Surgical Treatment Guidelines for Patients with Differentiated Thyroid Cancer: The Korean Association of Thyroid and Endocrine Surgeons (KATES) Guidelines Taskforce / 대한내분비외과학회지

No abstract available.

Clinical Comparative Evaluation of Open Method and Gasless or Gas Insufflation Anterior Chest Approach in Endoscopic Thyroidectomy in a Single Institution

PURPOSE: After the first endoscopic thyroidectomy by Huscher in 1997, several surgeons reported their experiences with endoscopic thyroidectomies. And these papers showed that clinical outcomes of endoscopic thyroidectomy are similar to conventional thyroidectomy. But, there was no randomized prospective trial to determine which approach of endoscopic thyroidectomy achieved better results. We evaluated clinical data of gasless and gas insufflation endoscopic thyroidectomies with conventional thyroidectomy to define its advantages or disadvantages. METHODS: Between 1999 and 2009, 1,117 patients underwent thyroidectomies (1,149 cases). 747 cases was performed by conventional open method, 402 cases by endoscopic thyroidectomy. Among them, 317 cases were operated by gasless techniques and 85 cases by carbon dioxide gas insufflation. RESULTS: Between conventional and endoscopic thyroidectomy groups, operation time, hospitalization period, tumor size, and number of retrieved lymph nodes were similar (P-value >0.05). Among 441 thyroid cancer patients, 19 had recurrence, of which 15/301 (4.98%) had conventional thyroidectomy, and 4/140 (2.85%) had endoscopic thyroidectomy. After postoperative radioactive iodine therapy, follow-up Tg levels were checked in 274 patients, the levels were <2.0 ng/ml in 87.63% (163/186) of patients after conventional thyroidectomies and in 93.18% (82/88) following endoscopic thyroidectomies. There were no significant differences (P-value=0.58). Complication incidences (hypocalcemia, hoarseness, bleeding, wound infection) in both groups were not significantly distinctive (P-value=0.58). CONCLUSION: Minimally invasive techniques are generally applied even for malignancy in selected cases because of its advantages, such as cosmetic results. Through this study, we showed similar clinical outcomes of conventional and gasless or gas insufflations endoscopic thyroidectomy.

Histopathologic Findings Related to the Indeterminate or Inadequate Results of Fine-Needle Aspiration Biopsy and Correlation with Ultrasonographic Findings in Papillary Thyroid Carcinomas

OBJECTIVE: To determine histopathologic findings related to the indeterminate or inadequate result of fine-needle aspiration biopsy (FNAB) in papillary thyroid carcinomas (PTCs) and to correlate histopathological findings with ultrasonographic features of tumors. Materials and METHODS: We retrospectively reviewed the medical records of FNAB, histopathologic characteristics, and sonographic findings of the solid portion of 95 PTCs in 95 patients. All cases were pathologically confirmed by surgery. Histopathologic characteristics were analyzed for tumor distribution, microcystic changes, fibrosis, and tumor component. We assumed several histopathologic conditions to be the cause of indeterminate or inadequate results of FNAB, including: 1) an uneven tumor distribution, 2) > 30% microcystic changes, 3) > 30% fibrosis, and 4) < 30% tumor component. Ultrasonographic findings of each PTC were evaluated for echotexture (homogeneous or heterogeneous), echogenicity (markedly hypoechoic, hypoechoic, isoechoic, or hyperechoic), and volume of the nodule. We correlated histopathologic characteristics of the PTC with results of the FNAB and ultrasonographic findings. RESULTS: From 95 FNABs, 71 cases (74%) were confirmed with malignancy or suspicious malignancy (PTCs), 21 (22%) had indeterminate results (atypical cells), and three (4%) were negative for malignancy. None of the assumed variables influenced the diagnostic accuracy of FNAB. Tumor distribution and fibrosis were statistically correlated with ultrasonographic findings of the PTCs (p < 0.05). Uneven tumor distribution was related with small tumor volume, and fibrosis over 30% was correlated with homogeneous echotexture, markedly hypoechoic and hypoechoic echogenicity, and small tumor volume (p < 0.05). CONCLUSION: No histopathologic component was found to correlate with improper results of FNAB in PTCs. In contrast, two histopathologic characteristics, uneven distribution and fibrosis, were correlated with ultrasonographic findings.

Analysis of Postoperative Pathological Findings of Graves' Disease / 대한내분비외과학회지

PURPOSE: The diagnosis of Graves' disease can be clinically made by the findings of hyperthyroidism combined with eye signs or a diffusely enlarged goiter. The pathological findings of Graves' disease are hypertrophy and hyperplasia of the thyroid follicles. Surgical treatment for Graves' disease is indicated for patients with a suspicion of cancer, a large goiter, medical failure, patient preference or severe ophthalmopathy. The aim of this study is to determine the diagnostic accuracy of clinically diagnosed Graves' disease on the basis of the postoperative pathologic findings. METHODS: We performed a retrospective analysis of the medical records of the patients who were diagnosed as having Graves' disease since Jan 2000 at St. Mary's Hospital, The Catholic University of Korea. To confirm the pathological findings in this study, the patients who underwent surgical treatment were enrolled, and their preoperative diagnostic tests were also reviewed. RESULTS: A total of 57 patients with Graves' disease underwent surgery due to medical failure in 45 (78.9%), ophthalmopathy in 25 (43.8%), huge goiter in 4 (7%), suspicion of cancer in 4 (7%), and others in 4 (7%). Thirty nine (68.4%) patients were female and total thyroidectomies were performed in 52 (91.2%) patients. The pathological reports of the thyroid specimens showed diffuse hyperplasia in 53 (92.9%), nodular hyperplasia in 2 (3.5%), Lymphocytic thyroiditis in 1 (1.8%) and Hashimoto's thyroiditis in 1 (1.8%). The diagnostic accuracy of preoperative antimicrosomal Ab, anti-TSHR Ab and a technetium 99m thyroid scan was 73.8%, 86.0% and 69.7%, respectively. Papillary carcinoma was identified in 6 patients (10.5%). CONCLUSION: The microscopic findings of 5 patients (7.0%) who were diagnosed clinically as having Graves' disease were not compatible with the criteria for a pathological diagnosis. Surgical treatment and confirmation of the exact pathology should be performed for the appropriate treatment.

Comparative Study of Endoscopic Thyroidectomy: Total Thyroidectomy versus Near Total Thyroidectomy / 대한내분비외과학회지

PURPOSE: The aim of this study was to evaluate and compare the surgical outcomes of endoscopic total and near-total thyroidectomies in patients with thyroid cancer. METHODS: Between February 2000 and January 2009, among 387 patients who underwent endoscopic thyroidectomy in our hospital, we evaluated 50 patients who underwent endoscopic total or near-total thyroidectomy. Thirtyfive and 15 patients underwent endoscopic total thyroidectomy and near-total thyroidectomy, respectively. We analyzed the patients' clinicopathologic characteristics and post-operative complications between the two groups. RESULTS: The mean size of tumors was 1.08 cm (range, 0.1 ~3.5 cm) and the mean operative time was 192 minutes. Forty-nine tumors were papillary cancers and 1 tumor was a follicular cancer. Two patients in the endoscopic total thyroidectomy group underwent re-operation because of bleeding. In the near-total thyroidectomy group, one patient had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. In the total thyroidectomy group, nine patients had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. There was no statistical difference in the post-operative complicationrates between the two groups (P=0.254 for hypocalcemia and P=0.470 for injury to the recurrent laryngeal nerve). CONCLUSION: Based on our experience, endoscopic total thyroidectomy is a safe and feasible alternative to endoscopic near-total thyroidectomy.

Analysis of the Korean Cases of Nonrecurrent Laryngeal Nerve / 대한내분비외과학회지

PURPOSE: This study was performed to readjust the clinical implications of a nonrecurrent laryngeal nerve by assessing the reported Korean cases of a nonrecurrent laryngeal nerve. METHODS: We analyzed the cases of nonrecurrent laryngeal nerve that have been reported in Korea between 1997 and 2008 by reviewing the literature. An internet search was conducted in the NDSL (National Digital Science Library) and the Korean Medical Database. RESULTS: The data included 3 men and 25 women with an average age of 45.1 (age range: 28~58). All the cases were right-sided, and the incidence rate was 0.38% and 0.86% in two articles, respectively. There was a type I variation in 4 cases (17.4%), type IIa in 19 cases (82.6%), and the others are unknown. Twenty-five cases (89.3%) had the vascular anomaly called arteria lusoria. Only 8 cases (28.6%) were preoperatively predicted as possibly having a nonrecurrent laryngeal nerve. Iatrogenic nerve injury developed in 1 case (3.57%) with a type I variation during the postoperative period. CONCLUSION: A similar tendency for the incidence rate, the genderratio, the type distribution and vascular anomaly was observed when comparing the Korean reports with those reports of overseas. The nonrecurrent laryngeal nerve can be preoperatively predicted if proper attention is given when vascular anomaly is noted on CT or USG, and injury will be avoided by intraoperatively following the standard operation technique. There is currently an increasing incidence of thyroid diseases, and so adequate attention must be given to the possibility of a nonrecurrent laryngeal nerve and its management.

Adenocarcinoma of the Gastro-esophageal Junction: Application of Siewert's Classification to the Eastern Experience

PURPOSE: Since the approval of Siewert's classification during the 2nd International Gastric Cancer Congress in 1997, there has been no report on gastro-esophageal junction (GEJ) cancer using this new classification in Korea. The aim of this study was to assess the clinical usefulness of the new classification by applying it to the Eastern experience. MATERIALS AND METHODS: One hundred forty-six patients with an adenocarcinoma of the GEJ who underwent surgery from January 1990 to December 1998 were retrospectively classified according to the Siewert's classification. RESULTS: There were 2 patients (1.4%) with type I, 37 patients (25.3%) with type II, and 107 patients (73.3%) with type III. The proportion of the GEJ cancer among all gastric cancer patients who underwent operation was found to be 6.6%. The average age was 46 years in type I, 53 years in type II, and 55 years in type III. All types of GEJ cancers predominantly affected men. No significant differences in the pathologic variables including gross appearance, tumor size, and histologic findings were found between type II and type III. A curative resection (R0) was achieved in 118 cases (80.8%) without difference among tumor types. Type I tumors were treated with a gastrectomy with distal esophagectomy. Most of the type II tumors were treated with a total gastrectomy, and in some patients, a transhiatal partial esophagectomy was added. Type III tumors were treated with a total gastrectomy. Among resected cases with curative intent, microscopic tumor involvement of the proximal resection margin was noted in two patients (6.3%) with type II tumors. Lymph node metastasis was found in 2 patients (100%) with type I, 24 patients (64.9%) with type II, and 66 patients (61.7%) with type III. Lymph nodes along the lesser curvature were the most common site of metastasis, followed by pericardial nodes. The main lymphatic drainage directed the lymph nodes along the left gastric artery among the group 2 nodes. There was no difference in patterns of lymph node metastasis between type II and type III. Postoperative complications occurred in 29 patients, and operative mortality was 2.7%. Five-year survival rates were 0% for type I, 54.3% for type II, and 51.8% for type III. CONCLUSION: The distribution of subtypes of adenocarcinomas of GEJ was markedly different in this study compared with reported Western data. Therefore, Siewert's classification is useful for discussing GEJ cancer in an international setting as it clearly specifies the subtype of GEJ cancer. However, discrimination of type II and type III may have little clinical benefit since there were no significant differences in clinicopathologic characteristics or in the recommended types of surgery.