These data suggest that cystic pancreatic neoplasms 1) occur in 0.7% of patients, 2) increase in 19% over 16 months, and 3) are likely (60%) to be malignant in patients older than 70 years. Therefore, we recommend surgical excision for pancreatic cysts that are increasing under observation, symptomatic, or detected radiologically in fit older patients.

This study assessed the impact of parathyroidectomy on the preoperative symptoms of patients with primary hyperparathyroidism (1 degrees HPT) using a surgical outcome tool designed specifically for HPT. The multicenter nature of this study allowed us to validate further this disease-specific outcome tool. 1 degrees HPT patients from Canada, the United States, and Australia filled out the questionnaire preoperatively and postoperatively on day 7 and at 3 and 12 months. The symptoms recorded by the patients were expressed as parathyroidectomy assessment of symptoms (PAS) scores: the higher the score, the more symptomatic is the patient. Quality of Life (QOL) and self-rated health uni-scales were included. Altogether, 203 patients with 1 degrees HPT were enrolled; 27 from center A, 54 from center B, and 122 from center C; 58 nontoxic thyroid patients were enrolled for comparison. The comparison group had no significant change in their PAS scores throughout the study (scores 184, 215, 156, 186). All three centers demonstrated a significant reduction in symptoms following surgery. The median preoperative PAS score from center B patients was 282. Following surgery, PAS scores decreased significantly: 136, 58, 0 (p <0.05). Center C patients had a median preoperative PAS score of 344, decreasing postoperatively to 228 (p <0.05) and continuing to decrease to 190, then 180. Center A also demonstrated a significant reduction in symptoms at 3 months, from 510 preoperatively to 209 (p <0.001). Both QOL and self-rated health improved in the HPT patients, whereas no change was found in the comparison group following surgery. PAS scores are a reliable, disease-specific measure of symptoms seen with HPT. Parathyroidectomy significantly reduces these preoperative symptoms, and this change translated into an improved health-related QOL for the patients.

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Background The optimal protocol for the detection and treatment of post-thyroidectomy hypoparathyroidism is unknown. We sought to identify and treat patients at risk for symptomatic hypocalcemia based on a single PTH obtained the morning after surgery (POD1). Methods We performed a prospective, randomized study of total thyroidectomy patients who had POD1 calcium and PTH (pg/mL) levels. Randomization was based on POD1 PTH: if ≥10, patients received no supplementation unless symptomatic; if <10, patients were randomized to calcium, calcium and calcitriol, or no supplementation. Results Of 143 patients, 112 (78%) had a POD1 PTH≥10. Hypocalcemic symptoms were transiently reported in 11 (10%) and managed with outpatient calcium. Of 31 patients with PTH<10, 15 (48%) developed symptoms, including 5 who required IV calcium. On multivariate logistic regression analysis, when adjusting for postoperative calcium level and performance of central neck dissection, predictors of hypocalcemic symptoms were younger age (OR 1.59, 95%CI 1.07 – 2.32) and a PTH <10 (OR 1.08, 95%CI 1.04 – 1.12). There were no patient or treatment-related factors that predicted a POD1 PTH<10. Conclusion A single POD1 PTH level<10 can accurately identify those patients at risk for clinically significant hypocalcemia. All total thyroidectomy patients with a postoperative PTH≥10 can be safely discharged without supplementation. Given the small number of patients with PTH<10, it is unclear if both calcium and calcitriol are needed for these higher-risk patients.

These data suggest that aggressive management of neuroendocrine hepatic metastases does improve survival, that chemoembolization increases the patient population eligible for this strategy, and that patients with more than 50% liver involvement may not benefit from an aggressive approach.