Lévêque Hospital, University Hospital Center of Bordeaux, Bordeaux France.
| | - Gianluca Donatini
- Digestive and endocrine surgery department, University Hospital Center of Poitiers, Poitiers, France
| | - Sam Van Slycke
- Digestive and endocrine surgery department, OLV Alost, Alost, Belgium
| | | | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospital of Genève and Faculty of Medicine, Genève, Switzerland
| | - Frédéric Sebag
- General and Endocrine Surgery Department, University Hospital of Marseille Conception, Marseille, France
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9
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Van Den Heede K, Bonheure A, Brusselaers N, Van Slycke S. Long-term outcome of surgical techniques for sporadic primary hyperparathyroidism in a tertiary referral center in Belgium. Langenbecks Arch Surg 2022; 407:3045-3055. [PMID: 36048245 DOI: 10.1007/s00423-022-02660-z] [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: 01/03/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Surgery remains the only permanent treatment option for primary hyperparathyroidism (pHPT). To date, the number of long-term outcome studies of parathyroidectomy is limited. This study aims to compare different surgical approaches and evaluate the importance of preoperative localization imaging in the treatment of pHPT. METHODS All 200 consecutive patients with a parathyroidectomy for sporadic pHPT without planned concomitant surgery between 09/2009 and 04/2021 in a Belgian tertiary referral hospital were enrolled. All patients underwent at least two preoperative localization imaging studies (neck ultrasound, CT, SPECT, and/or Sestamibi scintigraphy) of the parathyroid glands. The main outcomes were the (long-term) cured proportion and postoperative morbidity (hypocalcemia, recurrent laryngeal nerve palsy, return to theater for bleeding, and wound morbidity). RESULTS Most patients were referred with concordant positive imaging (82%, n = 164). Only nine patients (4.5%) had double negative imaging, not revealing a possible adenoma. The remaining 27 (13.5%) were referred with discordant imaging. Parathyroidectomy was performed via traditional cervicotomy (30%), mini-open approach (39.5%), or endoscopic approach (30.5%). Morbidity was low with no persistent hypocalcemia, one return to theater for bleeding, and no 30-day mortality. In the concordant imaging population, 13 patients (8%) had multiglandular disease. Overall, 97.5% was considered cured. Long-term recurrence was 12% with a minimal follow-up of 5 years. CONCLUSION This consecutive, single-surgeon, single-center cohort with extensive data collection and long-term follow-up confirms the safety and excellent cured proportions of minimally invasive parathyroidectomy. Disease recurrence becomes more important long after surgery.
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Affiliation(s)
- Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium. .,Department of Endocrine and Digestive Surgery, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Amélie Bonheure
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Nele Brusselaers
- Center for Translational Microbiome Research Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Karolinska Hospital, Tomtebodavagen 16, 17165, Stockholm, Sweden.,Global Health Institute, University of Antwerp, Doornstraat 331, 2610, Antwerp, Wilrijk, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
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10
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Van Den Heede K, Chidambaram S, Van Slycke S, Brusselaers N, Warfvinge CF, Ohlsson H, Gustafsson R, Nordenström E, Almquist M. Long-term survival of metastatic small intestine neuroendocrine tumors: a meta-analysis. Endocr Relat Cancer 2022; 29:163-173. [PMID: 34982042 DOI: 10.1530/erc-21-0354] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 01/02/2023]
Abstract
This meta-analysis aims to evaluate the long-term survival and prognostic factors in patients with metastatic small intestine neuroendocrine tumors (siNETs). Patients with siNETs usually present with advanced disease, limiting curative treatment options. The overall survival seems favorable compared to other cancers, but differences in terminology, lack of consistent coding, conflicting results from smaller cohorts, and recent developments of new treatment options make (reliable) survival data difficult to achieve. Nevertheless, accurate survival data are essential for many facets of health care. A systematic literature search was performed using MEDLINE®(PubMed), EMBASE®, Web of Science, and Cochrane Library up to June 30, 2021. Studies were included if the overall survival data in patients with metastatic siNETs were reported. The results were pooled in a random-effects meta-analysis and are reported as hazard ratios and 95% CIs. Subgroup analyses and meta-regression were performed to assess the observed heterogeneity and the impact of important prognostic factors. After screening 9065 abstracts, there were 23 studies, published between 1995 and 2021, that met the inclusion criteria, with a total of 8636 patients. The weighted 5- and 10-year overall survival was 67 and 37%, respectively. Meta-regression identified younger age and primary tumor resection to be associated with better prognosis. Subgroup analyses showed similar results. This study confirms that in an advanced, metastatic setting, the weighted 5- and 10-year overall survival reveal a favorable prognosis, improving over the last few decades. Meta-regression showed that age at diagnosis is an important prognostic factor.
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Affiliation(s)
- Klaas Van Den Heede
- Department of Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium
| | - Swathikan Chidambaram
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Endocrine Surgery, Hammersmith Hospital, London, UK
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
| | - Nele Brusselaers
- Center for Translational Microbiome Research Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Carl Fredrik Warfvinge
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Oncology and Pathology, Lund University, Lund, Sweden
| | - Håkan Ohlsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Surgery, Ystad Hospital, Ystad, Sweden
| | - Rita Gustafsson
- Department of Gastroenterology and Hepatology, Lund University, Lund, Sweden
| | - Erik Nordenström
- Department of Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Martin Almquist
- Department of Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Van Den Heede K, Chidambaram S, Van Slycke S, Brusselaers N, Warfvinge CF, Ohlsson H, Nordenström E, Almquist M. Effect of primary tumour resection without curative intent in patients with metastatic neuroendocrine tumours of the small intestine and right colon: meta-analysis. Br J Surg 2021; 109:191-199. [DOI: 10.1093/bjs/znab413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Patients with small intestinal neuroendocrine tumours (siNETs) usually present with advanced disease. Primary tumour resection without curative intent is controversial in patients with metastatic siNETs. The aim of this meta-analysis was to investigate survival after primary tumour resection without curative intent compared with no resection in patients with metastatic siNETs.
Methods
A systematic literature search was performed, using MEDLINE® (PubMed), Embase®, Web of Science, and the Cochrane Library up to 25 February 2021. Studies were included if survival after primary tumour resection versus no resection in patients with metastatic siNETs was reported. Results were pooled in a random-effects meta-analysis, and are reported as hazard ratios (HRs) with 95 per cent confidence intervals. Sensitivity analyses were undertaken to enable comment on the impact of important confounders.
Results
After screening 3659 abstracts, 16 studies, published between 1992 and 2021, met the inclusion criteria, with a total of 9428 patients. Thirteen studies reported HRs adjusted for important confounders and were included in the meta-analysis. Median overall survival was 112 (i.q.r. 82–134) months in the primary tumour resection group compared with 60 (74–88) months in the group without resection. Five-year overall survival rates were 74 (i.q.r. 67–77) and 44 (34–45) per cent respectively. Primary tumour resection was associated with improved survival compared with no resection (HR 0.55, 95 per cent c.i. 0.47 to 0.66). This effect remained in sensitivity analyses.
Conclusion
Primary tumour resection is associated with increased survival in patients with advanced, metastatic siNETs, even after adjusting for important confounders.
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Affiliation(s)
- Klaas Van Den Heede
- Department of Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium
| | - Swathikan Chidambaram
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Endocrine Surgery, Hammersmith Hospital, London, UK
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden
- Department of Family Medicine and Population Health, Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Carl Fredrik Warfvinge
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Oncology and Pathology, Lund University, Lund, Sweden
| | - Håkan Ohlsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Surgery, Ystad Hospital, Ystad, Sweden
| | - Erik Nordenström
- Department of Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Martin Almquist
- Department of Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Van Den Heede K, Van Slycke S, Brusselaers N. Reply to "Commentary on: Risk factors for postoperative morbidity after thyroid surgery in a PROSPECTIVE cohort of 1500 patients (Int. J. Surg. 2021, Epub ahead of print)". Int J Surg 2021; 91:105994. [PMID: 34118442 DOI: 10.1016/j.ijsu.2021.105994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Klaas Van Den Heede
- Department of Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden; Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium.
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium; Department of Head and Skin, University Hospital Ghent, Ghent, Belgium; Department of General Surgery, AZ Damiaan, Ostend, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Global Health Institute, University of Antwerp, Wilrijk, Belgium
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13
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Oscé H, Magamadov K, Van Den Heede K, Brusselaers N, Vermeersch H, Van Slycke S. Intra-operative recovery of preoperative vocal cord paralysis during hemithyroidectomy for benign thyroid disease: case report and review of the literature. Acta Chir Belg 2021; 121:215-218. [PMID: 31580203 DOI: 10.1080/00015458.2019.1675973] [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] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Multinodular goiter associated with preoperative vocal cord palsy is usually indicative of invasive thyroid malignancy. However, benign thyroid disease may also lead to vocal cord paralysis. CASE REPORT We present a case of a 63-year old woman with a two-month history of hoarseness, loss of vocal pitch, difficulties with swallowing and shortness of breath. Preoperative flexible fiberoptic laryngoscopy showed a left vocal cord paralysis. Left hemithyroidectomy with isthmectomy under intraoperative neuromonitoring for multinodular goiter was performed. Intra-operatively, both ipsilateral recurrent laryngeal nerve (RLN) and vagal nerve (VN) were identified and preserved. Follow-up laryngoscopy 5 weeks postoperatively showed complete recovery of the left vocal cord movement. DISCUSSION Intuitively, surgeons may assume that preservation of a palsied RLN in patients with preexisting vocal cord paralysis is not meaningful. However, patients with RLN palsy associated with benign thyroid disease can experience full recovery after surgery. CONCLUSION Multinodular goiter associated with preoperative vocal cord paralysis should be managed with extreme caution and use of intra-operative neuromonitoring. The existing probability of intra-operative recovery of a preoperative RLN palsy underlines the importance of preserving the affected RLN during surgery for benign thyroid disease.
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Affiliation(s)
- Hanne Oscé
- Group of Biomedical Sciences, University Hospital Leuven, Leuven, Belgium
| | - Khozh Magamadov
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Clinic Aalst, Aalst, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Clinic Aalst, Aalst, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Ghent, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, University Hospital Ghent, Ghent, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Clinic Aalst, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
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14
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Agcaoglu O, Sezer A, Makay O, Erdogan MF, Bayram F, Guldiken S, Raffaelli M, Sonmez YA, Lee YS, Vamvakidis K, Mihai R, Duh QY, Akinci B, Alagol F, Almquist M, Barczynski M, Bayraktaroglu T, Berber E, Bukey Y, Cakmak GK, Canturk NZ, Canturk Z, Celik M, Celik O, Ceyhan BO, Cherenko S, Clerici T, Coombes DS, Demircan O, Deyneli O, Dionigi G, Emre AU, Erbil Y, Filiz AI, Gozu HI, Gurdal SO, Gurleyik G, Haciyanli M, Kebudi A, Kim S, Koutelidakis G, Kuru B, Mert M, Oruk GG, Ozbas S, Palazzo F, Pandev R, Riss P, Sabuncu T, Sahin I, Sakman G, Saygili F, Senyurek YG, Sleptsov I, Van Slycke S, Teksoz S, Terzioglu T, Tezelman S, Tunca F, Ugurlu MU, Uludag M, Villar-Del-Moral J, Vriens M, Yazici D. Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options. Updates Surg 2021; 74:325-335. [PMID: 33840069 PMCID: PMC8036242 DOI: 10.1007/s13304-021-00979-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/12/2021] [Indexed: 12/03/2022]
Abstract
Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves’ disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3–4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.
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Affiliation(s)
- Orhan Agcaoglu
- Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Atakan Sezer
- Department of General Surgery, School of Medicine, Trakya University, Balkan Yerleskesi, 22030, Edirne, Turkey.
| | - Ozer Makay
- Department of General Surgery, School of Medicine, Ege University, Bornova, Turkey
| | - Murat Faik Erdogan
- Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey
| | - Fahri Bayram
- Department of Endocrinology and Metabolism, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Sibel Guldiken
- Department of Endocrinology and Metabolism, School of Medicine, Trakya University, Edirne, Turkey
| | - Marco Raffaelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Yusuf Alper Sonmez
- Department of Endocrinology and Metabolism, Gulhane School of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Yong-Sang Lee
- Department of General Surgery, Gangnam Severance Thyroid Center, Yonsei University, Seoul, South Korea
| | | | - Radu Mihai
- Department of General Surgery, Churchill Cancer Center, Oxford University, Oxford, UK
| | - Quan-Yang Duh
- Department of General Surgery, University of California, San Francisco, USA
| | - Baris Akinci
- Department of Endocrinology and Metabolism, School of Medicine, Dokuz Eylul University, İzmir, Turkey
| | - Faruk Alagol
- Department of Endocrinology and Metabolism, School of Medicine, Koc University, Istanbul, Turkey
| | - Martin Almquist
- Department of General Surgery, Skåne University Hospital, Malmö, Sweden
| | - Marcin Barczynski
- Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Taner Bayraktaroglu
- Department of Endocrinology and Metabolism, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Eren Berber
- Division of Endocrine Surgery, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, USA
| | - Yusuf Bukey
- Department of General Surgery, School of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Guldeniz Karadeniz Cakmak
- Department of General Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Nuh Zafer Canturk
- Department of General Surgery, School of Medicine, Kocaeli University, İzmit, Turkey
| | - Zeynep Canturk
- Department of Endocrinology and Metabolism, School of Medicine, Kocaeli University, İzmit, Turkey
| | - Mehmet Celik
- Department of Endocrinology and Metabolism, School of Medicine, Trakya University, Edirne, Turkey
| | - Ozlem Celik
- Department of Endocrinology and Metabolism, School of Medicine, Acibadem University, Istanbul, Turkey
| | | | - Sergii Cherenko
- Department of General Surgery, International Medical Center, Kyiv, Ukraine
| | - Thomas Clerici
- Department of Endocrinology and Metabolism, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Orhan Demircan
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Oguzhan Deyneli
- Department of Endocrinology and Metabolism, School of Medicine, Koc University, Istanbul, Turkey
| | - Gianlorenzo Dionigi
- Department of General Surgery, School of Medicine, Messina University, Messina, Italy
| | - Ali Ugur Emre
- Department of General Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | | | - Ali Ilker Filiz
- Department of General Surgery, School of Medicine, Okan University, Istanbul, Turkey
| | - Hulya Ilıksu Gozu
- Department of Endocrinology and Metabolism, School of Medicine, Marmara University, Istanbul, Turkey
| | - Sibel Ozkan Gurdal
- Department of General Surgery, Namik Kemal University, Zonguldak, Turkey
| | - Gunay Gurleyik
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Haciyanli
- Department of General Surgery, İzmir Ataturk Training and Research Hospital, İzmir, Turkey
| | - Abut Kebudi
- Department of General Surgery, School of Medicine, Okan University, Istanbul, Turkey
| | - Seokmo Kim
- Department of General Surgery, Gangnam Severance Thyroid Center, Yonsei University, Seoul, South Korea
| | - Giannis Koutelidakis
- Department of General Surgery, Aristoteleio University of Thessaloniki, Thessaloniki, Greece
| | - Bekir Kuru
- Department of General Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Meral Mert
- Department of Endocrinology and Metabolism, Bakirkoy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Guzide Gonca Oruk
- Department of Endocrinology and Metabolism, Ataturk Training and Research Hospital, Katip Celebi University, İzmir, Turkey
| | | | - Fausto Palazzo
- Department of Endocrinology and Metabolism, Imperial College, Hammersmith Hospital, London, UK
| | - Rumen Pandev
- Department of General Surgery, School of Medicine, Medical University Sofia, Sofia, Bulgaria
| | - Phillip Riss
- Department of General Surgery, School of Medicine, Medical University of Vienna, Vienna, Austria
| | - Tevfik Sabuncu
- Department of Endocrinology and Metabolism, School of Medicine, Harran University, Şanlıurfa, Turkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, School of Medicine, Malatya University, Malatya, Turkey
| | - Gurhan Sakman
- Department of General Surgery, School of Medicine, Cukurova University, Adana, Turkey
| | - Fusun Saygili
- Department of Endocrinology and Metabolism, School of Medicine, Ege University, Bornova, Turkey
| | - Yasemin Giles Senyurek
- Department of General Surgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilya Sleptsov
- North-West Center of Endocrinology and Metabolism, St. Petersburg State University, St. Petersburg, Russia
| | - Sam Van Slycke
- Department of General Surgery, Vattikutti Foundation, OLV Hospital, Aalst, Belgium
| | - Serkan Teksoz
- Department of General Surgery, School of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Tarik Terzioglu
- Department of General Surgery, VKV American Hospital, Istanbul, Turkey
| | - Serdar Tezelman
- Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Fatih Tunca
- Department of General Surgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Umit Ugurlu
- Department of General Surgery, School of Medicine, Marmara University, Istanbul, Turkey
| | - Mehmet Uludag
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Menno Vriens
- Department of General Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dilek Yazici
- Department of Endocrinology and Metabolism, School of Medicine, Koc University, Istanbul, Turkey
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De Graef A, Van Den Heede K, Meert V, Van Slycke S. Papillary thyroid carcinoma with hobnail features showing rapid progression and therapy resistance. Acta Chir Belg 2021; 121:77-85. [PMID: 33550925 DOI: 10.1080/00015458.2021.1881338] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hobnail variant of papillary thyroid carcinoma (HVPTC), also designated as a micropapillary variant, is a rare but aggressive variant of PTC, representing <2% of all PTC. It was adopted in the newest World Health Organization classification. HVPTC is strongly associated with higher mortality in comparison to classic PTC and a high propensity for disease progression. This paper aimed to investigate the clinical course, cytological and histopathological features, and mutational profile of the hobnail variant from a unique case. CASE REPORT A case of a 38-year-old female patient with HVPTC is presented. Total thyroidectomy with central and bilateral, lateral lymphadenectomy was performed. The clinical course showed aggressive features, as lymph node metastasis and extrathyroidal extension were present at the presentation. Molecular and immunohistochemical features are addressed along with a review of the literature. DISCUSSION The cytological examination of FNA was in consonance with published literature. The cells showed hobnail features in several segments of both thyroidal lobes on histological examination. The tumour displayed a typical BRAF mutation and Gly12Ala mutation in the KRAS gene, previously not associated with PTC. CONCLUSION We aimed to highlight the aggressive, clinicopathological features of this high-risk variant. We emphasise the need to evaluate suspicious thyroid nodules as an adequate diagnosis can prevent delayed therapy. It directly impacts the tumour's stage and prognosis. In fine-needle aspiration cytology showing papillary architecture carcinomas, HVPTC has to be part of the differential diagnosis.
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Affiliation(s)
- Anton De Graef
- University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium
- Department of Endocrine Surgery, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Vanessa Meert
- Department of Pathology, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan Ostend, Ostend, Belgium
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16
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Van Slycke S, Van Den Heede K, Bruggeman N, Vermeersch H, Brusselaers N. Risk factors for postoperative morbidity after thyroid surgery in a PROSPECTIVE cohort of 1500 patients. Int J Surg 2021; 88:105922. [PMID: 33774174 DOI: 10.1016/j.ijsu.2021.105922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/30/2020] [Revised: 01/20/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding are the most frequent postoperative complications after thyroid surgery, and therefore often used as quality indicators of thyroid surgery. We aimed to assess postoperative morbidity in a high-volume endocrine surgery unit, and to detect which factors are associated with higher risks. METHODS Prospective surgical cohort in a high-volume tertiary referral centre for endocrine surgery in xxx. The first 1500 patients operated with hemi or total thyroidectomy during 2010-2019 were included. Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and peri-operative characteristics using multivariable logistic regression analyses, expressed as odds ratios and 95% confidence intervals. RESULTS Overall, 1043 patients (69.5%) received a total thyroidectomy and 457 (30.5%) a hemithyroidectomy. Permanent hypocalcaemia occurred in 3.1%, permanent recurrent laryngeal nerve palsy in 1.8% and surgical reintervention for bleeding in 2.6%. Younger age, female sex and cancer were risk factors for permanent hypocalcaemia. No clear risk factors could be identified for permanent nerve palsy. Female sex, high body mass index and heavier thyroids were protective against postoperative bleeding after total thyroidectomy. CONCLUSIONS Surgical experience in endocrine surgery seems beneficial for clinical outcomes and contributes to organizational efficiency. A low complication risk can be obtained by trained high-volume endocrine surgeons, yet the risk is not negligible.
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Affiliation(s)
- Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium; Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium; Department of Endocrine Surgery, Hammersmith, 72 Du Cane Road, W12 0HS, London, UK
| | - Niels Bruggeman
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Plastic and Reconstructive Surgery, Department of Human Structure and Repair, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Brusselaers
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Karolinska Hospital, Solnavägen 9, 17165, Stockholm, Sweden.
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17
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Crona J, Baudin E, Terzolo M, Chrisoulidou A, Angelousi A, Ronchi CL, Oliveira CL, Nieveen van Dijkum EJM, Ceccato F, Borson-Chazot F, Reimondo G, Tiberi GAM, Ettaieb H, Kiriakopoulos A, Canu L, Kastelan D, Osher E, Yiannakopoulou E, Arnaldi G, Assié G, Paiva I, Bourdeau I, Newell-Price J, Nowak KM, Romero MT, De Martino MC, Bugalho MJ, Sherlock M, Vantyghem MC, Dennedy MC, Loli P, Rodien P, Feelders R, de Krijger R, Van Slycke S, Aylwin S, Morelli V, Vroonen L, Shafigullina Z, Bancos I, Trofimiuk-Müldner M, Quinkler M, Luconi M, Kroiss M, Naruse M, Igaz P, Mihai R, Della Casa S, Berruti A, Fassnacht M, Beuschlein F. ENSAT registry-based randomized clinical trials for adrenocortical carcinoma. Eur J Endocrinol 2021; 184:R51-R59. [PMID: 33166271 DOI: 10.1530/eje-20-0800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/05/2020] [Indexed: 11/08/2022]
Abstract
Adrenocortical carcinoma (ACC) is an orphan disease lacking effective systemic treatment options. The low incidence of the disease and high cost of clinical trials are major obstacles in the search for improved treatment strategies. As a novel approach, registry-based clinical trials have been introduced in clinical research, so allowing for significant cost reduction, but without compromising scientific benefit. Herein, we describe how the European Network for the Study of Adrenal Tumours (ENSAT) could transform its current registry into one fit for a clinical trial infrastructure. The rationale to perform randomized registry-based trials in ACC is outlined including an analysis of relevant limitations and challenges. We summarize a survey on this concept among ENSAT members who expressed a strong interest in the concept and rated its scientific potential as high. Legal aspects, including ethical approval of registry-based randomization were identified as potential obstacles. Finally, we describe three potential randomized registry-based clinical trials in an adjuvant setting and for advanced disease with a high potential to be executed within the framework of an advanced ENSAT registry. Thus we, therefore, provide the basis for future registry-based trials for ACC patients. This could ultimately provide proof-of-principle of how to perform more effective randomized trials for an orphan disease.
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Affiliation(s)
- Joakim Crona
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eric Baudin
- Gustave Roussy, Université Paris-Saclay, Département d'imagerie, Service d'oncologie endocrinienne, Villejuif, France
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, University of Turin at San Luigi Hospital, Orbassano, Italy
| | | | - Anna Angelousi
- 1st Department of Internal Medicine, Unit of Endocrinology, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
| | - Cristina L Ronchi
- Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK
- Division of Endocrinology and Diabetes, University Hospital of Würzburg, Würzburg, Germany
| | | | - Els J M Nieveen van Dijkum
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
| | - Françoise Borson-Chazot
- Hospices Civils de Lyon, Fédération d'Endocrinologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Giuseppe Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Guido A M Tiberi
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Hester Ettaieb
- Division of Endocrinology, Department of Internal Medicine, Maxima Medical Center, Eindhoven/Veldhoven, The Netherlands
| | - Andreas Kiriakopoulos
- 5th Surgical Clinic, 'Evgenidion Hospital' National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Esthr Osher
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eugenia Yiannakopoulou
- Department of Biomedical Sciences, Faculty of Health Sciences, University of West Attica, Athens, Greece
| | - Giorgio Arnaldi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Guillaume Assié
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
- Endocrinology, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Isabel Paiva
- Department os Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine, Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - John Newell-Price
- Department of Oncology and Metabolism, The Medical School University of Sheffield, Sheffield, UK
| | - Karolina M Nowak
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - M Tous Romero
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Maria Cristina De Martino
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Maria João Bugalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, CHULN and Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Mark Sherlock
- Department of Endocrinology, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie-Christine Vantyghem
- Endocrinology, Diabetology, Metabolism and Nutrition Department, Lille University Hospital, Lille, France
| | - Michael Conall Dennedy
- Department of Endocrinology & Diabetes Mellitus, c/o Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Galway, Ireland
| | - Paula Loli
- Ospedale Niguarda Ca' Granda, Endocrinology, Napoli, Italy
| | - Patrice Rodien
- Service d'Endocrinologie Diabétologie et Nutrition, CHU d'Angers, Angers Cedex 9, France
| | - Richard Feelders
- Erasmus Medical Center, Division of Endocrinology, Department of Internal Medicine, Rotterdam, The Netherlands
| | - Ronald de Krijger
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - Sam Van Slycke
- General and Endocrine Surgery, OLV Hospital Aalst, Aalst, Belgium
| | | | - Valentina Morelli
- Endocrinology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laurent Vroonen
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liege, Belgium
| | - Zulfiya Shafigullina
- Endocrinology Department, North-Western Medical University named after I.I.Mechnikov, Saint-Petersburg, Russia
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Michaela Luconi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Matthias Kroiss
- Division of Endocrinology and Diabetes, University Hospital of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Mitsuhide Naruse
- Endocrine Center, Ijinkai Takeda General Hospital and Clinical Research Institute of Endocrinology and Metabolism, NHO Kyoto Medical Center, Kyoto, Japan
| | - Peter Igaz
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
- MTA-SE Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Radu Mihai
- Churchill Cancer Centre, Department of Endocrine Surgery, Oxford University, Oxford, UK
| | - Silvia Della Casa
- Endocrinology Department, Gemelli Polyclinic Foundation, Catholic University, Rome, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, University Hospital of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
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18
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Iwata AJ, Liddy W, Barczyński M, Wu CW, Huang TY, Van Slycke S, Schneider R, Dionigi G, Dralle H, Cernea CR, Kamani D, Ahmed AH, Okose OC, Wang B, Randolph GW. Superior Laryngeal Nerve Signal Attenuation Influences Voice Outcomes in Thyroid Surgery. Laryngoscope 2021; 131:1436-1442. [PMID: 33521945 DOI: 10.1002/lary.29413] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/02/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to identify whether injury of the external branch of the superior laryngeal nerve (EBSLN) or changes in EBSLN parameters after dissection during thyroidectomies correlate with changes in voice quality postoperatively. STUDY DESIGN Prospective multicenter case series. METHODS A prospective multicenter study was conducted on patients undergoing thyroidectomies with intraoperative nerve monitoring. Electromyography waveforms of EBSLN stimulation before (S1) and after superior pole dissection (S2) were evaluated using endotracheal tube (ETT) and cricothyroid intramuscular (CTM) electrodes. Voice outcomes were assessed using Voice-Related Quality of Life Surveys and Voice Handicap Index. RESULTS A total of 131 at-risk EBSLNs were evaluated in 80 patients. Two nerves showed loss of CTM twitch coupled with an absent S2 signal response. Complete EBSLN loss of signal was more likely with: 1) Cernea EBSLN anatomic classification Type 2B; 2) with a longer distance from the sternothyroid muscle insertion site; and 3) with larger lobar volumes (P < .05). Patients who experienced a more than 50% decrement in CTM amplitudes of S2 (n = 7) by CTM electrodes had a statistically significant decline in their voice outcomes compared to those who did not (n = 69) (P < .05). CONCLUSIONS Patients experienced worse voice outcomes when at least one EBSLN response amplitude decreased by more than 50% after dissection when measured by CTM needle electrodes. CTM needle electrodes have an ability to measure finer amplitude changes compared to ETT electrodes, may represent a safe method to deduce subtle EBSLN injuries, and may serve to optimize voice outcomes during thyroidectomy. CTM needle electrodes are safe and tolerated well. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1436-1442, 2021.
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Affiliation(s)
- Ayaka J Iwata
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Whitney Liddy
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Che-Wei Wu
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yen Huang
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Ziekenhuis Aalst, Aalst, Belgium
| | - Rick Schneider
- Department of Surgery, University Hospital Halle, Martin-Luther-University, Haller-Wittenberg, Germany
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery. Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, University of Duisburg-Essen, Essen, Germany
| | - Claudio R Cernea
- Department of Surgery, Head and Neck Surgery Service of the Hospital das Clínicas, University of Sao Paulo, Sao Paulo, Brazil
| | - Dipti Kamani
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Amr H Ahmed
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Okenwa C Okose
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Bo Wang
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, China
| | - Gregory W Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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19
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Van Slycke S, Van Den Heede K, Brusselaers N, Vermeersch H. Feasibility of Autofluorescence for Parathyroid Glands During Thyroid Surgery and the Risk of Hypocalcemia: First Results in Belgium and Review of the Literature. Surg Innov 2020; 28:409-418. [PMID: 33372584 DOI: 10.1177/1553350620980263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Post-operative hypocalcemia remains the most frequent complication after total thyroidectomy. Recently, autofluorescence imaging was introduced to detect parathyroid glands early during dissection. Aim. We aimed to check the feasibility of autofluorescence regarding the number of parathyroid glands visualised and the risk of post-operative hypocalcemia. Methods. In a prospectively gathered cohort of patients undergoing thyroid surgery, we describe the risk of hypocalcemia in relation to the number of parathyroid glands visualised during surgery (and the risk reported in the scientific literature) and the feasibility to obtain an autofluorescence of the parathyroid glands. Results. From 2010 to 2019, 1083 patients were referred for total thyroidectomy in our tertiary referral centre for endocrine surgery, of which, 40 consecutive cases were operated using autofluorescence. Among the autofluorescence group, 14 (35.0%) had all 4 parathyroid glands visualised, compared to 147 (14.1%) in the other patients, without differences in the number of parathyroid glands reimplanted. No permanent hypocalcemia occurred in the autofluorescence group and 17.5% temporary hypoparathyroidism, compared to 3.1% and 31.9% among the other patients, and 4% (95% confidence interval [CI] 3-5%) and 19% (95% CI 15-24%) in the literature. Conclusion. Autofluorescence imaging provides reliable real-time visualisation at any point during thyroid surgery and helps to identify the parathyroid glands before detection with the naked eye. To date, it cannot be used as a standard technique and does not replace meticulous dissection. To become a useful adjunct in peroperative parathyroid management, large multicentre studies need to establish a potential clinical benefit of this novel technique.
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Affiliation(s)
- Sam Van Slycke
- Department of General and Endocrine Surgery, 74840Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium.,Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Department of General Surgery, 81800AZ Damiaan, Gouwelozestraat, Ostend, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, 74840Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium.,Department of Endocrine Surgery, 129363Hammersmith Hospital, London, UK
| | - Nele Brusselaers
- Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, 27106Karolinska Institute, Stockholm, Sweden
| | - Hubert Vermeersch
- Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Plastic and Reconstructive Surgery, Department of Human Structure and Repair, 60200University Hospital Ghent, Ghent, Belgium
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20
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Vancraeynest L, Van Slycke S. Lateral neck cyst as initial presentation of thyroid malignancy. Acta Chir Belg 2020; 120:413-416. [PMID: 31012377 DOI: 10.1080/00015458.2019.1610261] [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] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A mass in the lateral aspect of the neck may cause a diagnostic dilemma for the clinician. Cystic lateral neck masses in young adults are most often benign as the most frequent cause is a branchial cleft cyst. However, this may be a pitfall as such a cystic mass can be a first presentation of occult malignancy. CASE REPORT Here we present a case of a 25-year-old female patient with a cystic mass in the right lateral neck. This lesion was eventually diagnosed as cystic degeneration within a metastatic invaded lymph node from papillary thyroid carcinoma. Total thyroidectomy with right central and lateral lymphadenectomy was performed. DISCUSSION The correct diagnosis risked to be missed as the initial appearance was mimicking a benign branchial cleft cyst. CONCLUSION We aimed to highlight the possibility of an underlying unsuspected thyroid carcinoma in young patients initially presenting with a neck mass mimicking the more common benign branchial cleft cyst. We underline the necessity of thoroughly examining suspected cysts as adequate diagnosis should avoid delayed treatment as it directly affects the tumor stage and prognosis.
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Affiliation(s)
- Lieze Vancraeynest
- University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium
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21
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Sengul D, Sengul I, Van Slycke S. Risk stratification of the thyroid nodule with Bethesda indeterminate cytology, category III, IV, V on the one surgeon-performed US-guided fine-needle aspiration with 27-gauge needle, verified by histopathology of thyroidectomy: the additional value of one surgeon-performed elastography. Acta Chir Belg 2019; 119:38-46. [PMID: 30606092 DOI: 10.1080/00015458.2018.1551769] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim is to assess the value of strain elastography (SE) in differentiating likelihood of malignancy for the thyroid nodules, possessing the Bethesda Category III, IV, and V indeterminate cytology. METHODS The data was obtained by ultrasonography (US)-guided fine-needle aspiration (US-g-FNA) via 27-gauge needle, with the verification of indicated thyroidectomies in a retrospective analysis, from April 2010 to April 2014, by enrolling the documents of 262 consecutive patients, with 327 thyroid nodules, subjected to one-surgeon performed neck US, SE, and US-g-FNA with 27-G needle to rule out the malignancy. RESULTS 122 of 327 cases were Bethesda Category III, IV, and V with histopathologically benign, 110 (90.2%); PTC, 7 (5.7%); FTC, 4 (3.3%); HCC, 1 (0.8%). Tsukuba Elasticity Score (TES) 1, 2, 3, 4, and 5 were detected as 38 (31.1%), 8 (6.6%), 59 (48.4%), 4 (3.3%), and 13 (10.7%), respectively for the cases with the indeterminate cytology. No significant difference was detected between TES 4 and 5 and malign histopathology by McNemar test (p = .727) with a good level of concordance, the kappa coefficient, 0.737. CONCLUSION SE may be a useful tool in differentiating malign from benign thyroid nodules by selecting surgery adaptation even for Bethesda indeterminate cytology on FNAC.
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Affiliation(s)
- Demet Sengul
- Department of Pathology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Ilker Sengul
- Division of Endocrine Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Ziekenhuis Aalst, Aalst, Belgium
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22
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Willems E, Willaert B, Van Slycke S. Transmesenteric hernia: a rare case of acute abdominal pain in children: a case report and review of the literature. Acta Chir Belg 2018; 118:388-391. [PMID: 29115904 DOI: 10.1080/00015458.2017.1399662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this report, we discuss the case of an 11-year old girl presenting with acute abdominal pain caused by gangrene of a large part of the small bowel. During urgent surgical exploration, the cause of gangrene appeared to be herniation of the small bowel through a congenital defect in the mesentery with subsequent strangulation. A resection was performed leaving the patient with only 130 cm of small bowel remaining. Transmesenteric hernia is a rare type of internal herniation consisting of a small congenital defect in the small bowel mesentery through which the intestine can herniate and subsequently become strangulated. We present a case of transmesenteric hernia with disastrous effects and review the literature regarding this rare type of hernia.
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Affiliation(s)
- Edward Willems
- Department of General and Abdominal Surgery, OLV Hospital Aalst, Aalst, Belgium
| | - Bart Willaert
- Department of General and Abdominal Surgery, OLV Hospital Aalst, Aalst, Belgium
| | - Sam Van Slycke
- Department of General and Abdominal Surgery, OLV Hospital Aalst, Aalst, Belgium
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23
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Liddy W, Lawson BR, Barber SR, Kamani D, Shama M, Soylu S, Wu CW, Chiang FY, Scharpf J, Barczynski M, Dralle H, Van Slycke S, Schneider R, Dionigi G, Randolph GW. Anterior laryngeal electrodes for recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: New expanded options for neural monitoring. Laryngoscope 2018; 128:2910-2915. [PMID: 30417384 DOI: 10.1002/lary.27362] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 04/24/2018] [Accepted: 05/25/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Intraoperative neural monitoring is a useful adjunct for the laryngeal nerve function assessment during thyroid and parathyroid surgery. Typically, monitoring is performed by measurement of electromyographic responses recorded by endotracheal tube (ETT) surface electrodes. Tube position alterations during surgery can cause displacement of the electrodes relative to the vocal cords, leading to false positive loss of signal. Numerous reports have denoted monitoring equipment-related issues, especially endotracheal tube displacement, as the dominant source of false positive error. The false positive error may result in inappropriate decisions by the surgeon. This study tests the hypothesis that anterior laryngeal electrodes (ALEs) can help reduce this error. Placement of ALEs directly onto the thyroid cartilage represent an adjunctive and possible alternative method to standard ETT surface electrodes. STUDY DESIGN Retrospective review. METHODS Fifteen consecutive patients undergoing thyroid and parathyroid surgery with intraoperative neuromonitoring using both ETT electrodes and ALEs were studied. Data collected included site of neural stimulation, laterality, and electromyographic parameters. RESULTS With vagal and recurrent laryngeal nerve stimulation, the ALEs recorded mean vocalis muscle waveform amplitude within 83% of that recorded with standard ETT electrodes. The latency measurements with the anterior laryngeal and endotracheal electrodes were similar, with both electrodes recording significantly longer latency for the left vagus nerve as compared to the right vagus nerve. With superior laryngeal nerve stimulation, the ALEs recorded a 800% greater mean amplitude than the ETT electrodes. The ALEs demonstrated similar sensitivity to stimulation at low current as ETT electrodes and provided stable intraoperative monitoring information. CONCLUSIONS Compared to ETT surface electrodes, the ALEs provide similar and stable electromyographic responses with equal sensitivity for recording evoked responses during neural monitoring in thyroid and parathyroid surgery. The ALEs offer significantly more robust monitoring of the external branch of the superior laryngeal nerve. Furthermore, ALEs are contained within the operative field, are totally surgeon controlled, and are unaffected by the potential vicissitudes of ETT position during surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2910-2915, 2018.
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Affiliation(s)
- Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Bradley R Lawson
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Samuel R Barber
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Dipti Kamani
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohamed Shama
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Selen Soylu
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Che Wei Wu
- Department of Otorhinolaryngology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Joseph Scharpf
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Third Chair of General Surgery, Krakow, Poland
| | - Henning Dralle
- Department of General Surgery, University Hospital Halle, Halle/Saale, Germany
| | | | - Rick Schneider
- Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Gregory W Randolph
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Division of Surgical Oncology, Endocrine Surgery Service, Boston, Massachusetts, U.S.A
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Wu CW, Dionigi G, Barczynski M, Chiang FY, Dralle H, Schneider R, Al-Quaryshi Z, Angelos P, Brauckhoff K, Brooks JA, Cernea CR, Chaplin J, Chen AY, Davies L, Diercks GR, Duh QY, Fundakowski C, Goretzki PE, Hales NW, Hartl D, Kamani D, Kandil E, Kyriazidis N, Liddy W, Miyauchi A, Orloff L, Rastatter JC, Scharpf J, Serpell J, Shin JJ, Sinclair CF, Stack BC, Tolley NS, Slycke SV, Snyder SK, Urken ML, Volpi E, Witterick I, Wong RJ, Woodson G, Zafereo M, Randolph GW. International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data. Laryngoscope 2018; 128 Suppl 3:S18-S27. [PMID: 30291765 DOI: 10.1002/lary.27360] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [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: 02/27/2018] [Revised: 04/22/2018] [Accepted: 05/24/2018] [Indexed: 12/30/2022]
Abstract
The purpose of this publication was to inform surgeons as to the modern state-of-the-art evidence-based guidelines for management of the recurrent laryngeal nerve invaded by malignancy through blending the domains of 1) surgical intraoperative information, 2) preoperative glottic function, and 3) intraoperative real-time electrophysiologic information. These guidelines generated by the International Neural Monitoring Study Group (INMSG) are envisioned to assist the clinical decision-making process involved in recurrent laryngeal nerve management during thyroid surgery by incorporating the important information domains of not only gross surgical findings but also intraoperative recurrent laryngeal nerve functional status and preoperative laryngoscopy findings. These guidelines are presented mainly through algorithmic workflow diagrams for convenience and the ease of application. These guidelines are published in conjunction with the INMSG Guidelines Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal. Level of Evidence: 5 Laryngoscope, 128:S18-S27, 2018.
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Affiliation(s)
- Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University, Third Chair of General Surgery, Krakow, Poland
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Henning Dralle
- Department of General Surgery, University Hospital Halle, Halle/Saale, Germany
| | - Rick Schneider
- Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Zaid Al-Quaryshi
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Peter Angelos
- Division of Endocrine Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jennifer A Brooks
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Claudio R Cernea
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - John Chaplin
- Department of Otolaryngology-Head and Neck Surgery, Gillies Hospital and Clinics, Epsom, New Zealand
| | - Amy Y Chen
- VA Endocrine Surgery, Department of Otolaryngology Emory University School of Medicine, Atlanta, GA, USA
| | - Louise Davies
- Outcomes Group, Veterans Affairs Medical Center, Norwich, Vermont, U.S.A
| | - Gill R Diercks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Quan Yang Duh
- Department of Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Christopher Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Peter E Goretzki
- P.G. Stadtische Kliniken Neuss Lukaskrankenhaus GmbH, Neuss, Nordrhein-Westfalen, DE
| | - Nathan W Hales
- Department of Otolaryngology, Uniformed Services of the Health Sciences, San Antonio, Texas, U.S.A.,San Antonio Head and Neck, San Antonio, Texas, U.S.A
| | - Dana Hartl
- Department of Otolaryngology Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Dipti Kamani
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Natalia Kyriazidis
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York, U.S.A
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | | | - Lisa Orloff
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Jeff C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Joseph Scharpf
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Jonathan Serpell
- Breast, Endocrine and General Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University School of Languages, Literatures, Cultures, and Linguistics, Clayton, Victoria, Australia
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York, U.S.A
| | - Brendan C Stack
- Department of Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Neil S Tolley
- Department of Otolaryngology-Head and Neck Surgery, Imperial College Hospitals NHS Trust, St. Mary's Hospital, London, United Kingdom
| | | | - Samuel K Snyder
- Department of General Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, U.S.A
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York, U.S.A
| | - Erivelto Volpi
- Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ian Witterick
- Department of Otolaryngology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Richard J Wong
- Department of Surgery-Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A
| | | | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Gregory W Randolph
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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Schneider R, Randolph GW, Dionigi G, Wu CW, Barczynski M, Chiang FY, Al-Quaryshi Z, Angelos P, Brauckhoff K, Cernea CR, Chaplin J, Cheetham J, Davies L, Goretzki PE, Hartl D, Kamani D, Kandil E, Kyriazidis N, Liddy W, Orloff L, Scharpf J, Serpell J, Shin JJ, Sinclair CF, Singer MC, Snyder SK, Tolley NS, Van Slycke S, Volpi E, Witterick I, Wong RJ, Woodson G, Zafereo M, Dralle H. International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope 2018; 128 Suppl 3:S1-S17. [DOI: 10.1002/lary.27359] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Rick Schneider
- Martin Luther University Halle-Wittenberg; Department of General, Visceral, and Vascular Surgery; Halle Germany
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology; Massachusetts Eye and Ear Harvard Medical School; Boston Massachusetts
- Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, at the Department of Human Pathology in Adulthood and Childhood “G. Barresi,” University Hospital G. Martino; University of Messina; Italy
| | - Che-Wei Wu
- Kaohsiung Medical University Hospital, Kaohsiung Medical University; Otolaryngology-Head and Neck Surgery; Kaohsiung Taiwan
| | - Marcin Barczynski
- Jagiellonian University, Department of Endocrine Surgery, Third Chair of General Surgery; Krakow Poland
| | - Feng-Yu Chiang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University; Otolaryngology-Head and Neck Surgery; Kaohsiung Taiwan
| | - Zaid Al-Quaryshi
- University of Iowa Hospitals and Clinics, Otolaryngology; Iowa City Iowa
| | - Peter Angelos
- University of Chicago; Division of Endocrine Surgery, Department of Surgery; Chicago Illinois
| | - Katrin Brauckhoff
- Haukeland Universitetssjukehus; Department of Breast and Endocrine Surgery; Bergen Norway
| | - Claudio R. Cernea
- University of Sao Paulo Medical School; Department of Head and Neck Surgery; Sao Paulo SP Brazil
| | | | - Jonathan Cheetham
- Cornell University, Clinical Sciences, College of Veterinary Medicine; Ithaca New York
| | - Louise Davies
- VA Outcomes Group at the Veterans Affairs Medical Center; Norwich Vermont
| | - Peter E. Goretzki
- Stadtische Kliniken Neuss Lukaskrankenhaus GmbH; Neuss Nordrhein-Westfalen Germany
| | - Dana Hartl
- Institut Gustave Roussy, Otolaryngology Head & Neck Surgery; Villejuif France
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology; Massachusetts Eye and Ear Harvard Medical School; Boston Massachusetts
| | - Emad Kandil
- Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana
| | - Natalia Kyriazidis
- State University of New York Upstate Medical University; Otolaryngology; Syracuse New York
| | - Whitney Liddy
- Northwestern University Feinberg School of Medicine Department of Psychiatry and Behavioral Sciences, Otolaryngology; Chicago Illinois
| | - Lisa Orloff
- Stanford University School of Medicine, Otolaryngology, Division of Head and Neck Surgery; Stanford California
| | | | - Jonathan Serpell
- Alfred Hospital; Melbourne Victoria Australia
- Monash University School of Languages Literatures Cultures and Linguistics; Clayton Victoria Australia
| | | | | | - Michael C. Singer
- Henry Ford Hospital, Otolaryngology-Head & Neck Surgery; Detroit Michigan
| | - Samuel K. Snyder
- University of Texas Rio Grande Valley School of Medicine; Department of General Surgery; Edinburg Texas
| | - Neil S. Tolley
- St. Mary's Hospital, Imperial College Hospitals NHS Trust, St. Mary's Hospital; London United Kingdom
| | | | - Erivelto Volpi
- Hospital das Clinicas-University of Sao Paulo Medical School; Sao Paulo Brazil
| | - Ian Witterick
- Mount Sinai Hospital; Department of Otolaryngology; Toronto Ontario Canada
| | - Richard J. Wong
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, Head and Neck Service; New York New York
| | | | - Mark Zafereo
- MD Anderson Cancer Center, Head and Neck Surgery; Houston Texas U.S.A
| | - Henning Dralle
- Allgemeinchirurgie, Uniklinik Halle; Halle/Saale Germany
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Sundahl N, Van Slycke S, Brusselaers N. A rare case of clinically and biochemically silent giant right pheochromocytoma: case report and review of literature. Acta Chir Belg 2016; 116:239-242. [PMID: 27426649 DOI: 10.1080/00015458.2016.1139838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Non-secreting pheochromocytomas are rare adrenal tumours. We report the case of a clinically and biochemically silent giant pheochromocytoma that presented as bilateral pulmonary embolisms. Successful surgical resection was performed. Multiple endocrine neoplasia 2 syndrome and neurofibromatosis type 1 were clinically excluded. Subsequent DNA analysis of the succinate dehydrogenase complex subunits B and D (SDHB and SDHD), and Von Hippel-Lindau (VHL) genes revealed no mutations.
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Abstract
Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders for which parathyroidectomy is the most effective therapy. Until late 1970s, the standard approach to parathyroidectomy was a four-gland exploration using a large skin incision. However, 80 to 85 percent of cases of PHPT are caused by a single adenoma. As such, the concept of performing a bilateral exploration in order to visualize all four glands has been argued to be excessive since in the majority of cases, there is only one abnormal gland. Focused exploration (one gland) is currently the standard technique for parathyroidectomy worldwide. Despite a rapid acceptance of minimally invasive approaches in most endocrine surgery centers, the use of an endoscope with or without the use of a robotic system to perform parathyroidectomy remains controversial. The goal of this study was to review current available data about surgical approaches using an endoscope with or without the use of a robotic system in the management of patients with PHPT. For conventional endoscopic and video assisted parathyroidectomy, several comparative studies have demonstrated some advantages in terms of reduced postoperative pain, better cosmetic results and higher patient satisfaction compared to open non-endoscopic minimally invasive parathyroidectomy. Robot-assisted transaxillary parathyroidectomy has the advantage of leaving no scar in the neck but its role has not yet been delineated clearly given the limited number of published series. Subjective postoperative cosmetic evaluation is good by concealing the scar in the axilla or infraclavicular area. However, this approach is associated with more extensive dissection than during conventional open or endoscopic neck access surgical procedures. Patients with true ectopic mediastinal parathyroid glands are good candidates for conventional or robot-assisted thoracoscopic approaches because these glands are in remote and narrow anatomical locations.
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Affiliation(s)
- Laurent Brunaud
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Zhen Li
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Klaas Van Den Heede
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Thomas Cuny
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Sam Van Slycke
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
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Van Slycke S, Gillardin JP, Van Den Heede K, Minguet J, Vermeersch H, Brusselaers N. Comparison of the harmonic focus and the thunderbeat for open thyroidectomy. Langenbecks Arch Surg 2016; 401:851-9. [DOI: 10.1007/s00423-016-1448-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 05/11/2016] [Indexed: 02/04/2023]
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Schneider R, Randolph G, Dionigi G, Barczyński M, Chiang FY, Triponez F, Vamvakidis K, Brauckhoff K, Musholt TJ, Almquist M, Innaro N, Jimenez-Garcia A, Kraimps JL, Miyauchi A, Wojtczak B, Donatini G, Lombardi D, Müller U, Pezzullo L, Ratia T, Van Slycke S, Nguyen Thanh P, Lorenz K, Sekulla C, Machens A, Dralle H. Prospective study of vocal fold function after loss of the neuromonitoring signal in thyroid surgery: The International Neural Monitoring Study Group's POLT study. Laryngoscope 2015; 126:1260-6. [PMID: 26667156 DOI: 10.1002/lary.25807] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Intraoperative neuromonitoring identifies recurrent laryngeal nerve (RLN) injury and gives prognostic information regarding postoperative glottic function. Loss of the neuromonitoring signal (LOS) signifies segmental type 1 or global type 2 RLN injury. This study aimed at identifying risk factors for RLN injury and determining vocal fold (VF) function initially and 6 months after definitive LOS. STUDY DESIGN Prospective study encompassing 21 hospitals from 13 countries. METHODS Included in this study were patients with persistent intraoperative LOS. RESULTS At first postoperative laryngoscopy, early VF palsy was present in 94 of all 115 patients with LOS (81.7%): in 53 of 56 patients (94.6%) with type 1 injury and 41 of 59 patients (69.5%) with type 2 injury. In LOS type 1, women outnumbered men >5-fold. Traction produced LOS type 1 in 38 of 56 patients (67.9%) and LOS type 2 in 54 of 59 patients (91.5%). Course of the RLN posterior and/or anterior to the inferior thyroid artery, extralaryngeal branching, or tuberculum of Zuckerkandl did not increase VF palsy rates. Permanent VF palsy rates were also lower (P = .661) after LOS type 2 than after LOS type 1: 6.8% (four of 59 patients) versus 10.7% (six of 56 patients). Intraoperative administration of steroids did not diminish postoperative VF palsy rates. CONCLUSIONS LOS type 1 entails more severe nerve damage than LOS type 2, affecting women disproportionately. Both LOS types, being primarily associated with traction injury, are unaffected by variant neck anatomy in expert hands and unresponsive to steroids. LEVEL OF EVIDENCE 2b Laryngoscope, 126:1260-1266, 2016.
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Affiliation(s)
- Rick Schneider
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Gregory Randolph
- Division of Thyroid and Parathyroid Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | - Marcin Barczyński
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University, Krakow, Poland
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Frédéric Triponez
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Katrin Brauckhoff
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - Thomas J Musholt
- Endocrine Surgery Section, Clinic of General, Visceral, and Transplantation Surgery, University Medical Center, Mainz, Germany
| | - Martin Almquist
- Department of Surgery, Lund University Hospital, Lund, Sweden
| | - Nadia Innaro
- Department of General Surgery, University of Catanzaro, Catanzaro, Italy
| | | | - Jean-Louis Kraimps
- Department of Endocrine Surgery, University Hospital of Poitiers, Poitiers, France
| | | | - Beata Wojtczak
- Department of General, Gastroenterological and Endocrine Surgery, Medical University Wrocław, Wrocław, Poland
| | - Gianluca Donatini
- Department of Endocrine Surgery, University Hospital of Poitiers, Poitiers, France
| | - Davide Lombardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Uwe Müller
- Department of General, Viszeral and Thoracic Surgery, Bundeswehr Hospital, Berlin, Germany
| | - Luciano Pezzullo
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale, Naples, Italy
| | - Tomas Ratia
- Department of General Surgery, "Principe de Asturias" University Hospital, Madrid, Spain
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium
| | - Phuong Nguyen Thanh
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Kerstin Lorenz
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Carsten Sekulla
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
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Van Slycke S, Gillardin JP, Brusselaers N, Vermeersch H. Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery. Langenbecks Arch Surg 2013; 398:717-22. [DOI: 10.1007/s00423-013-1068-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 02/18/2013] [Indexed: 10/27/2022]
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Dionigi G, Van Slycke S, Rausei S, Boni L, Dionigi R. Parathyroid function after open thyroidectomy: A prospective randomized study for ligasure precise versus harmonic FOCUS. Head Neck 2012; 35:562-7. [PMID: 22715020 DOI: 10.1002/hed.23005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Options for controlling hemostasis during thyroidectomy include bipolar vessel sealing system and ultrasonic technology. The purpose of this study was to compare these energy-based devices on the performance of open thyroidectomy for benign disease with emphasis given to postoperative parathyroid function. METHODS Among the available energy-based devices, the LigaSure Precise (LP; Valleylab, Boulder, CO) and FOCUS Shears (FS; Ethicon Endo-Surgery, Cincinnati, OH) were evaluated. One hundred ninety-nine consecutive patients scheduled for open thyroidectomy were prospectively randomized into 2 similar-sized groups. Operative time, morbidity, incision length, postoperative pain, and hospital stay were analyzed. Postoperative hypoparathyroidism was monitored with serial determinations of intact parathyroid hormone (iPTH) and serum calcium. RESULTS Early postoperative measurement of iPTH plasma level, although within the reference range, was significantly lower in the FS group (p < .001). Oral calcium supplementation was significantly higher and prolonged in the FS group. CONCLUSION The present study demonstrates a significant difference of the rates for postoperative parathyroid malfunction when using different energy-based devices.
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Affiliation(s)
- Gianlorenzo Dionigi
- Department of Surgical Sciences, University of Insubria, Varese-Como, Italy.
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32
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Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011; 121 Suppl 1:S1-16. [PMID: 21181860 DOI: 10.1002/lary.21119] [Citation(s) in RCA: 605] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problem-solving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options.
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Affiliation(s)
- Gregory W Randolph
- Department of Otology and Laryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Van Slycke S, Caiazzo R, Pigny P, Cardot-Bauters C, Arnalsteen L, D'Herbomez M, Leteurtre E, Rouaix-Emery N, Ernst O, Huglo D, Vantyghem MC, Wemeau JL, Carnaille B, Pattou F. Local-regional recurrence of sporadic or syndromic abdominal extra-adrenal paraganglioma: incidence, characteristics, and outcome. Surgery 2009; 146:986-92. [PMID: 19958924 DOI: 10.1016/j.surg.2009.10.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 03/17/2009] [Accepted: 10/19/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Operative excision of abdominal extra-adrenal paragangliomas (EAPs) does not preclude the late development of local-regional recurrence. We describe the incidence, characteristics, and outcome of this rarely reported feature. METHODS Retrospective analysis of local-regional recurrence that occurred during follow-up of 51 consecutive patients operated for a sporadic (n = 26) or hereditary (n = 25) EAP. RESULTS Seven patients with a sporadic or syndromic EAP (n = 4: von Hippel-Lindau syndrome and SDHB, SDHC, and SDHD gene mutations) underwent reoperation for a local-regional recurrence after a median time of 46 months (interquartile range [IQR], 16-100). The Kaplan-Meier estimated incidence of local-regional recurrence (+/- standard error of the mean) reached 15% +/- 7% at 5 years and 23% +/- 9% after 10 years. Recurrent EAPs were all secreting and 38% provoked clinical symptoms. New lesions were smaller than the primary EAP (P = .01) and more often associated with lymph node metastases (43% vs 4%, P = .01). Operative excision seemed complete in 5 patients. Clinical remission was maintained in 4 patients after a median follow-up of 57 months (IQR, 22-102). CONCLUSION Local-regional recurrence of sporadic and syndromic EAPs is frequent and may be delayed beyond 10 years, requiring lifelong follow-up after the initial operation. When technically feasible, operative excision can lead to prolonged remission.
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Casselman FP, Van Slycke S, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H. Mitral valve surgery can now routinely be performed endoscopically. Circulation 2003; 108 Suppl 1:II48-54. [PMID: 12970208 DOI: 10.1161/01.cir.0000087391.49121.ce] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an increasing interest in minimally invasive cardiac surgery. METHODS AND RESULTS Since February 1, 1997 till April 1, 2002, 306 patients underwent endoscopic mitral valve surgery (226 repair, MVP; 80 replacement, MVR). Predominant valve pathology was degenerative in MVP (83.6%) and rheumatic in MVR (65%). Mean age was 61.5+/-12.9 years. Median preoperative functional class (MVP+MVR) and mitral regurgitation (MVP) were II and 4+. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19.6+/-17.3 months and complete. The procedure was successfully performed in all but 6 patients. Hospital mortality included 3 patients (1%) and was technology related in one. Postoperative morbidity included aggressive re-exploration (8.5%), new onset atrial fibrillation (17.0%), and pacemaker implantation (2.3%). There were 1 early and 10 late reoperations, 5 of which were because of endocarditis. Freedom from mitral valve reoperation at 4 years was 91+/-3.5%. No risk factors for reoperation could be detected. Echocardiographic follow-up showed a median degree of mitral regurgitation (MVP) of 0 and a small paravalvular leak in four patients (MVR). Ninety-four percent of the patients reported no or mild postoperative pain and 99.3% felt they had an esthetically pleasing scar. Ninety-three percent would choose the same procedure again and 46.1% were back at work within 4 weeks. CONCLUSIONS Endoscopic mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed. It is now our exclusive approach for isolated atrioventricular valve disease.
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Affiliation(s)
- Filip P Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium.
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Abstract
OBJECTIVE We sought to document the feasibility, safety, and effectiveness of performing mitral valve repair using a totally endoscopic approach. METHODS Between February 1997 and October 1, 2001, 187 patients underwent totally endoscopic mitral valve repair at our institution. The mean age was 60.7 +/- 13.1 years, and 62% were male. Median preoperative functional class and degree of mitral regurgitation were II and 4, respectively. Data collection included an institutional protocol assessing procedure-related pain, cosmesis, and functional recovery. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19 +/- 15.2 months and was 100% complete. RESULTS Associated atrial procedures were performed in 9.1% (n = 17) of the patients. Two patients required intraoperative conversion to sternotomy. Thoracoscopic re-evaluation for suspected bleeding (n = 19) was part of our aggressive postoperative management. One patient required sternotomy for control of bleeding. Hospital mortality included 1 (0.5%) patient and was not technology related. There were 1 early and 6 late reoperations, 4 of which were due to endocarditis. No risk factors for repair failure could be detected. Freedom from mitral valve reoperation at 4 years was 93.3% +/- 2.6%. The median degree of mitral regurgitation at follow-up was 0. Ninety-three percent of the patients were highly satisfied with either no or mild postoperative pain, and 98.4% believed they had an aesthetically pleasing scar. CONCLUSIONS Totally endoscopic mitral valve repair can be done safely with excellent results and a high degree of patient satisfaction. It is now our exclusive approach for isolated atrioventricular valve disease.
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Affiliation(s)
- Filip P Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
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Casselman FP, Van Slycke S, Wellens F, De Geest R, Degrieck I, Vermeulen Y, Van Praet F, Vanermen H. From classical sternotomy to truly endoscopic mitral valve surgery: A step by step procedure. Heart Lung Circ 2003; 12:172-7. [PMID: 16352128 DOI: 10.1046/j.1444-2892.2003.00209.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is an increasing tendency towards minimally invasive valve surgery and various surgical techniques have been proposed to realise this goal. The aim of the present study was to describe our current surgical technique and clinical experience with respect to an endoscopic technique that allows the surgeon to perform an operation through a series of small intercostal ports. METHODS After a learning experience with thoracoscopic left internal mammary to left anterior descending coronary artery bypass surgery, we adopted the endocardiopulmonary bypass technique to perform mitral valve surgery. The technique requires exclusive use of video-assisted surgery and control by transoesophageal echocardiography (TEE). Surgery requires long instruments and extra-corporeal knot tying. Between February 1997 and November 2001, 259 patients were operated on. Mitral valve repair was performed in 190 of them. One patient had a redo procedure using this approach to correct a paravalvular leak, but all other procedures were primary interventions. RESULTS In all patients, surgery was performed using a 2 inch working port and two additional half-inch trocar-ports. Five patients required a conversion to median sternotomy: three because of inadequate size of the femoral vessels and two because of intraoperative aortic dissection. Hospital mortality included two patients, and seven patients required late reoperation (four of these were as a result of endocarditis). CONCLUSIONS Endoscopic mitral valve surgery is demanding, but feasible. Once the appropriate skills are acquired, both patient and surgeon can enjoy the benefits of this exciting new technique.
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