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.

The Clinicopathological Features and Postoperative Complications of Completion Thyroidectomy for Recurrent Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: A completion thyroidectomy after less than total thyroidectomy is needed for the treatment of recurrent papillary thyroid carcinoma (PTC). The aim of this study is to evaluate the clinicopathological features and the postoperative complications of completion thyroidectomy for patients with recurrent PTC. METHODS: A total 94 PTC patients who had undergone prior less than total thyroidectomy underwent completion thyroidectomy for recurrence from March 1986 to June 2009. We retrospectively analyzed the clinicopathological features and postoperative complications. RESULTS: At the initial operation, the patients' mean age was 38.2 years old. Central node metastasis was found in 37 cases and extrathyroidal invasion was found in 12 cases. The mean interval time between the initial operation to the completion thyroidectomy was 76.6 months. Fifty six patients underwent completion thyroidectomy only and 38 underwent a completion thyroidectomy combined with a modified radical neck dissection. In the combined group, central neck node metastasis and extrathyroidal invasion at the time of the initial operation were significantly more frequent than those in the completion thyroidectomy only group. The postoperative complications were 14 cases of transient hypocalcemia and 8 cases of permanent hypocalcemia and there were no significant differences between the two groups. CONCLUSION: When performing completion thyroidectomy, it is important to check the lateral neck nodes for metastasis when central neck node metastasis or extrathyroidal invasion were present at the initial operation, and this can be done safely without severe complications even though it is combined with modified radical neck dissection.

Initial Experience with Laparoscopic and DaVinci Robotic-assisted Liver Resection

PURPOSE: Although laparoscopic surgery has become more popular, its technical difficulties have limited the applications of this technique to liver surgery. We report here on our experience with liver resection with perfoming laparoscopic assisted and DaVinci robot assisted hepatectomy. METHODS: We retrospectively evaluated 40 patients who underwent laparoscopic assisted and DaVinci robotic assisted hepatectomy at the Yonsei University Health System from January 2002 to January 2008. RESULTS: Thirty patients (75%) had malignancy and ten patients (15%) had benign disease. We performed Lt. hepatectomy (7.5%), wedge resection (17.5%), segmentectomy (30%) and Lt. lateral segmentectomy (45%). The rate of conversion to laparotomy was due to intraoperative bleeding was 10%. The complication and mortality rates were 7.5% and 0%, respectively CONCLUSION: Laparoscopic and DaVinci robot hepatectomy showed a reduced time to oral intake, a shortened hospital stay and a smaller incisional scar compared to open surgery. So, laparoscopic and DaVinci robot hepatectomy should be performed in selected patients as the postoperative status of the patients is better than that with performing open hepatectomy.