Staged Thyroidectomy: A Single Institution Perspective

Wu, Che‐Wei; Sun, Hui; Zhang, Guang; Kim, Hoon Yub; Catalfamo, Antonio; Portinari, Mattia; Carcoforo, Paolo; Randolph, Gregory W.; Chai, Young Jun; Dionigi, Gianlorenzo

doi:10.1002/lio2.171

Cited by 19 publications

(13 citation statements)

References 26 publications

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“…(14-17) Anaway, the routinary use of NIM has the enormous advantage to avoid bilateral palsy in case of loss of signal on the initial site, forcing to stop the operation. (18)(19)(20) After RLN palsy, the recovery of the nerve at one year is expected to be as high as 95% when the anatomic integrity is con rmed during the procedure. Consequently, the non-visualization of the nerve during dissection represents a striking risk factor for permanent damage.…”

Section: Discussionmentioning

confidence: 99%

Adverse Events in Thyroid Surgery. Observational Study in Three Surgical Units With High Volume/Year.

Río¹,

Carcoforo

Medas

et al. 2020

Preprint

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Background Thyroid surgery, performed for benign or malignant pathologies, is one of the most frequently performed procedures and its frequency has even been increasing in recent years. Postoperative bleeding, recurrent laryngeal nerve (RLN) palsy, associated to dysphonia, dysphagia, dyspnea, and hypoparathyroidism represent the most fearful and common complications. We conducted a multicenter, observational study of retrospectively collected data in three high-volume referral centers, enrolling all patients undergone to thyroid surgery between January 2016 and December 2017 in Parma University Hospital, Cagliari University Hospital and Ferrara University Hospital.Materials Patients were divided into 5 groups, differentiated thyroid carcinoma, medullary thyroid carcinoma, non-toxic benign pathology, hyperfunctioning benign pathology and NIFTP (Non-invasive Follicular Thyroid neoplasm with Papillary-like nuclear features). A follow up at 7 and 30 days was executed, evaluating the onset of paresthesia, dysphonia and dysphagia. A six-month follow-up was conducted in cases of early complications.Results Totally, 1252 patients were eligible for the study: 907 female and 345 male, with a female to male ratio of 2.6:1 and an average age of 53.428. Total thyroidectomy was performed in 1022 cases, lobectomy in 230.After 6 months we recorded paresthesia in 0.5%, dysphonia in 1.8% and dysphagia in 0.5%.Conclusion Our study confirms once again that a share of morbidity escapes the possibilities of prediction and control by the operator, depending on patient anamnestic, pathological or anatomical factors.

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Section: Discussionmentioning

confidence: 99%

Adverse Events in Thyroid Surgery. Observational Study in Three Surgical Units With High Volume/Year.

Río¹,

Carcoforo

Medas

et al. 2020

Preprint

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“…On the other hand, the presence of cervical lymph nodes without a palpable tumour in the thyroid may be the first finding in thyroid carcinomas. Park and Min reported that they made a diagnosis from lateral neck nodes in a group of patients with nonpalpable thyroid carcinoma, and they performed near-total lobectomy + cervical lymph node dissection in some of these patients and only hemithyroidectomy in some of them (20). Likewise, other authors, who believe that small carcinomas of the thyroid may be more aggressive than palpable tumours, turned to additional neck dissections along with total thyroidectomy for these tumours (21).…”

Section: Discussion Discussionmentioning

confidence: 99%

“…The fact that the possibility of multicentric carcinoma increases the risk of subsequent local recurrence in the contralateral thyroid lobe and the expectation for a facilitating effect for ablation treatment when required after this approach is argued as the main indications for the method (22,23). The incidence of residual carcinoma in the contralateral lobe obtained with completion thyroidectomy was reported to be 28% by some authors and 27% by Rao et al (20)(21). Another author stated that the incidence of residual thyroid cancer in reoperation specimens was 31%, and they emphasised that completion thyroidectomy was an appropriate option for lesions larger than 1 cm in the first operation because 0% of these patients had the potential for residual cancer (22).…”

Section: Discussion Discussionmentioning

confidence: 99%

What Should We Prefer in the Surgical Management of Differentiated Thyroid Carcinomas?

Çiftçi¹

2019

SGO

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Aim: The study evaluates the results of surgical procedures performed in patients with differentiated thyroid carcinoma. There are many discussions regarding the optimal surgical treatment of differentiated thyroid carcinoma; their focal point is the type or extent of thyroidectomy. Material and Method: We performed a retrospective analysis on 85 patients diagnosed with differentiated thyroid carcinoma, treated in the period July 2007-April 2017. The average age the patients, consisting of 15 males and 70 females, was of 41 (17-85) years. The gross findings at operation and the prognostic factors such as patients' age, tumour size, local invasion, nodal involvement and the presence of distant metastasis were taken into account when deciding on the type of thyroidectomy, and cervical neck dissection. Results: The most prominent symptom was the existence of a cervical mass (85%); fineneedle aspiration biopsy (FNAB) was performed in 73 patients and revealed a diagnostic accuracy in 61 patients (72%). Histological examination confirmed papillary carcinoma in 76 patients, follicular carcinoma in 8 patients and medullary carcinoma in 1 patient. When the diagnosis was established, 19 patients had palpable neck lymph nodes, and 25 patients had a local invasion to surrounding structures. While total thyroidectomy was performed in 71 (83.5%) patients, 11 (12.4%) patients underwent lobectomy and subtotal thyroidectomy, and 3 (3.5%) patients underwent lobectomy and near-total lobectomy. Modified neck dissection was added to 13 patients who underwent total thyroidectomy. No operative mortality was observed, and the cancer-related mortality rate was 10.2%. Temporary and permanent hypoparathyroidism rates were 5% and 1.1%, respectively. Temporary and permanent recurrent nerve paralysis was observed to be of 3% and 0%, respectively. Conclusion: The selection of treatment for differentiated thyroid carcinoma should be made based on risk factors. All procedures such as lobectomy + subtotal lobectomy, near-total thyroidectomy, and total thyroidectomy are selected in safe conditions. In addition to total thyroidectomy, modified neck dissection should also be considered for patients with differentiated thyroid carcinoma with nodal involvement.

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“…Only under exceptional circumstances, including advanced cancer, should contralateral surgery be pursued (36), and if so, solely at surgical centers experienced in complex neck surgery. Whenever the thyroid condition at hand is benign and not life-threatening, interests of patient safety should always take precedence over considerations of economy and convenience (37).…”

Section: Same-session Thyroidectomy Versus Staged Thyroidectomymentioning

confidence: 99%

Intraoperative nerve monitoring in thyroid surgery—shifting current paradigms

Schneider¹,

Machens²,

Lorenz³

et al. 2020

Gland Surg

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Over the past two decades, intraoperative neural monitoring (IONM) has matured into a powerful risk minimization tool. Meta-analyses of studies, most of which were limited by poor study designs and the sole use of intermittent nerve stimulation, failed to demonstrate superiority of IONM over anatomic recurrent laryngeal nerve (RLN) dissection in the absence of IONM. With the advent of continuous IONM (CIONM), intraoperative nerve electromyographic tracings, registered almost in real time during the operation, accurately predict postoperative vocal fold function when International Neural Monitoring Study Group quality standards are adhered to. CIONM aids in avoiding permanent traction-related nerve injury by urging surgeons to reverse harmful surgical maneuvers. CIONM also forms an integral part in the surgical concept of staged thyroidectomy. Delaying completion surgery on the other side until nerve function has recovered mitigates the risk of bilateral vocal fold palsy. CIONM has greatly furthered our understanding of functional RLN injury, enabling conception of effective risk minimization strategies tailored to the individual patient. The review summarizes the advances of continuous IONM technology that caused a quantum leap in risk minimization for thyroid surgery, shifting current paradigms.

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Staged Thyroidectomy: A Single Institution Perspective

Abstract: 4.

Cited by 19 publications

References 26 publications

Adverse Events in Thyroid Surgery. Observational Study in Three Surgical Units With High Volume/Year.

Adverse Events in Thyroid Surgery. Observational Study in Three Surgical Units With High Volume/Year.

What Should We Prefer in the Surgical Management of Differentiated Thyroid Carcinomas?

Intraoperative nerve monitoring in thyroid surgery—shifting current paradigms

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