Intraoperative neuromonitoring in thyroid surgery: Is the two-staged thyroidectomy justified?

Calò, Pietro Giorgio; Medas, Fabio; Conzo, Giovanni; Podda, Francesco; Canu, Gian Luigi; Gambardella, Claudio; Pisano, Giuseppe; Erdas, Enrico; Nicolosi, Angelo

doi:10.1016/j.ijsu.2017.02.001

Cited by 55 publications

(49 citation statements)

References 27 publications

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“…Although mortality due to this surgical procedure is negligible, morbidity remains a challenging problem, even in the most experienced hands. In this kind of surgery, morbidity is mainly represented by recurrent laryngeal nerve injury, hypoparathyroidism and cervical haematoma [ 21 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

et al. 2020

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Background Obesity is a growing public health concern in most western countries. More and more patients with high body mass index (BMI) are undergoing surgical procedures of all kinds and, in this context, obese patients are undergoing thyroid surgery more than ever before. The aim of the present study was to evaluate whether thyroidectomy can be considered safe in obese patients. Methods Patients undergoing thyroidectomy in our Unit between January 2014 and December 2018 were retrospectively analysed. Patients were divided into two groups: those with BMI < 30 kg/m2 were included in Group A, while those with BMI ≥ 30 kg/m2 in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analyses were performed to evaluate whether the BMI value (considered in this case as a continuous variable) had a significant role in the development of each individual postoperative complication. Results A total of 813 patients were included in this study: 31 (3.81%) were underweight, 361 (44.40%) normal-weight, 286 (35.18%) overweight, 94 (11.57%) obese and 41 (5.04%) morbidly obese. Six hundred and seventy-eight patients were included in Group A and 135 in Group B. At univariate analysis, the comparison between the two groups, in terms of operative time and thyroid weight resulted in statistically significant results (P = 0.001, P = 0.008; respectively). These features were significantly higher in Group B than in Group A. About postoperative stay and complications, no statistically significant difference was found between the two groups. At multivariate analyses, only the development of cervical haematoma was statistically significantly correlated to the BMI value. Patients with high BMI had a lower risk of cervical haematoma (P = 0.045, OR 0.797, 95% CI 0.638–0.995). Conclusions This study showed that obesity, in the field of thyroid surgery, is not associated with any increase of postoperative complications. Thus, it is possible to conclude that thyroidectomy can be performed safely in obese patients. Our result about operative times had no clinical significance.

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Section: Discussionmentioning

confidence: 99%

Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

et al. 2020

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“…Moreover, we demonstrated that the analysis of liquid biopsy can help in the identification of a subset of PTCs with more aggressive characteristics even in the group of low-risk cancer patients. The use of an effective method in the early identification of a thyroid tumor could permit a minimal invasive surgery preventing some of the complication related to conventional surgery [37,38]. Our data suggest the potential utility of liquid biopsy in guiding the surgical decision, however, additional studies addressing this specific question are needed.…”

Section: Discussionmentioning

confidence: 85%

Detection of BRAFV600E in Liquid Biopsy from Patients with Papillary Thyroid Cancer Is Associated with Tumor Aggressiveness and Response to Therapy

Jensen

Thakur

Patel

et al. 2020

JCM

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The detection of rare mutational targets in plasma (liquid biopsy) has emerged as a promising tool for the assessment of patients with cancer. We determined the presence of cell-free DNA containing the BRAFV600E mutations (cfBRAFV600E) in plasma samples from 57 patients with papillary thyroid cancer (PTC) with somatic BRAFV600E mutation-positive primary tumors using microfluidic digital PCR, and co-amplification at lower denaturation temperature (COLD) PCR. Mutant cfBRAFV600E alleles were detected in 24/57 (42.1%) of the examined patients. The presence of cfBRAFV600E was significantly associated with tumor size (p = 0.03), multifocal patterns of growth (p = 0.03), the presence of extrathyroidal gross extension (p = 0.02) and the presence of pulmonary micrometastases (p = 0.04). In patients with low-, intermediate- and high-risk PTCs, cfBRAFV600E was detected in 4/19 (21.0%), 8/22 (36.3%) and 12/16 (75.0%) of cases, respectively. Patients with detectable cfBRAFV600E were characterized by a 4.68 times higher likelihood of non-excellent response to therapy, as compared to patients without detectable cfBRAFV600E (OR (odds ratios), 4.68; 95% CI (confidence intervals)) 1.26–17.32; p = 0.02). In summary, the combination of digital polymerase chain reaction (dPCR) with COLD-PCR enables the detection of BRAFV600E in the liquid biopsy from patients with PTCs and could prove useful for the identification of patients with PTC at an increased risk for a structurally or biochemically incomplete or indeterminate response to treatment.

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“…Over the years, oncologic radicality in case of two-staged thyroidectomy has been a matter of debate; in this regard, we should consider that differentiated thyroid tumors have a good prognosis even in case of local or distant metastases, and that radioablative therapy with iodine-131 can be delayed safely. Thus twostaged thyroidectomy seems to be adequate also in case of thyroid carcinoma [38]; in this case, the endocrinologist can prescribe a TSH-suppressive therapy to reduce the risk of tumor progression of eventually unresected foci of tumor. Alternatively, a near-total lobectomy could be performed on the second side to preserve contralateral RLN.…”

Section: Two-staged Thyroidectomymentioning

confidence: 99%

Intraoperative Neuromonitoring in Thyroid Surgery

Medas¹,

Canu²,

Erdas³

et al. 2019

Knowledges on Thyroid Cancer

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Recurrent laryngeal nerve (RLN) injury is the most feared complication in thyroid surgery, resulting in a worse patients' quality of life, and is the most common cause of medical claim. Visualization of RLN before proceeding with dissection of the gland is considered the gold standard. In the last decade, intraoperative neuromonitoring (IONM) of RLN has progressively gained acceptance; nowadays, this method is widely spread, being routinely used in large workflow centers. IONM is helpful in the identification of RLN and allows to asses nerve functionality during and at the end of surgical procedure. In this chapter, IONM features, its advantages and limits, and its usefulness will be discussed.

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Intraoperative neuromonitoring in thyroid surgery: Is the two-staged thyroidectomy justified?

Cited by 55 publications

References 27 publications

Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

Detection of BRAFV600E in Liquid Biopsy from Patients with Papillary Thyroid Cancer Is Associated with Tumor Aggressiveness and Response to Therapy

Intraoperative Neuromonitoring in Thyroid Surgery

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