Surgery For Thyroid Cancer Research Articles

Critical Analysis of the Frequency and Factors Leading to Hypocalcemia after Total/ Near Total Thyroidectomy

Objective: To critically analyze the frequency and factors leading to hypocalcemia in Total/ Near Total thyroidectomy Methods: This descriptive case series study was conducted over period of one year by taking sample of 138 patients of simple multinodular goiter or carcinoma of thyroid who underwent total/near total thyroidectomy and patients who had serum calcium <8mg/dl postoperatively. Recurrent thyroid surgery or patients undergoing lobectomy were excluded from the study. SPSS version 21 was used for data analysis. Mean ± SD represent the continuous variables & frequencies/ percentages represent the quantitiave results. Chi-square test was applied to analyze effect modification. P value <0.05 was taken as significant. Study was approved by the ethical review committee of the SMBBMU - Larkana. Results: The mean ± SD age of patients was 39.86 ± 11.5 years with a range from 22 to 60 years. The mean ± SD serum Pre-operative calcium was 9.64 ± 0.44 mg/dL. Post thyroidectomy) values of serum calcium were noted as mean ± SD 7.68 ± 2.11 mg/dL. Sixty five percent (n =90) of all patients were females. NTT- were 67.4% (n = 93) while TT- 32.6% (n = 45). Frequency of hypocalcemia was 28.3% (n = 39). More patients after TT developed hypocalcemia (44.4%) than NTT (20.4%) P value = 0.004). Old age, female gender, surgery for thyroid cancer and patient with lower preoperative serum calcium had a higher frequency of hypocalcemia after thyroidectomy. Practical implication Conclusion:The frequency of post thyroidectomy hypocalcemia in this study is 28.3%. Post thyroidectomy hypocalcemia is associated with both NTT and TT, however the frequency is more common (more than twice) after TT. Factors like old age, female gender, patients having thyroid cancer and having lower serum calcium preoperatively are strong effect-modifiers. Keywords: Total thyroidectomy. Near total thyroidectomy,Calcium, Hypocalcemia, .Parathyroid hormone.

Successful localization of abnormal parathyroid tissue with ultrasound-guided methylene blue dye injection before surgery for metastatic or recurrent thyroid cancers and parathyroid adenomas

ObjectivesA surgery to be performed on a previously operated neck includes difficulties such as increased risk of complications and prolonged operation time. The aim of the present study is to analyze the benefit of pre-anesthetic ultrasound-guided injection of methylene blue into parathyroid adenomas and abnormal lymph nodes to simplify their safe and satisfactory extraction. MethodsWe analyzed the case series records of 14 patients who were operated for reoperative neck surgery due to recurrent thyroid cancer (8 patients) and parathyroid adenoma (6 patients) and in the technique; 0.2 ml of a 1:5 dilution of 1 % methylene blue solution was injected directly onto the target during real-time ultrasound guidance before the operating room. ResultsIn adenomas, ultrasound-guided methylene blue injection was successfully applied in all cases, an average of 33.1 min before entering the operating room (range = 28–38 min). There were no complications related to dye injection. For patients with recurrent thyroid tumors, preoperative ultrasound-guided methylene blue injection was successfully applied in all patients, on average 27.5 min before entering the operating room (range = 20–35 min). No complications occurred due to dye injection. The blue stained lesion was easily identified during surgery. ConclusionsWe analyzed the feasibility of the injection process, the certainty of defining pathological lymph nodes, and the complications of the procedure. Preoperative administration of methylene blue preserved its intraoperative efficacy and maintained the easy the detection of reoperative or primary pathologies. The present study suggest that methylene blue dye injection is a safe, sufficient, and quietly effective method for identifying recurrent tumors and parathyroid adenomas in scarred reoperative neck surgeries. Our cases had comparatively short operative times and lower complication rates.

Intraoperative Nerve Monitoring Is Associated with Less Postoperative Vocal Cord Dysfunction and Hypoparathyroidism in Patients Undergoing Thyroidectomy for Thyroid Cancer

INTRODUCTION: Intraoperative nerve monitoring (IONM) during thyroid operation for benign disease is associated with a lower risk of recurrent laryngeal nerve injury. This study aimed to investigate factors associated with short- and long-term vocal cord (VC) dysfunction in patients undergoing operation for thyroid cancer. METHODS: Patients ≥18 years of age undergoing thyroid operation for malignant disease from January 2014 to April 2021 in the Collaborative Endocrine Surgery Quality Improvement Program database were included. Multivariable logistic regression analyses investigated variables associated with short-term (≤30 days postoperative) and long-term (31 to 180 days) VC dysfunction and characteristics associated with IONM use. RESULTS: Among 5,446 patients, 76.7% were women, and the mean age was 49 years. Papillary thyroid cancer (PTC) was the most common type (84.6%). Few patients had nodal metastases or extrathyroidal extension (27.3% and 3.9%, respectively). Postoperative VC dysfunction was diagnosed by laryngoscopy in 3.0% of patients in the short term and in 2.7% in the long term. Patients with tumors who had extrathyroidal extension or nodal metastases were at higher risk for short-term (odds ratio [OR] 3.17, p < 0.001; OR 1.91, p = 0.005, respectively) and long-term (OR 3.1, p < 0.001; OR 2.34, p < 0,001, respectively) VC dysfunction. IONM was independently associated with a reduced risk of short-term (OR 0.61, p = 0.006) and long-term (OR 0.48, p < 0.001) VC dysfunction. IONM use was associated with outpatient surgery (OR 1.61, p < 0.001) and fewer postoperative hypoparathyroidism events in the short (OR 0.7, p < 0.001) and long term (OR 0.64, p = 0.002). CONCLUSION: IONM is independently associated with a lower rate of endocrine-specific complication and more outpatient surgery. Future studies are needed to identify barriers to broader IONM use.

Racial Disparity in Thyroid Cancer Surgery Outcomes

Racial Disparity in Thyroid Cancer Surgery Outcomes

Predictors of impaired effectiveness of carbon nanoparticle-based central lymph node tracing in patients who underwent surgery for papillary thyroid cancer: A retrospective cohort study.

Carbon nanoparticles (CNs) are used in papillary thyroid cancer (PTC) surgery to facilitate central lymph node dissection (CLND) and protect the parathyroid glands (PGs). However, some cases develop hypoparathyroidism after using CNs. This cohort study was undertaken to explore the predictors of the reduced effectiveness of CNs. Data on patients with PTC who underwent surgery wherein CNs were used during CLND were reviewed retrospectively. Patients who did not develop hypoparathyroidism and developed hypoparathyroidism were classified into Group A and B, respectively. Demographic and clinical characteristics were compared between the 2 groups. Univariate and multivariate logistic regression analysis were performed on related variables. The receiver operating characteristic curve was used to evaluate the predictors of the binary logistic model and the cutoff value of each predictor was obtained. A total of 265 patients were included. Compared with Group A, the patients in Group B had a higher body mass index (BMI) (P = .003), were more frequently associated with Hashimoto thyroiditis (HT) (P = .001), and tumors were larger in size (P = .026). Multivariate logistic regression analyses were performed on these variables and showed that HT (P = .001) and tumor size (P = .001) predicted the impaired role of CNs. CNs are not always useful in protecting PG function in patients who undergo CLND for PTC. In patients with coexisting HT (blood thyroid peroxidase antibody [TPOAb] level higher than 44.0 IU/mL or blood anti-thyroglobulin antibody [ATG] level higher than 125.0 IU/mL) or a tumor size exceeding 1.1 cm in diameter, the protective role of CNs may be impaired.

Effects of Systemic Lidocaine Versus Dexmedetomidine on the Recovery Quality and Analgesia After Thyroid Cancer Surgery: A Randomized Controlled Trial.

Surgical management is commonly used for thyroid cancer. We evaluated the effects of systemic lidocaine versus dexmedetomidine on the recovery quality and analgesia after thyroid cancer surgery. A total of 120 patients with thyroid cancer were randomly allocated to groupL (received lidocaine 1.5mg/kg loading, continuously infused 1.5mg/kg per hour), groupD (received dexmedetomidine 0.5µg/kg loading, continuously infused 0.5µg/kg per hour) and groupC (received normal saline), with 40 cases in each group. Anaesthesia induction and maintenance were performed using target-controlled infusions (TCIs) of propofol and remifentanil. The primary outcome of the quality of recovery-15 (QoR-15) score was recorded on the day before surgery and postoperative day1 (POD1). Secondary outcomes included the consumption of remifentanil during surgery, time to first required rescue analgesia, number of patients requiring rescue analgesia, postoperative cumulative consumption of tramadol, visual analogue scale (VAS) pain score, incidence of postoperative nausea or vomiting (PONV) and side effects. The total score of the QoR-15 at POD1 (median, IQR) was higher in groupL (128.0, 122.0-132.8) and groupD (127.5, 122.5-132.5) compared to groupC (118.5, 113.0-123.5) (P = 0.000). Compared to groupC, systemic lidocaine and dexmedetomidine reduced cumulative consumption of remifentanil and VAS pain score (P = 0.000). The time to first required rescue analgesia (mean, SD) was longer in groupL (8.1h, 1.2h) and groupD (8.5h, 1.9h) than groupC (5.9h, 0.9h) (P = 0.000). The number of patients requiring rescue analgesia was lower in groupL (8/40, 20%) and groupD (6/40, 15%) than groupC (16/40, 40%) (P = 0.029), and cumulative consumption of tramadol (mean, SD) was lower in groupL (44.0mg, 17.1mg) and groupD (51.7mg, 14.1mg) than groupC (73.9mg, 18.4mg) (P = 0.000). The incidence of PONV in groupL (7/40, 17.5%) and groupD (9/40, 22.5%) was lower than groupC (18/40, 45.0%) (P = 0.016). Bradycardia (heart rate less than 50beats/min or lower) was noted in 25 patients (25/40, 62.5%), which was reversed by intravenous administration of atropine 0.5mg. Systemic lidocaine and dexmedetomidine had similar effects on enhancing the quality of recovery, alleviating the intensity of pain and reducing the incidence of PONV after thyroid cancer surgery. However, dexmedetomidine may result in bradycardia. Therefore, lidocaine was superior to dexmedetomidine. ChiCTR.org.cn (ChiCTR2000038442). Registered on September 22, 2020.

Factors Associated With Injury to Recurrent Laryngeal Nerve in Patients Undergoing Surgery for Thyroid Cancer: A Single-centre Study Using Translaryngeal Ultrasound

Intraoperative injury to the recurrent laryngeal nerve (RLN) is a serious complication occurring more frequently in patients with thyroid cancer than in those with benign thyroid diseases. However, data on the risk factors for RLN injury among patients with thyroid cancer are scarce. Currently, RLN injury is diagnosed by laryngoscopy, but translaryngealultrasonography (TLUS), which is less invasive, appears to have a similar accuracy. Herein, we analysed risk factors ofintraoperative RLN injury in patients with thyroid cancer and assessed the diagnostic performance of TLUS. In this prospective study, we enrolled patients undergoing surgery for thyroid cancer from October 2020 to October 2021. Medical and surgical variables were analysed as risk factors of RLN injury. TLUS was compared with laryngoscopy in diagnosing RLN injury. There were 185 patients who underwent 196 surgeries. Of all surgeries, 23 (11.7%) caused RLN injury ascertained on laryngoscopy. Compared with laryngoscopy, TLUS displayed high sensitivity (97.7%; 95%CI: 94.3%-99.4%) and specificity (100%; 95% CI: 82.4%-100%). Before surgery, medical and surgical characteristics did not differ significantly between patients with or without RLN injury, but RLN entrapment by tumour was more frequent in those with the injury (P < 0.001). The risk of RLN injury was increased in patients undergoing thyroidectomy with lateral neck dissection (OR=4.53; 95% CI: 1.29-14.32) and in those with lymph node metastases (OR=2.76; 95% CI: 1.03-7.01). Intraoperative RLN injury in patients with thyroid cancer is more common after operations requiringgreater resections and with lymph node involvement. TLUS could be used to diagnose RLN injury.

Care Fragmentation in Patients with Differentiated Thyroid Cancer.

Among surgical patients, care fragmentation (CF) is associated with worse outcomes. However, oncologic literature documents an association between high surgical volume and improved outcomes, favoring centralized cancer-surgery centers and thus predisposing to CF in patients with surgically treated tumors. We aimed to identify features associated with CF and ascertain differences in overall survival (OS) among patients with differentiated thyroid cancer (DTC). The National Cancer Database was queried for DTC patients diagnosed from 2009 to 2017. Patients experienced CF if part of their treatment was performed outside of the reporting facility or an associated office. A multivariable logistic regression analysis identified independent features associated with CF. A Cox multivariable regression analysis assessed the impact of CF on OS. A Kaplan-Meier analysis compared survival differences between patients experiencing CF or unified care (UC). A total of 131,620 patients were included. Among them, 70,204 (53.3%) experienced CF and 61,416 (46.7%) experienced UC. Age < 55, residing in high-income areas, and stage 3 and 4 tumors were features independently associated with CF, whereas uninsured patients were less likely to experience CF than the privately insured. The features most strongly associated with CF were treatment at highest thyroid cancer-surgery volume institutions and traveling in the top distance quartile. While patients with CF experienced minor delays in time from diagnosis to surgery, 5-year OS was improved among patients with CF compared to UC for those with Stage 1-3 disease. Among patients with DTC, CF is associated with treatment at a highest thyroid cancer surgery volume facility and improved OS in a setting of minor treatment delays.

The Role of Carbon Nanoparticles in Lymph Node Dissection and Parathyroid Gland Preservation during Surgery for Thyroid Cancer: A Systematic Review and Meta-Analysis.

Simple SummaryThe incidence of thyroid cancer has been increasing over the past few years. Surgery remains still the primary therapeutic option and lymph node dissection is often required. The aim of this study was to perform a meta-analysis of the available data on carbon nanoparticles, a novel agent that can be used to identify lymph nodes intraoperatively more efficiently, while also promoting the protection of the parathyroid glands by reducing the rate of accidental removal. Based on our study, carbon nanoparticles significantly increase the number of lymph nodes harvested during thyroid surgery, while they decrease the accidental removal of parathyroid glands removal rate by 34%. Thus, we suggest their use on a wider basis so that more data can be available for future research on the subject.Thyroid cancer is the most common endocrine malignancy with an increasing incidence over the past few years. Surgery is considered the primary therapeutic option, which often involves lymph node dissection. The aim of this study was to assess the role of carbon nanoparticles, a novel agent, in thyroid cancer surgery. For that purpose, we conducted a systematic review of the literature on MEDLINE, EMBASE, Scopus, Cochrane and Google Scholar databases from 1 January 2002 to 31 January 2022. Ultimately, 20 articles with a total number of 2920 patients were included in the analysis. The outcome of the analysis showed that the use of carbon nanoparticles is associated with a higher number of harvested lymph nodes (WMD, 1.47, 95% CI, 1.13 to 1.82, p < 0.001) and a lower rate of accidental parathyroid gland removal (OR 0.34, CI 95% 0.24 to 0.50, p < 0.001). Based on these results, we suggest that carbon nanoparticles are applied in thyroid cancer surgery on a wider scale, so that these findings can be confirmed by future research on the subject.

Effect of a Polyglycolic Acid Mesh Sheet (Neoveil™) in Thyroid Cancer Surgery: A Prospective Randomized Controlled Trial.

Simple SummaryPapillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and lymph node dissection around thyroid. Lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. A polyglycolic acid mesh sheet (Neoveil™) has been proven to prevent postoperative fluid leakage in other surgeries. So, we aim to evaluate whether Neoveil™ can reduce postoperative drainage and chyle leakage in surgery for PTC. With the use of Neoveil™, the amount of drainage significantly decreased on the postoperative 2nd day and postoperative total drainage amount was lower. Triglyceride level was lower in the Neoveil™ group but was not statistically significant. No adverse effect from the Neoveil™ was observed during 9 months follow up. Our study suggests that Neoveil™ can be applied to reduce postoperative drainage in thyroid surgery for PTC.Papillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and central lymph node dissection. Central lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. There are few studies that deal with reducing fluid drainage and preventing chyle leakage after thyroid surgery with central lymph node dissection. A polyglycolic acid mesh sheet (Neoveil™) has been demonstrated to prevent postoperative fluid leakage in other surgeries. This study aims to evaluate whether a polyglycolic acid mesh sheet can reduce postoperative drainage and chyle leakage in papillary thyroid cancer surgery, and this study was designed as a prospective, open-label, randomized controlled trial in a single university hospital. The patients were randomly assigned to having only fibrin glue used in the central node dissection area (control group) or to having a polyglycolic acid mesh sheet applied after fibrin glue (treatment group). A total of 330 patients were enrolled, of which 5 patients were excluded. A total of 161 patients were included in the treatment group, and 164 patients were included in the control group. The primary outcome was the drainage amount from the Jackson-Pratt drain, and the secondary outcome was the triglyceride level in the drained fluid on the 1st and 2nd postoperative days. The drainage amount was significantly lower in the treatment group on the 2nd postoperative day (60.9 ± 34.9 mL vs. 72.3 ± 38.0 mL, p = 0.005). The sum of drainage amount during the whole postoperative days (1st and 2nd days) was also significantly lower in the treatment group (142.7 ± 71.0 mL vs. 162.5 ± 71.5 mL, p = 0.013). The postoperative triglyceride levels were lower in the treatment group but were not statistically significant (92.1 ± 60.1 mg/dL vs. 81.3 ± 58.7 mg/dL on postoperative day 1, p = 0.104 and 67.6 ± 99.2 mg/dL vs. 53.6 ± 80.4 mg/dL on postoperative day 2, p = 0.162). No adverse effects were observed in the treatment groups during the postoperative 9-month follow-up. Our study suggests that polyglycolic acid mesh sheets can be safely applied to reduce postoperative drainage amount in thyroidectomy patients who need lymph node dissection.

Prophylactic antibiotics may not be necessary for transoral endoscopic thyroidectomy.

BackgroundWith the recent advances in thyroid cancer surgery techniques and the increasing number of patients concerned about cosmetics, the use of transoral endoscopic thyroidectomy is increasing globally. The aim of this study was to determine whether transoral endoscopic thyroidectomy is truly a clean-contaminated surgery.MethodsFrom September 2016 to April 2018, 20 patients with thyroid cancer underwent transoral endoscopic thyroidectomy performed by a single surgeon at Gangnam Severance Hospital. Before and after surgery, the oral cavity was swabbed to obtain culture samples, and antibiotics were administered before and after surgery each once.ResultsOf the total 20 patients, no bacteria were identified before or after surgery in eight (40%) patients. Bacteria were identified both before and after surgery in seven patients (35%). In four patients (20%), bacteria were not identified before surgery, but bacteria were identified after surgery. Bacteria were identified before surgery but not after surgery in one patient (5%). No surgical site infection was observed. All the bacteria identified were normal flora of the oral cavity and skin.ConclusionsThere was no difference between the preoperative culture and postoperative culture of the oral cavity in patients undergoing TOET, and there were no postoperative surgical site infection with prophylactic pre & post-operative antibiotics use. Considering the patient's position and surgical extent in TOET, it appears to be difficult for non-indigenous bacteria to invade the surgical site in oral cavity.

O049 FRAX score assessment of long term follow up thyroid cancer patients

Abstract Introduction Thyroid stimulating hormone (TSH) suppression with Levothyroxine (LT4) following thyroid cancer surgery is recommended in some patients under long term follow up. However, LT4 may cause reduced bone mineral density. We aimed to assess patients in our long-term thyroid cancer follow up clinic for risk to bone health. Methods We conducted a review of all patients in the thyroid cancer follow-up clinic and calculation of FRAX score for those that are &amp;gt;40 years old who are followed up in the Endocrine Surgical Service of NUH. Subsequently patients were categorised into risk groups according to the Osteoporosis Group Guideline (2017) and managed accordingly. Results 78 patients were identified and had ongoing follow up. 23 patients were excluded as they were &amp;lt;40 years old. 10 patients did not want to participate in the study. 45 patients were assessed with the FRAX score. There were 31 female and 14 male patients, mean age 60.8 (±12.3) years. The mean follow up was 75.0 (±78.9) months. 11% (five patients) were found to require treatment for Osteoporosis without a bone mineral density (BMD) scan, 38% (17 patients) were recommended to assess their BMD, 4% had borderline risk to measure BMD, and 47% required lifestyle and dietary modification. Conclusion Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score. Take-home message Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.

Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines

Optimized preoperative diagnostic tools with calcitonin tests, ultrasound features, functional imaging modalities, and genetic testing to detect hereditary forms have led to an increased rate of earlier diagnosis and surgery for medullary thyroid cancer (MTC). This helps to adapt the primary surgery to the tumor stage and avoid surgical overtreatment for localized tumor growth, i.e., deviating from the regularly recommended thyroidectomy with bilateral central lymph node dissection in favor of a limited unilateral approach. To limit primary surgical therapy, it is crucial that the MTC is clinically unifocal, sporadic, and confined to the thyroid, and that calcitonin levels indicate biochemical recovery after surgery. The main requirement for such a limited approach is the availability of frozen section studies that reliably indicate (i) R0 resection of the MTC, (ii) absence of infiltration of the organ capsule, (iii) lack of desmoplasia (i.e., evidence of the metastatic potential of the MTC), (iiii) absence of contralateral disease or precancerous lesions. Informed consent is mandatory from the patient, who has been fully informed of the advantages, disadvantages, and potential risks of not undergoing the “classic” surgical procedure. The aim of this article is to review the guidelines for the management of early-stage MTC.

Value of dissection of lymph nodes posterior to the right recurrent laryngeal nerve in patients with cN0 papillary thyroid carcinoma.

BackgroundTumor metastasis to lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) is a main cause of disease recurrence in patients with papillary thyroid carcinoma (PTC), which may increase the risk of recurrence and secondary surgery, and the disruption of normal anatomical relationships during secondary surgery increases the risk of laryngeal nerve injury and hypoparathyroidism. However, controversy remains as to whether the dissection of LN-prRLN is required in cN0 PTC patients. The purpose of this study is to explore the factors associated with LN-prRLN metastasis in patients with cN0 PTC and the need for LN-prRLN node dissection in patients with cN0 PTC who undergo right central compartment dissection.MethodsThe clinical data of 290 patients with cN0 PTC who received radical thyroid cancer surgery from December 2019 to March 2022 at our center were retrospectively analyzed. All the patients underwent thyroid lobectomy and right central lymph node dissection (CLND), along with other treatments. SPSS 26.0 statistical software was used for the analysis. The measurement data were compared using the rank-sum test, and the count data were compared using the chi-square test.ResultsLN-prRLN metastasis was detected in 65 (22.4%) of the 290 cN0 PTC patients. The metastasis sites included level VIa (51.72%), the left central compartment (22.76%), and the prelaryngeal compartment (8.97%). The univariate analysis revealed that tumor multifocality, a tumor diameter >1 cm, capsular invasion, LN metastasis in the left central compartment, and level VIa positivity were influencing factors of LN-prRLN metastasis in PTC patients. The logistic regression analysis showed that a tumor diameter >1 cm (OR =2.897, 95% CI: 1.630–5.147, P<0.001), LN metastasis in the left central compartment (OR =3.724, 95% CI: 2.039–6.801, P<0.001), and level VIa (OR =3.405, 95% CI: 1.846–6.281, P<0.001) positivity were independent risk factors of LN-prRLN metastasis in PTC patients.ConclusionsThe high-risk factors of LN-prRLN metastasis in cN0 PTC patients include a large tumor (a diameter >1 cm), lymph node metastasis in the left central compartment, and lymph node metastasis in level VIa. For patients with cN0 PTC undergoing right CLND, with high-risk factors of LN-prRLN metastasis, LN-prRLN dissection is recommended.KeywordsPapillary thyroid carcinoma (PTC); lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN); central compartment lymph node dissection; risk factor

Clinical Predictors of Minimal Extrathyroid Invasion of Papillary Thyroid Cancer

extrathyroidal invasion (ETI) of papillary thyroid cancer (PTC) is a risk factor for lo-coregional metastasis. The clinical significance of minimal ETI depending on the primary tumor size&#x0D; has not been studied thoroughly. The combination of tumor diameter and minimal ETI can be used asa reliable prognostic factor for persistence of the disease. Given that the identification of the minimal&#x0D; ETI is possible only during the final histopathological study, there is a need to assess the existing pre-operative clinical predictors that increase the probability of minimal ETI of PTC. The aim of the study&#x0D; is to assess preoperative clinical predictors that increase the probability of minimal extrathyroidalinvasion of papillary thyroid cancer. A retro-prospective single-center study of preoperative clinicalpredictors that increase the probability of extrathyroidal invasion of thyroid cancer was conducted.Data from 514 patients aged 5 to 81 years were processed. Patients underwent surgery for papillarythyroid cancer for the first time. Scope of the operation: extrafascial thyroidectomy. Central neckdissection. Lymphadenectomy. All patients had clinical signs of low risk of recurrence. The meanage of patients was 44.4 ± 14.5 years. There were 91 men (17.7%) and 423 women (82.3%). Patientswere divided into two groups: group 1 with 169 patients with minimal extraorganic invasion aged 5to 71 years, group 2 with 345 patients without invasion aged 10 to 81 years. The following featureswere taken into account for the analysis: 1) age of patients; 2) their sex; 3) the size of the dominanttumor. The results were statistically processed using a specialized statistical program StatPlus Prov.7 (AnalystSoft Inc.) and Epitools statistical calculators (Ausvet, https://epitools.ausvet.com.au/).According to the results, both by age (mean age of patients in group 1 - 44.7 ± 14.4 years; meanage of patients in group 2 - 44.3 ± 14.6 years) and by sex (in group 1 – 30 men (17.8%), 139 women&#x0D; (82.2%), in group 2 – 61 men (17.7%), 284 women (82.3%), the groups were almost identical, bothgroups were significantly (p &lt;0.01) dominated by women. The size of the primary tumor in group1 - 15.0 (10.0; 20.0) mm - was statistically significantly higher (p &lt;0.001) than in the second - 10.0(7.0; 15.0) mm. Most of patients (71.0%) with invasion had a primary tumor size &gt; 10 mm, while ingroup 2 there were only 42.6% of such patients. Within the size ranges up to 10 mm, the probabilityof detection of invasion is 14.0% - 21.6%, while within the size ranges over 10 mm, it may be 41.9% -50.0%. A tumor size of PTC over 10 mm, with a diagnostic strength of 61.9%, increases the risk ofminimal extrathyroidal invasion. The average size of the primary tumor in the group of patients withminimal ETI is 15.0 (10.0; 20.0) mm, which is statistically significantly higher (p &lt;0.001) than thesame value in the group of patients without EIT - 10.0 (7.0; 15.0) mm. In patients with a PTC tumor&#x0D; size of less than 10 mm, the probability of minimal ETI ranges from 14.0% to 21.6%, while the prob-ability of minimal ETI in patients with a tumor size over 10 mm ranges from 41.9% to 50.0%. Given&#x0D; that minimal ETI may be one of the factors of increased risk of PTC locoregional metastasis, surgeryfor PTC patients with a tumor size over 10 mm should be supplemented with central neck dissection,lymphadenectomy. A tumor size of PTC over 10 mm, with a diagnostic strength of 61.9%, increases the risk of minimal extrathyroidal invasion, which is also an argument in favor of central neck dis-section, lymphadenectomy during surgery for patients with tumor size over 10 mm. The patients’ age and sex cannot be the factors that increase the risk of minimal extrathyroidal invasion of papillarythyroid cancer.

Application of Indocyanine Green Angiography in Bilateral Axillo-Breast Approach Robotic Thyroidectomy for Papillary Thyroid Cancer.

BackgroundIndocyanine green angiography (ICGA) has been used to identify and preserve the parathyroid glands (PGs), and to evaluate PGs viability and function during thyroid surgery. However, evidence on the utilization of IGCA in thyroid cancer and robotic surgery is lacking. The efficacy of IGCA remains to be evaluated in PTC patients undergoing bilateral axillo-breast approach robotic thyroidectomy (BABA RT) and central neck dissection (CND).MethodsFrom March 2020 to August 2021, 81 papillary thyroid cancer (PTC) patients receiving total thyroidectomy and CND were enrolled in this retrospective analysis. An intravenous bolus of 7.5 mg ICG was administrated three times in the ICGA group (n=34). Medical records were reviewed and analyzed, including the baseline characteristics, surgical parameters, PGs-related parameters, and perioperative PTH and calcium levels.ResultsThe mean number of total identified PGs and preserved PGs were significantly more in the ICG group than in the control group (3.74 ± 0.45 vs. 3.15 ± 0.55, P<0.001; 3.12 ± 0.64 vs. 2.74 ± 0.57, P=0.007, respectively), as were PTH and calcium levels on POD 1 (23.16 ± 18.32 vs. 6.06 ± 7.74, P=0.039; 2.13 ± 0.11 vs. 2.08 ± 0.08, P=0.024, respectively). While there were no differences in PTH levels on POD 30. Additionally, patients with at least one well vascularized PG had higher ioPTH 3 and PTH on POD 1, which significantly suggested the absence of postoperative hypocalcemia. Although not statistically significant, ICGA seemed superior to relative ioPTH decline and ioPTH 3 in predicting postoperative hypocalcemia.ConclusionIn PTC patients undergoing BABA RT and CND, ICGA is a simple, safe, effective, and cost-effective tool in better identification and preservation of PGs as well as evaluation of PGs viability and function, with the potential to preserve more PGs, guide more appropriate autotransplantation, and accurately predict postoperative hypocalcemia.

Clinical and prognosis value of the number of metastatic lymph nodes in patients with papillary thyroid carcinoma

ObjectiveIt has been reported that papillary thyroid carcinoma (PTC) patients with lymph node metastasis (LNM) are largely associated with adverse outcomes. The present study aimed to assess the correlation between the number of metastatic lymph nodes (NMLNs) and clinical prognosis in patients with PTC.MethodsWe retrospectively reviewed the medical records of patients with PTC who underwent initial thyroid cancer surgery in Renmin Hospital of Wuhan University between 2017 and 2019. A total of 694 patients with PTC and cervical lymph node dissection as well as a total checked number of lymph nodes ≥ 5 were involved in this study. The clinicopathological characteristics of patients were compared according to NMLNs, the number of central cervical lymph nodes (CLNs) and the number of lateral lymph nodes (LLNs).ResultsNMLNs > 5, CLNs > 5 and LLNs > 5 were 222 (32.0%), 159 (24.3%) and 70 (10.1%) seen in the analyzed samples, respectively. Young patients, patients with larger tumor diameter, bilaterality, multifocality and gross extrathyroidal extension (ETE) were more inclined to NMLNs > 5, CLNs > 5 and LLNs > 5 (P < 0.05). It was found that the recurrence-free survival among pN1 patients was significantly discrepant between different groups (NMLNs ≤ 5/5: P = 0.001; LLNs ≤ 5/5: P < 0.001). In multivariate logistic regression analysis, patients aged < 55 years (OR = 1.917), primary tumor size > 10 mm (OR = 2.131), bilaterality (OR = 1.889) and tumor gross ETE (OR = 2.759) were independent predictors for high prevalence of total NMLNs > 5 (P < 0.05). Specially, patients aged < 55 years (OR = 2.864), primary tumor size > 10 mm (OR = 2.006), and tumor gross ETE (OR = 2.520) were independent predictors for high prevalence of CLNs > 5 (P < 0.01); Bilaterality (OR = 2.119), CLNs > 5 (OR = 6.733) and tumor gross ETE (OR = 4.737) were independent predictors for high prevalence of LLNs > 5 (P < 0.05).ConclusionsIn conclusion, it is evident that NMLNs is related to the invasive clinicopathological features and adverse outcome of patients with PTC which should be correctly evaluated to provide an appropriate guidance for reasonable treatment and careful follow-up.

Changing Trends What Patients with Thyroid Cancer Surgery Are Concerned About: Comparison between 2012 and 2020

Changing Trends What Patients with Thyroid Cancer Surgery Are Concerned About: Comparison between 2012 and 2020

Validity of operative information in Japanese administrative data: a chart review-based analysis of 1221 cases at a single institution.

To evaluate the validity of operative information recorded in the Diagnosis Procedure Combination (DPC) database, a national inpatient database including administrative claims data. We reviewed the medical charts of 1221 patients who underwent one of six surgeries (breast, esophageal, gastric, thyroid cancer surgery, appendectomy, or inguinal hernia repair) at a surgery department of a university hospital from April 2016 to March 2019. We compared operative information (type, date, laterality of procedure; type of anesthesia; transfusion; and duration of anesthesia) recorded in the DPC database with the information recorded in the medical charts. The DPC data for type, date, laterality of surgery, and type of anesthesia were accurate in 99% of the reviewed patients. The sensitivity and specificity for identifying whether a patient received a transfusion procedure were 97.5% and 99.6%, respectively. Data regarding the duration of anesthesia in the DPC database were identical to those in medical chart records in 1114 of 1216 cases that received general or spinal anesthesia (91.5%). The duration of anesthesia in the DPC data was 53min longer on average than the recorded operative time in the medical charts. The DPC database had high validity for operative information.

Risk Factors Associated With Reoperative Surgery for Thyroid Malignancies: A Retrospective Cohort Study.

To examine various factors associated with an increased risk of reoperation for persistent or recurrent malignant thyroid cancers. Retrospective cohort study. Tertiary academic hospital centers. Patients undergoing surgery for thyroid cancer at 2 tertiary academic institutions from 2006 to 2020 were included. Those who underwent a reoperative procedure were compared with patients only requiring 1 procedure. The Pearson chi-square and independent t test were used to compare group data accordingly. Furthermore, a binomial logistic regression was performed, while machine learning models were used to construct a predictive algorithm. This study included 2266 patients with surgically managed thyroid malignancy, of which 54 (2.4%) necessitated reoperations. Those requiring a second surgical procedure were more likely to be male (40.7% vs 20.9%, P < .001), undergo bilateral (24.1% vs 3.3%, P < .001) and lateral (16.7% vs 1.8%, P < .001) neck dissections, and have a greater number of metastatic lymph nodes (mean, 9.1 vs 3.5; P < .001) and a larger tumor size (mean, 3.0 vs 2.0 cm; P < .001). According to the binomial logistic regression model, lateral neck dissection, greater number of metastatic lymph nodes, and larger tumor size significantly increased the odds of necessitating a second procedure by 7.8 (95% CI, 2.523-24.083), 1.1 (95% CI, 1.032-1.152), and 1.3 (95% CI, 1.064-1.559), respectively. Last, machine learning models could not significantly predict the occurrence of reoperation. This study identified patient- and cancer-related characteristics associated with an increased risk of requiring reoperation for thyroid malignancies.