ImportancePopulation-based genomic screening can facilitate early detection of medullary thyroid carcinoma (MTC) in patients with pathogenic/likely pathogenic (P/LP) RET variants.ObjectiveTo evaluate the clinical treatment and patient outcomes after identification of P/LP RET proto-oncogene variants associated with the risk of MTC via a population genomic screening program.Design, Setting, ParticipantsThis retrospective cross-sectional study was completed between June 1, 2016, and May 31, 2022, for a mean follow-up period of 22.4 months (range, 2-76 months). The study included patients who were identified as having P/LP RET variants through a population genomic screening program at a rural tertiary care center and who underwent thyroidectomy after results disclosure.Main Outcomes and MeasuresThe outcomes of interest were preoperative evaluation and treatment-related outcomes. Measures included imaging and laboratory findings, extent of surgery, pathologic diagnosis, and staging.ResultsSeventy-five patients were identified as having P/LP RET variants exclusively through genomic screening. Twenty of these patients (27%; 11 women [55%] and 9 men [45%]; median age, 48 years [range, 22-73 years]) underwent total thyroidectomy; 13 of these patients (65%) also had a central neck dissection. No patients had clinically apparent disease at the time of surgery. Pathologic findings indicated MTC for 12 patients and papillary thyroid carcinoma in 2. Of patients with MTC, 10 had stage I disease, 1 had stage II disease, 1 had stage III disease, and none had stage IV disease. Based on postoperative surveillance imaging and laboratory results, no patient had evidence of recalcitrant disease.Conclusions and RelevanceIn this cross-sectional study, all malignant neoplasms identified on surgical pathology were clinically occult, with surgical intervention based solely on the identification of the P/LP RET variant via population genomic screening. This finding suggests that genomic screening may provide opportunities for early detection and treatment of MTC, with the potential for improved patient outcomes.

Introduction: Pancreaticoduodenectomy (PD) is a challenging operation. Multiple studies have shown robotic PD (RPD) to be safe, with equivalent oncologic outcomes as compared to open PD (OPD). Our aim was to assess the translation of the safety profile of RPD and to determine the learning curve for RPD in a community setting. Methods: A retrospective review of 67 consecutive patients who underwent PD from January 2014 to February 2015 was performed. Results: Of the 67 PD, 55 (82%) underwent OPD and 12 (18%) RPD. Both groups were similar. There was a statistically significant difference in operative time (OT), OPD vs. RPD (OvR); (223 min vs. 337 min [P < 0.0001]), although the OT for RPD improved from 463 min (1st case) to 250 min in the last 3 cases. No statistical difference in blood loss (OvR; 435 mL vs. 335 mL [p > 0.67]), length of stay (OvR; 10.1 vs. 10.6 days [p > 0.61]) and R0 resection status (OvR; 36 vs 9 [p > 0.74]) was found. There was 1/55 (2%) mortality in the OPD group. Conclusion: Our data reflects the experience (>500 PD's) of a single high volume (>50 PD's a year) community hospital based surgeon. Similar safety profile and outcomes were achieved compared to large academic centers. For experienced HPB surgeons learning is faster and OT can be reduced to half within 10 RPD cases.

The COVID‐19 pandemic has illustrated that global events can have a profound impact on our health systems. While the pandemic is unprecedented, it does underscore the need to prepare for future global health concerns. Climate change is a looming threat with significant consequences for otolaryngologists and our patients. In this commentary, we discuss the need to assess our preparedness for climate change as well as the importance of reflecting on our responsibility to minimize our footprint.

Objective In this retrospective case series, we chronicle six patients presenting with acute suppurative thyroiditis (AST) with progression to thyroid abscess in a single institution. Methods Patients ranged in age from 16 to 74 years of age. The most common presenting symptoms were progressive unilateral neck pain, swelling, and odynophagia. Other symptoms included hoarseness and systemic signs of infection. Diagnosis of thyroid abscess was made with a CT scan of the neck, fine needle aspiration, and/or incision and drainage (I&D). Results Management included antibiotic therapy, I&D, and thyroidectomy. All patients were successfully treated except for one who developed mediastinitis and died. Conclusion A complete literature review was performed to determine etiologies, common findings, and management of similar cases.

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