Unilateral Thyroid Lobectomy as Day Care Procedure: A Cross Sectional Study with Literature Review on the Safety and Cost Effectiveness

Abstract Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure. Objective To access the feasibility and safety of thyroid lobectomy as a day care surgery and its effect on decreasing overall financial burdens. Methods This retrospective chart review was done from 2006 to 2022. A total of 736 patients underwent thyroid lobectomy among which only 56 were done as day care surgery. Data analysis was done using the IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 40% of the population was male. The mean age of the study population was 42 years. Bethesda II was the most encountered diagnosis, with a rate of 69%. The majority of patients were discharged after 6 hours of postoperative observation. The only complication encountered was seroma, which was seen in two patients. Conclusion Thyroid lobectomy appears to be a safe procedure with a drastic difference in overall cost as a day care procedure. We recommend switching the practice of inpatient thyroid lobectomy to a day care procedure in carefully selected candidates. The major hurdle in day care lobectomy can be approval from insurance.

Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension

Abstract Introduction Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously. Objective To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained. Methods We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study. Results We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (p = 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI. Conclusion Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.

Outcome of thyroid lobectomies undergone with and without drains

Background: Thyroid lobectomy is a common operative technique of management of benign solitary thyroid nodules in which drains are used routinely. Objective of this study to compare the outcome of thyroid lobectomies undergone with and without drains in patients of benign solitary thyroid nodules.Methods: A comparative cross-sectional research was completed on 98 patients of benign solitary thyroid nodules at surgery department of Liaquat University Hospital Jamshoro. Patients having age of 18-60 years underwent thyroid lobectomies were included and distributed in two groups A and B. Group A includes thyroid lobectomies with drain and Group B without drain. Postoperative outcomes including pain score assessed via visual analog score (VAS), hospital stay and complications including wound infection, seroma and hematoma.Results: Out of 98 cases, 49 underwent thyroid lobectomy with drain and 49 without a drain. Females patients were in majority in group A 42 (85.7%) and also in group B 47 (95.9%). No significant difference (p-value=0.674) was in mean age of group A 30.8±10.2 years and group B 31.8±12.2 years. Higher mean with significant difference (p-value=0.001) was in pain score of group A 5.61±1.25 as compared to group B 3.55±0.70. No significant difference was in complications; seroma 1 (2.04%) vs 5 (10.20%), hematoma 1 (2.04%) vs 1 (2.04%) and infection 3 (6.12%) vs 0 (0.0%) in group A and B respectively. Higher mean with significant difference (p-value=0.001) was in hospital stay of group A 2.40±1.57 days as compared to group B 1.42±0.54 days. No significant difference (p-value=0.748) was in overall rate of complications in group A 5 (10.20%) and B 6 (12.24%).Conclusions: Thyroid lobectomy with drain is not effective in lowering the postoperative complications whereas enhanced the risk of postoperative pain, wound infection and duration of hospital stay as compared to thyroid lobectomy without a drain.

Is local resection sufficient for parathyroid carcinoma?

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy. .

Thyroid Lobectomy for Treatment of Well Differentiated Thyroid Cancer Confined to One Lobe / 대한내분비외과학회지

PURPOSE: There has been controversy of the lobectomy for well differentiated thyroid cancer (WDTC). Current guidelines recommend total thyroidectomy for the cancer over 1cm, despite previous report suggesting that the lobectomy provides similar excellent outcomes. The purpose of our study is to report our experience of WDTC treated by thyroid lobectomy. METHODS: We retrospectively analyzed 284 patients with WDTC treated by thyroid lobectomy at department of Surgery in Chosun University Hospital from January 2002 to December 2010. Overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method. Factors predictive of recurrence by univariate and multivariate analysis were determined using the χ2 test and Cox proportional hazard model respectively. RESULTS: With a mean follow-up of 60.4 months, OS and RFS for all patients were 97.9% and 96.5% respectively. No patient died due to WDTC. Univariate analysis showed statistically significant differences in recurrence by tumor size (P=0.013) and presence of invasion (P=0.039). However, Multivariate analysis showed no significant difference in local recurrence. CONCLUSION: Patients with WDTC confined to one lobe can be safely treated by lobectomy.

The Feasibility of Lateral Minimal Invasive Open Thyroid Lobectomy / 대한내분비외과학회지

PURPOSE: Minimal invasive open thyroidectomy is one option for minimal invasive surgery. The population of planned unilateral lobectomy is on the rise in parallel to the increased incidence of confined papillary thyroid microcarcinomas in Korea. In contrast to other minimal invasive modalities, few studies have examined the surgical outcome of minimal invasive open thyroidectomy. This study compared the lateral minimal invasive open thyroid lobectomy with conventional surgery and endoscopic surgery in terms of the feasibility and safety. METHODS: A retrospective study was performed on 197 patients undergoing a thyroid lobectomy between January 2001 and December 2010. One hundred and three patients underwent a lateral minimal invasive open thyroid lobectomy, 42 patients underwent conventional surgery, and 44 patients underwent endoscopic surgery. RESULTS: The hospitalization period with endoscopic surgery was 6.2 days, which was longer than the 5.3 days with a lateral minimal invasive open thyroid lobectomy (P=0.000). The surgical time was lower in those who underwent a lateral minimal invasive open thyroid lobectomy (88.2 minutes) than in those who underwent conventional surgery (107 minutes, P=0.000) or endoscopic surgery (124.1 minutes, P=0.000). In the patients with a diagnosis of malignancy, the mean number of retrieved LNs was similar in the three groups. CONCLUSION: A lateral minimal invasive open thyroid lobectomy offers advantages, such as a shorter surgical time and hospitalization period than others. This procedure can be a feasible alternative to the conventional or endoscopic approach in selected patients undergoing thyroid lobectomy.

Synchronous Carcinoma Showing Thymus-like Elements (CASTLE) of the Thyroid Combined with Rectal Carcinoma: Report of a Case and Review of the Literature / 대한내분비외과학회지

Carcinoma showing thymus-like elements (CASTLE) is a rare neoplasm arising from the thyroid gland. This tumor is thought to originate from ectopic thymic tissue or remnants related to thymic development in or adjacent to the thyroid gland and usually located in the lower two-thirds of the thyroid gland. The patient was a 66-year-old man admitted to our hospital with rectal carcinoma for surgery. He had undergone a right upper lobectomy of the lung for the pulmonary tuberculosis 35 years previously. He underwent a chest computed tomography (CT) pre-operatively, and an incidental nodule of the thyroid gland was detected. Based on aspiration cytology of the nodule, the lesion was suspected to be an anaplastic carcinoma. He underwent a low anterior resection and thyroid lobectomy for a double primary neoplasm. On the final pathologic examination, the thyroid lesion was shown to be CASTLE. Therefore, completion thyroidectomy with lymph node dissection of the central compartment and radiotherapy were performed, and there was no evidence of recurrence 15 months postoperatively.

Trend in Surgical Management for Thyroid Diseases

PURPOSE: Thyroid disease is the most common form of endocrinologic disease. Despite recent advances in diagnosis, controversy still remains concerning the surgical management of thyroid disease. The aim of this study was to analyze the clinical distribution and the inclination of surgical treatment for thyroid disease. METHODS: The medical records from 1,743 patients who had undergone thyroid resections for thyroid diseases between January 1989 and December 1998 at Kwangju Christian Hospital were reviewed retrospectively. RESULTS: Of the 1,743 patients with thyroid diseases, 1,285 had benign diseases and 458 had carcinomas, resulting in a 26.3% prevalence of malignancy. Female patients were predominate, being 6.89 times the number of males. The peak incidence of age was the 4th decade for patients with benign diseases (29.4%) and the 5th decade for those with malignant diseases (26.0%). Both benign (39.4%) and malignant diseases (42.1%) were more prevalent on the right lobe. The incidence of carcinomas was 28.9% in solitary nodules and 29.3% in multinodular goiters. In the histopathologic study, the most common type was a papillary carcinoma (84.5%) in malignancies and an adenomatous goiter (48.8%) in benign diseases. The most commonly performed surgical procedures were a total thyroidectomy (75.4%) for malignancies and a lobectomy for benign diseases (63.3%). Postoperative complications were 3.1% in patients with benign diseases and 29.7% in those with malignancies. Regional recurrence or distant metastases appeared in 5.5% of the patients during the 10 years following treatment. CONCLUSION: The treatments of choice were a thyroid lobectomy for patients with benign diseases and a total thyroidectomy for those with malignant diseases. However, the decision to perform a surgical resection should be based on the age and the general condition of patient.