Population-Based Assessment of Complications Following Surgery for Thyroid Cancer

Papaleontiou, Maria; Hughes, David T.; Guo, Cui; Banerjee, Mousumi; Haymart, Megan R.

doi:10.1210/jc.2017-00255

Cited by 93 publications

(85 citation statements)

References 36 publications

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“…Damage of the PGs can cause hypoparathyroidism, which results in hypocalcaemia. The reported incidence of hypocalcaemia after total thyroidectomy varies widely: between 1.6% and 50% . Hypocalcaemia can result in increased morbidity, including cardiac arrhythmias and tetany leading to prolonged hospitalization and even death .…”

Section: Introductionmentioning

confidence: 99%

“…The reported incidence of hypocalcaemia after total thyroidectomy varies widely: between 1.6% and 50%. [2][3][4] Hypocalcaemia can result in increased morbidity, including cardiac arrhythmias and tetany leading to prolonged hospitalization and even death. 5 To avoid parathyroid injury, it is essential to identify the PGs and preserve their blood supply.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery

et al. 2018

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Background This study assessed the feasibility of near‐infrared fluorescence imaging with indocyanine green (ICG) to identify the parathyroid glands (PGs) intraoperatively and to assess their perfusion after thyroid resection. Methods Patients undergoing elective thyroidectomy were enrolled in this prospective study. An intravenous bolus of 7.5 mg ICG was administered twice: the first bolus to identify the PGs before resection of the thyroid and the second to assess vascularization of the PGs after resection. Results A total of 30 operations in 26 patients were included. In 17 surgeries (56.7%), fluorescence imaging was of added value, especially to confirm the presence of a suspected PG. No intraoperative or postoperative complications occurred because of the use of ICG. Conclusion Near‐infrared fluorescence imaging with the use of ICG for intraoperative identification of the PGs and the assessment of its vascularization is feasible and safe and can provide more certainty about the location of the PGs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery

et al. 2018

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“…Regularly performing IONM during thyroid surgery was suggested, but its cost‐effectiveness remains unclear . A more effective application of IONM is reasonable in patients with higher risks . To this end, this study aimed to identify the risk factors for thyroid surgery–related UVFP by analyzing patient demographics, comorbidities, diagnosis, and surgery type.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for thyroid surgery–related unilateral vocal fold paralysis

Chen¹,

Pei

Fang

2018

The Laryngoscope

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Objectives/Hypothesis We aimed to identify the risk factors for iatrogenic unilateral vocal fold paralysis (UVFP) caused by thyroid surgery, to allow the identification of patients requiring nerve‐protection procedures and monitoring technologies. Study Design Retrospective case study in a medical center. Methods Patients who underwent thyroid surgery from April 2011 to February 2016 and who were diagnosed with UVFP by laryngoscopy and laryngeal electromyography were included. Patient demographics, types of surgery, and characteristics of the thyroid lesions were analyzed. Results Sixty (2.1%) of 2,815 patients who received thyroid surgery developed UVFP. The risk of UVFP was higher in patients over 60 years old (odds ratio, 1.89; 95% confidence interval, 1.01‐3.26; P = .01). Involvement of the external branch of superior laryngeal nerve (EBSLN) occurred in 19 (31.7%) of the 60 UVFP patients, and was more likely to occurr in patients with diabetes mellitus (odds ratio, 14.19; 95% confidence interval, 3.80‐52.94; P < .001). The incidence of UVFP and involvement of the EBSLN differed among surgery types, and was the highest among patients undergoing total thyroidectomy with neck dissection (TTND) (10/158, 6.3% and 5/158, 3.2%, respectively). Conclusions The risk of thyroid surgery–related UVFP is higher in older patients. EBSLN involvement is more likely in patients with diabetes mellitus. TTND is associated with higher risks of UVFP and EBSLN injury than other types of surgery, implying the need of intraoperative nerve monitoring in these high‐risk characteristics. Level of Evidence 4 Laryngoscope , 129:275–283, 2019

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“…Patients should have their vocal‐fold function evaluated between 2 weeks and 2 months after thyroid surgery. Among nearly 28 000 patients undergoing surgery for DTC or medullary thyroid cancer, postoperative vocal cord paralysis occurred in 4.1% of instances . Voice assessment should be based on the patient's subjective report and the physician's objective findings.…”

Section: Resultsmentioning

confidence: 99%

American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence‐based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules

et al. 2018

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Background Care for patients with thyroid nodules is complex and multidisciplinary, and research demonstrates variation in care. The objective was to develop clinical guidelines and quality metrics to reduce unwarranted variation and improve quality. Methods Multidisciplinary expert consensus and modified Delphi approach. Source documents were workflow algorithms from Kaiser Permanente Northern California and Cancer Care of Ontario based on the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Results A consensus‐based, unified preoperative, perioperative, and postoperative workflow was developed for North American use. Twenty‐one panelists achieved consensus on 16 statements about workflow‐embedded process and outcomes metrics addressing safety, access, appropriateness, efficiency, effectiveness, and patient centeredness of care. Conclusion A panel of Canadian and United States experts achieved consensus on workflows and quality metric statements to help reduce unwarranted variation in care, improving overall quality of care for patients diagnosed with thyroid nodules.

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Population-Based Assessment of Complications Following Surgery for Thyroid Cancer

Abstract: The rates of thyroid cancer surgery complications are higher than predicted, and patients with older age, more comorbidities, and advanced disease are at greatest risk. Efforts to reduce complications are needed.

Cited by 93 publications

References 36 publications

Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery

Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery

Risk factors for thyroid surgery–related unilateral vocal fold paralysis

American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence‐based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules

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