Background: Active surveillance for low-risk papillary microcarcinoma (PMC) of the thyroid is an accepted and safe management strategy. However, some patients undergo conversion surgery after the initiation of active surveillance for various reasons. We investigated the reasons for conversion surgery and whether and how they changed over time. Methods: We enrolled 2288 patients with PMC who underwent active surveillance. Of these, 162 (7.1%) underwent conversion surgery >12 months after initiating active surveillance due to disease progression (57 patients), patient preference (43 patients), physician preference (31 patients), other associated thyroid or parathyroid diseases (24 patients), and other reasons (7 patients). We analyzed cumulative conversion rates not only in the whole cohort but also in the first three major subsets based on the reasons for surgery. We also divided our whole cohort into two groups based on the period of active surveillance commencement: the first-half group (February 2005-November 2011; 561 patients) and the second-half group (December 2011-June 2017; 1727 patients). Results: The criteria for PMC progression did not differ between the first-and second-half groups. The proportion of female patients in the physician preference group was significantly higher than that in the disease progression and the patient preference groups. Tumor size at surgery was larger, and tumor volume-doubling rate was higher in the disease progression group than in the other two groups. Patients in the second-half group were significantly less likely to undergo conversion surgery than those in the first-half group. Furthermore, conversion surgery rates in the second-half group were significantly lower than those in the first-half group in the patient preference, physician preference, and disease progression groups. Conclusions: Patients with PMC in the second-half group were significantly less likely to undergo conversion surgery than those in the first-half group regardless of the reason. This is probably because data accumulation of favorable outcomes with active surveillance significantly contributed to physicians' confidence and patients' trust and understanding of this disease.

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Zushi ENT clinic Osaka prefectureThis study was aimed at evaluating the results of collaborative endoscopic endonasal transsphenoidal surgery EETS performed by a multidisciplinary team comprising otolaryngologists and neurosurgeons for pituitary adenomas PAs , and at evaluating the safety of this procedure.We performed a retrospective review of the medical records of 123 consecutive operations of 102 patients who underwent EETS for PAs between July 2003 and May 2016 in Osaka City General Hospital.The incidence of the postoperative complication of rhinosinusitis was assessed retrospectively. Sphenopalatine artery bleeding was recorded in 2 patients 1.6 , acute sphenoiditis occurred in 1 patient 0.8 , and CSF leak was recorded in 3 patients 2.4 , of which 1 0.8 developed bacterial meningitis. The clinical course of the olfactory symptoms could be clearly delineated in 36 patients, of which none had anosmia. Postoperatively, none of the cases that developed permanent nasal obstruction, deterioration of salivary function, lacrimal gland dysfunction or palatal sensitivity decrease.In conclusion, EETS is a reasonably safe surgical modality for PAs. With recent advances in endoscopic technologies, the scope of transnasal surgery, especially for skull base surgery, including for PAs, has expanded remarkably. Our results indicate that a collaborative approach involving a multidisciplinary team comprising otolaryngologists and neurosurgeons can contribute to effective management of postoperative complications, including rhinosinusitis.

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