Differentiated Thyroid Carcinoma of Children and Adolescents: 27-Year Experience in the Yonsei University Health System

Thyroid carcinomas are uncommon in childhood and adolescence. The aim of this study was to analyze clinical features and clinical outcomes of thyroid cancer in the pediatric population treated in the Yonsei University Health System. From September 1982 to June 2009, 90 patients (75 females, 15 males; female:male ratio of 5:1) with differentiated thyroid carcinoma were identified in our institute. The mean age at diagnosis was 15.8 yr old (range 4.8-19.9 yr). Cervical masses were most common clinical manifestations at diagnosis in 65 patients (72.2%). Forty-two patients underwent less than total thyroidectomy and 18 patients underwent total thyroidectomy. Thirty patients (33.3%) had lateral neck lymph node metastasis and seven patients (7.8%) had lung metastasis at the time of surgery. Among the 90 patients, recurrence occurred in 14 patients (15.5%). Mean follow-up period for patients with differentiated thyroid carcinoma was 81.6 months (13-324 months). No patients died of differentiated thyroid carcinoma. Patients with differentiated thyroid carcinoma who were < 20-yr-of-age were present with aggressive local disease and a high frequency of lymph node and distant metastasis. It is recommended that pediatric thyroid cancer should be managed mostly using proper surgical approach with thyroidectomy and lymph node dissection when indicated.

Coexistence of Chronic Lymphocytic Thyroiditis with Papillary Thyroid Carcinoma: Clinical Manifestation and Prognostic Outcome

The study aimed to identify the clinical characteristics of coexisting chronic lymphocytic thyroiditis (CLT) in papillary thyroid carcinoma (PTC) and to evaluate the influence on prognosis. A total of 1,357 patients who underwent thyroid surgery for PTC were included. The clinicopathological characteristics were identified. Patients who underwent total thyroidectomy (n = 597) were studied to evaluate the influence of coexistent CLT on prognosis. Among the total 1,357 patients, 359 (26.5%) had coexistent CLT. In the CLT group, the prevalence of females was higher than in the control group without CLT (P < 0.001). Mean tumor size and mean age in the patients with CLT were smaller than without CLT (P = 0.040, P = 0.047, respectively). Extrathyroidal extension in the patients with CLT was significantly lower than without CLT (P = 0.016). Among the subset of 597 patients, disease-free survival rate in the patients with CLT was significantly higher than without CLT (P = 0.042). However, the multivariate analysis did not reveal a negative association between CLT coexistence and recurrence. Patients with CLT display a greater female preponderance, smaller size, younger and lower extrathyroidal extension. CLT is not a significant independent negative predictive factor for recurrence, although presence of CLT indicates a reduced risk of recurrence.

Prophylactic Central Compartment Node Dissection for Papillary Thyroid Carcinoma: Complication and Outcome / 대한내분비외과학회지

PURPOSE: Prophylactic central compartment node dissection is gaining acceptance in the treatment of papillary thyroid carcinoma (PTC). However, its benefits remain controversial. The aim of study was to evaluate the effects of prophylactic central compartment node dissection on the complication rate and the short-term disease-free survival rate. METHODS: Our treatment strategy for PTC without clinical evidence of lymph node metastasis has been changed from total thyroidectomy alone (group I) to total thyroidectomy with prophylactic central compartment node dissection (group II) since January 2007. Before and after 2007, 70 consecutive patients were selected in each group. RESULTS: The average age of patients was 46.3±11.8 years. Average follow-up period was 51.9±10.9 months. The average size of maximum diameters of the tumors was 1.3±0.8 cm. Lymph node metastasis was identified in 22.9% of patients in group II. Recurrent laryngeal nerve injury occurred in one patient in each group. Temporary and permanent hypoparathyroidism occurred in 32.9% and 2.9% in group I, 40.0% and 7.1% in group II respectively (P=0.483 and P=0.441, respectively). Locoregional recurrences developed in seven patients in group I. Fifty month disease-free survival rate was 90.0% and 100% in group I and group II, respectively (P=0.0078). CONCLUSION: Prophylactic central compartment node dissection did not seem to increase the risk of recurrent laryngeal nerve injury, but may increase the risk of temporary and permanent hypoparathyroidism. Prophylactic central compartment node dissection decreased the risk of locoregional recurrences, especially in central compartment. However, the size of metastatic lymph nodes in central compartment in the present study was relatively small and their clinical implication remains to be evaluated.

Initial Experience with Posterior Retroperitoneoscopic Adrenalectomy for the Adrenal Tumors / 대한내분비외과학회지

PURPOSE: Posterior retroperitoneoscopic adrenalectomy (PRA) for small adrenal tumors has recently been in the spotlight due to its several benefits. Compelling advantages for endoscopic surgeons include direct, safe, and fast approach to the adrenal gland without trespass to the intraperitoneal organ. This study reports our initial experiences of PRA for the management of adrenal tumors. METHODS: From December 2009 to August 2011, 63 patients underwent PRA for the management of adrenal tumor. Among these patients, laparoscopic adrenalectomy and robotic adrenalectomy were performed in 54 and nine patients, respectively. We retrospectively reviewed records of all surgical outcomes. RESULTS: Of the 54 patients, 22 were male and 32 were female, and mean age was 51.7±14.0 years. Mean body mass index was 24.6±3.6 kg/m² and mean dimension of the tumors was 2.66±1.36 cm. Six patients were diagnosed with Cushing's disease, 22 patients with primary aldosteronism, seven patients with pheochromocytoma, one patient with metastatic adrenal gland cancer, and 18 patients with nonfunctioning adrenal tumors. Mean operative time was 88.5±27.1 min, mean blood loss was 17.4±37.4 ml, and mean duration to first oral intake was 0.83±0.4 days. Mean number of postoperative analgesics used was 2.28±2.54, and mean postoperative hospital stay was 2.85±1.43 days. There was no open conversion during the operation and no post-operative complication. CONCLUSION: PRA is a safe and fast procedure. In experienced hands, PRA represents one of the ideal approaching methods in the adrenal gland surgery.

Single Incision Three Ports Laparoscopic Appendectomy / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy (LA) is becoming popular for the treatment of acute appendicitis. The laparoscopic appendectomy has the advantages of a more rapid recovery, better cosmetic outcome and reduced postoperative pain compared to the open appendectomy. Several laparoscopic procedures have been described that used two or more trocars. We present the results of a new LA technique that performed through three ports in a single incision. METHODS: A single incision three-port LA was performed in 10 patients. Under general anesthesia, a 5 mm scope (0degrees), 2 mm working port and 5 mm working port were inserted through the umbilicus. The appendix was grasped and dissected from the surrounding tissues with a grasper or dissector. The base of the appendix was ligated with an endo-loop two times and cut by scissors. The appendix was then withdrawn through the umbilicus. RESULTS: The average operating time in our series was 69.5+/-23.3 minutes and the median time to discharge 4.5+/-1.9 days. Wound infection developed in two patients. There was no conversion to traditional LA or laparotomy. CONCLUSION: A single incision three port LA was safe and effective for LA. The availability of laparoscopic procedures has expanded the range of options available from which to choose a suitable procedure for individual cases.

Laparoscopic Appendectomy Using a 5 mm Scope / 대한내시경복강경외과학회지

PURPOSE: This clinical research was performed to determine the safety of laparoscopic appendectomy using a 5 mm scope by comparing the outcomes with open appendectomy. METHOD: We examined the medical records of 441 patients that underwent either laparoscopic appendectomy (LA) or open appendectomy (OA) from March 2005 to August 2007. We retrospectively reviewed the clinical data and compared: age, gender, days of hospitalization, operation time, time to oraldiet, complications, and readmission, between the LA and OA groups. RESULTS: Among the 441 patients that were diagnosed with appendicitis, LA was attempted in 332 patients; 325 (73.7%) of them received the procedure. One hundred-nine patients (24.7%) received an OA. There were no differences in operation time (p=0.072), length of hospitalization, and complication or re-admission rates; however the time to oral diet (p=0.025) was earlier in patients in the LA group. There were no differences in the outcomes of patients that had an uncomplicated appendicitis and received LA or OA; however patients diagnosed with complicated appendicitis had a shorter length of hospitalization after a LA compared to those that had an OA (p=0.03). CONCLUSION: There was no difference in safety between the laparoscopic appendectomy using a 5 mm scope and an open appendectomy. Laparoscopic appendectomy using a 5 mm scope provided a better cosmetic outcome.