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BACKGROUND: We compared cosmetic outcomes, pain intensity, and costs between dermal stapling and intradermal suturing in patients who underwent thyroidectomy through cervical incision. PATIENTS AND METHODS: In total, 40 patients were randomly assigned to undergo thyroidectomy through a low cervical incision and dermal closure using either absorbable staples (n = 20, staple group) or interrupted intradermal sutures (n = 20, suture group). Wound complications, cosmetic outcomes (modified Stony Brook Scar Evaluation Scale [SBSES] and Manchester Scar Scale [MSS]), and pain intensity (visual analog scale) were assessed at 1, 4, 12, and 24 weeks postoperatively. The difference in total "wound-closure cost" between the two groups was also analyzed. RESULTS: There were no wound-related complications and no significant differences in SBSES or MSS scores between the two groups (P = 0.609 and P = 0.141, respectively). However, the staple group had significantly higher SBSES scores, compared to the suture group, at 24 wk postoperatively (4.06 ± 0.94 versus 3.26 ± 1.24; P = 0.030, respectively); MSS scores were significantly lower in the staple group than in the suture group at 24 wk postoperatively (6.72 ± 1.27 versus 8.16 ± 2.17, respectively; P = 0.028). Visual analog scale scores were significantly lower in the suture group than in the staple group (P = 0.038). The total wound-closure cost was significantly higher in the staple group than in the suture group (137.10 ± 8.39 versus 81.79 ± 19.95 USD; P < 0.001). CONCLUSIONS: When dermal staples were used, wound complications were absent and long-term cosmetic outcomes were superior; however, pain intensity was higher and the cost was greater, although healing was significantly more rapid, compared to intradermal sutures. Closure using absorbable dermal staples may be safe and effective for cervical incisions during thyroid surgery. Further studies with larger number of participants are needed to confirm our findings.
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Cicatriz/diagnóstico , Dolor Postoperatorio/diagnóstico , Grapado Quirúrgico/efectos adversos , Técnicas de Sutura/efectos adversos , Tiroidectomía/efectos adversos , Adulto , Anciano , Cicatriz/etiología , Cicatriz/prevención & control , Estética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Dimensión del Dolor , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Grapado Quirúrgico/economía , Técnicas de Sutura/economía , Tiroidectomía/economía , Tiroidectomía/métodos , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas , Adulto JovenRESUMEN
The persistence of neck scarring is a common concern among patients undergoing thyroidectomy. Botulinum toxin A (BTA (Botox)) has been shown to suppress scar enlargement at the incision site. The objective of this study was to evaluate the effect of intraoperative Botox administration on neck scarring after thyroidectomy. A prospective double-blind randomized clinical trial was performed in patients undergoing conventional thyroidectomy. Forty patients were randomly allocated to a Botox or a control group (both, n = 20). The wound was closed after injection into the platysma muscle of 50 U of Botox diluted in 1 mL of normal saline or 1 mL of saline alone. Skin scars were assessed using the modified Stony Brook Scar Evaluation Scale (SBSES) and Manchester Scar Scale (MSS) at 1, 12, and 24 weeks postoperatively. The SBSES and MSS scores of the Botox group were significantly better than those of the control group (p = 0.034 and p = 0.039). At 24 weeks postoperatively, the SBSES and MSS scores were significantly better in the Botox group (p = 0.006 and p = 0.030). BTA injected into the incision site can suppress postoperative scar formation and thereby improve the cosmetic outcome.
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BACKGROUND: During bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT), carbon dioxide (CO2) gas is insufflated into the operative cavity, not only triggering hemodynamic and metabolic changes, but also inducing postoperative pain and gas embolism. Here, we explored whether the new gasless BABA RoT approach was as safe and efficacious as conventional robotic surgery using CO2 insufflation. PATIENTS AND METHODS: We performed a prospective, randomized controlled trial comparing conventional BABA RoT to gasless BABA RoT (CO2 group, n = 14; gasless group, n = 14). All clinicopathological and oncological outcomes were evaluated. The hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and cardiac index (CI)] and metabolic parameters [partial pressure of carbon dioxide (PaCO2) and pH] were measured at baseline; 30, 60, 90, and 120 min after CO2 insufflation; and 30 min after desufflation. Pain parameters [numeric rating scale (NRS) score, number of analgesics (NA), and bottom hit count (BHC)] were measured at 2, 24, 48, and 72 h after surgery. RESULTS: We found no statistically significant differences between the two groups in terms of any demographic or baseline characteristic. The clinicopathological and oncological outcomes did not differ significantly between the two groups, but the operation time was longer for the gasless group (187.50 ± 42.64 vs. 212.50 ± 35.88 min; P = 0.028). In terms of the hemodynamic, metabolic, and pain parameters, the pH fell significantly less in the gasless group (P = 0.047), but there were no significant between-group differences in the HR, MAP, CO, CI, PaCO2, NRS, NA, or BHC. No safety concerns arose. CONCLUSION: The new, gasless BABA RoT technique employing the da Vinci robotic surgical system is safe. Although metabolic changes during operation are thereby minimized, gasless BABA RoT should be used carefully when engaging in thyroid surgery; more experience is required.
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Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Anciano , Axila , Mama , Femenino , Humanos , Insuflación , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: The aim of this study, from a surgical, oncological, and functional perspective, was to identify whether bilateral axillo-breast approach robotic total thyroidectomy (RTT) for differentiated thyroid cancer (DTC) has different surgical outcomes compared to open total thyroidectomy (OTT). METHODS: Initially, 796 patients who underwent total thyroidectomy were primarily reviewed and 178 who were ineligible for analysis were excluded. Propensity score matching analysis adjusted for clinicopathological characteristics (sex, age, body mass index, extent of central node dissection, tumor size, extrathyroidal extension, and thyroiditis) was conducted, with 246 patients in the OTT group matched with 123 patients in the RTT group. RESULTS: There were no significant differences in surgical outcomes in terms of surgical safety and oncological safety between the OTT and RTT groups, except in mean operation times (123.51 ± 32.63 vs. 198.39 ± 37.93 min, respectively; P < 0.001). However, the median parathyroid and laryngeal function recovery times were shorter in the RTT group than in the OTT group [88 ± 33.09 (95% CI: 23.148-152.852) vs. 100 ± 16.20 (95% CI: 68.242-131.768) days; P = 0.044 and 87 ± 32.40 (95% CI: 23.489-150.511) vs. 118 ± 49.50 (95% CI: 20.985-215.015) days; P = 0.002]. CONCLUSIONS: The recovery times of laryngeal and parathyroid function were significantly shorter in RTT patients than in OTT patients for DTC. To verify a definitive conclusion about the superiority of robotic total thyroidectomy in terms of parathyroid and laryngeal function recovery, further studies may be necessary.
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Puntaje de Propensión , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Disección del Cuello , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/fisiopatología , Resultado del TratamientoRESUMEN
Background. Fine-needle aspiration cytology (FNAC) is diagnostic standard for thyroid nodules. However, the influence of size on FNAC accuracy remains unclear especially in too small or too large thyroid nodules. The objective of this retrospective cohort study was to investigate the effect of nodule size on FNAC accuracy. Methods. All consecutive patients who underwent thyroidectomy for nodules in 2010 were enrolled. FNAC results (according to the Bethesda system) were compared to pathological diagnosis. The nodules were categorized into groups A-E on the basis of maximal diameter on ultrasound (≤0.5, >0.5-1, >1-2, >2-4, and >4 cm, resp.). Results. There were 502 cases with 690 nodules. Overall FNAC sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.4%, 98.2%, 99.4%, 86.4%, and 96.0%, respectively. False-negative rates (FNRs) of groups A-E were 3.2%, 5.1%, 1.3%, 13.3%, and 50%, respectively. Accuracy rates of groups A-E were 96.8%, 94.8%, 99%, 94.7%, and 87.5%, respectively. Conclusion. Although accuracy rates of FNAC in thyroid nodules smaller than 0.5 cm are comparable to the other group, thyroid nodules larger than 4 cm with benign cytology carry a higher risk of malignancy, which suggest that those should be considered for intensive follow-up or repeated biopsy.
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BACKGROUND: D-dimer levels are closely related to the clinical status of deep vein thrombosis (DVT). This study aimed to investigate the factors which were associated with the normalization of D-dimer level by vitamin K antagonist (VKA) therapy, the maintenance of normal D-dimer levels for 6 months during VKA therapy, and the recurrent elevations of D-dimer above normal level after VKA withdrawal, in DVT of the legs. METHODS: The 469 consecutive patients with first-episode leg swelling were examined. All blood tests were measured from the initially sampled blood before the administration of medications. RESULTS: Of the 469 patients, 288 (61.4%) showed positive D-dimer test. Radiologic examinations, including Doppler ultrasound and computed tomography venography, of the 288 patients revealed positive DVT of the legs in 135 (46.9%) patients and of these, 122 with total follow-up durations of >6 months were enrolled in this study. Linear regression analysis of 100 patients who experienced D-dimer normalization revealed initial D-dimer levels were positively correlated with D-dimer normalization time during VKA therapy (P = 0.010). Logistic regression analysis showed initial D-dimer level was negatively associated with the normalization of D-dimer levels by VKA therapy (P = 0.045), and being a woman (P = 0.005) and having lower protein C (P = 0.002) level had negative impacts on the maintenance of normal D-dimer levels for 6 months during VKA therapy. Finally, after VKA withdrawal, the recurrent elevations of D-dimer above normal level were more likely to occur in women than in men (P = 0.004). CONCLUSIONS: From these observations, it is suggested that higher initial D-dimer level, lower protein C level, and female gender may be the adverse risk factors for the treatment of DVT of the legs using VKA.
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Anticoagulantes/administración & dosificación , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Extremidad Inferior/irrigación sanguínea , Tromboembolia Venosa/sangre , Tromboembolia Venosa/tratamiento farmacológico , Trombosis de la Vena/sangre , Trombosis de la Vena/tratamiento farmacológico , Vitamina K/antagonistas & inhibidores , Warfarina/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Angiografía por Tomografía Computarizada , Esquema de Medicación , Femenino , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Imagen de Perfusión/métodos , Flebografía/métodos , Valor Predictivo de las Pruebas , Proteína C/metabolismo , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único , Resultado del Tratamiento , Ultrasonografía Doppler , Regulación hacia Arriba , Tromboembolia Venosa/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Warfarina/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: We evaluated the effects of ropivacaine for pain relief after robotic thyroid surgery. METHODS: One hundred eight patients scheduled for robotic thyroid surgery were randomized into ropivacaine (n = 54) or control (n = 54) groups. After surgery, 40 mL of 0.25% ropivacaine or 0.9% saline (control) was instilled into the skin flap. Postoperative pain intensity (visual analog scale [VAS]), analgesic requirements (fentanyl), and adverse events were assessed at 1, 2, 4, 8, 16, and 24 hours postoperatively. RESULTS: One hundred three patients completed the study protocol. VAS scores were lower in the ropivacaine group than the control group (p = .010); however, VAS scores were not significantly different after 8 hours postoperatively. Total analgesic consumption was higher in controls than ropivacaine-treated patients (p = .01). Adverse events did not differ between the 2 groups. CONCLUSION: Ropivacaine instillation after robotic thyroid surgery reduces acute postoperative pain and analgesic requirements without adverse events. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016.
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Amidas/uso terapéutico , Anestésicos Locales/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Procedimientos Quirúrgicos Robotizados , Neoplasias de la Tiroides/cirugía , Adulto , Analgésicos/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ropivacaína , Glándula Tiroides/cirugía , TiroidectomíaRESUMEN
PURPOSE: Primary thyroid lymphoma (PTL) is a rare disease and it has been investigated in a limited number of studies. The present multicenter study evaluated the clinical features and treatment outcomes of PTL. METHODS: The medical records of patients diagnosed with PTL between 2000 and 2013 in three centers were retrospectively reviewed. RESULTS: The study included 11 men and 27 women with a median age of 63.3 years (range, 42-83 years). The median follow-up was 56.0 months (range, 3-156 months). Of the 38 patients included, 16 had mucosa-associated lymphoid tissue (MALT) lymphoma, six had mixed MALT and diffuse large B-cell lymphoma (DLBCL), and 16 had DLBCL. Thirty-five patients (92.1%) had early stage (stage I/II) disease. Of the 16 MALT lymphoma patients, 14 were treated by surgery, and radiotherapy (RT) or chemotherapy was combined in five patients. Two patients received RT or chemotherapy alone. Of the six mixed MALT and DLBCL patients, three underwent surgery with chemotherapy and three underwent chemotherapy alone, RT alone, or surgery with RT. All of the 16 DLBCL patients received chemotherapy, and surgery and RT was combined in 4 and 1 patients, respectively. The 5-year survival was 100% for MALT lymphoma (7 of 7) and mixed MALT and DLBCL patients (5 of 5) and 87.5% for DLBCL patients (7 of 8). CONCLUSION: Early stage PTL has an excellent prognosis when managed by single or combined treatment modalities. Clinicians should consider PTL in patients with underlying Hashimoto's thyroiditis presenting with an enlarging thyroid mass.
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PURPOSE: Oncologic and surgical outcomes of bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) are comparable with those of open thyroidectomy (OT). We compared degree of scarring and psychological/physical distress between OT and BABA RoT. MATERIALS AND METHODS: Study included 129 cases of thyroidectomy (78 OT, 51 BABA RoT). Patients were evaluated by psychology consultant using 5-point scale questionnaire. RESULTS: BABA RoT was associated with lower degree of scarring than OT (7.8 vs. 11.7, P<0.001). Psychological distress immediately after operation and during surveillance period was higher in OT than in BABA RoT (3.1 vs. 2.6, P=0.009 and 2.4 vs. 1.9, P<0.001). Physical distress (pain and exercise limitation) did not differ between groups (2.5 vs. 2.6, P=0.321 and 2.0 vs. 1.9, P=0.0175). CONCLUSIONS: BABA RoT was associated with less scarring and psychological distress than OT. BABA RoT might be alternative for patients who are concerned about neck scar.
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Cicatriz/epidemiología , Complicaciones Posoperatorias/epidemiología , Robótica/métodos , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Enfermedades de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Anciano , Axila , Mama , Cicatriz/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/psicología , República de Corea/epidemiología , Estudios Retrospectivos , Estrés Psicológico/psicología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Radioiodine activity required for remnant thyroid ablation is of great concern, to avoid unnecessary exposure to radiation and minimize adverse effects. We investigated clinical outcomes of remnant thyroid ablation with a low radioiodine activity in Korean patients with low to intermediate-risk thyroid cancer. For remnant thyroid ablation, 176 patients received radioiodine of 1.1 GBq, under a standard thyroid hormone withdrawal and a low iodine diet protocol. Serum levels of thyroid stimulating hormone stimulated thyroglobulin (off-Tg) and thyroglobulin-antibody (Tg-Ab), and a post-therapy whole body scan (RxWBS) were evaluated. Completion of remnant ablation was considered when there was no visible uptake on RxWBS and undetectable off-Tg (<1.0 ng/mL). Various factors including age, off-Tg, and histopathology were analyzed to predict ablation success rates. Of 176 patients, 68.8% (n = 121) who achieved successful remnant ablation were classified into Group A, and the remaining 55 were classified into Group B. Group A presented with significantly lower off-Tg at the first radioiodine administration (pre-ablative Tg) than those of Group B (1.2 ± 2.3 ng/mL vs. 6.2 ± 15.2 ng/mL, P = 0.027). Pre-ablative Tg was the only significant factor related with ablation success rates. Diagnostic performances of pre-ablative Tg < 10.0 ng/mL were sensitivity of 99.1%, specificity of 14.0%, positive predictive value of 71.1%, and negative predictive value of 87.5%, respectively. Single administration of low radioiodine activity could be sufficient for remnant thyroid ablation in patients with low to intermediate-risk thyroid cancer. Pre-ablative Tg with cutoff value of 10.0 ng/mL is a promising factor to predict successful remnant ablation.
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Radioisótopos de Yodo/uso terapéutico , Glándula Tiroides/patología , Glándula Tiroides/efectos de la radiación , Neoplasias de la Tiroides/radioterapia , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , República de Corea , Tiroglobulina/sangre , Tiroglobulina/inmunología , Tirotropina/sangre , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The implementation of the Korean diagnosis-related groups (DRG) payment system has been recently introduced in selected several diseases including appendectomy in Korea. Here, we report the early outcomes with regard to clinical aspects and medical costs of the Korean DRG system for appendectomies in Seoul Metropolitan Government - Seoul National University Boramae Medical Center throughout comparing before and after introduction of DRG system. METHODS: The DRG system was applied since January 2013 at our institute. After the DRG system, we strategically designed and applied our algorithm for the treatment of probable appendicitis. We reviewed the patients who were treated with a procedure of appendectomy for probable appendicitis between July 2012 and June 2013, divided two groups based on before and after the application of DRG system, and compared clinical outcomes and medical costs. RESULTS: Total 416 patients were included (204 patients vs. 212 patients in the group before vs. after DRG). Shorter hospital stays (2.98 ± 1.77 days vs. 3.82 ± 1.84 days, P < 0.001) were found in the group after DRG. Otherwise, there were no significant differences in the perioperative outcomes and medical costs including costs for first hospitalization and operation, costs for follow-up after discharge, frequency of visits of out-patient's clinic or Emergency Department or rehospitalization. CONCLUSION: In the Korean DRG system for appendectomy, there were no significant differences in perioperative outcomes and medical costs, except shorter hospital stay. Further studies should be continued to evaluate the current Korean DRG system for appendectomy and further modifications and supplementations are needed in the future.
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BACKGROUND: The behavior and optimal management of papillary thyroid microcarcinomas (PTMCs) after thyroidectomy remain unclear. The purpose of this study was to compare the clinicopathologic features and tumor recurrence rates of patients with PTMCs ≤5 mm and >5 mm in diameter after total thyroidectomy. METHODS: A group of patients with PTMCs ≤5 mm (n=83) has been compared to a group with >5 mm (n=122). All of these patients had conventional type PTMCs and were followed up for 5 years. Both the histology and the outcome have been compared. RESULTS: Sex (p=.014) and extrathyroidal extension (p=.003) of patients in the ≤5 mm and >5 mm groups differed significantly. Two and 5 patients from these groups, respectively, experienced tumor recurrence within 5 years (2.4% vs 4.1%; p=.634). CONCLUSION: The clinicopathologic features of PTMCs ≤5 mm and >5 mm are similar, except for sex distribution and extrathyroidal extension. The 5-year recurrence rate in the 2 groups did not differ significantly.
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Carcinoma Papilar/patología , Ganglios Linfáticos/patología , Recurrencia Local de Neoplasia/patología , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Carga Tumoral , Adulto , Biopsia con Aguja , Carcinoma Papilar/mortalidad , Carcinoma Papilar/cirugía , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Ganglios Linfáticos/cirugía , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , República de Corea , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Tasa de Supervivencia , Neoplasias de la Tiroides/mortalidad , Tiroidectomía/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: More than 8,000 cases of robotic thyroidectomy (RoT) were performed in South Korea from 2007 to 2011 using either a transaxillary approach (TAA) or a bilateral axillo-breast approach (BABA). However, there is no consensus regarding patient selection for RoT. This study used a web-based survey questionnaire to examine the current status of RoT in South Korea. METHODS: Thirty-two of 50 surgeons (64.0 %) who had performed RoT in South Korea participated in the web-based survey in August 2011. The questionnaires comprised four main domains: surgeon characteristics, surgical approach, patient selection, and future prospects. RESULTS: In terms of surgical approach, 43.8 % respondents used the TAA method and 53.1 % used the BABA method. The main advantage cited by surgeons using the TAA method was that it made lateral lymph node dissection easier (35.7 %), whereas those using the BABA method cited more cosmesis (100 %) and ease of performing a contralateral thyroidectomy (88.2 %). Papillary thyroid cancer ≤2 cm (65.3 %), intracapsular lesion (76.7 %), nonposterior location (53.6 %), and no clinical evidence of lateral lymph node metastasis (76.7 %) were cited as main indications for RoT. Of respondents, 87.5 % agreed that RoT would play a future role as a treatment modality for thyroid disease. CONCLUSIONS: Opinions differed regarding the advantages and disadvantages of two approaches for RoT. This may be due to differences in surgical procedure itself between two approach methods. Accumulation of RoT surgeon's experiences might establish consensus regarding patient selection and indications for the RoT will need to be further investigated.
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Carcinoma/cirugía , Escisión del Ganglio Linfático/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Axila , Mama , Carcinoma/patología , Carcinoma/secundario , Carcinoma Papilar , Encuestas de Atención de la Salud , Humanos , Internet , Curva de Aprendizaje , Metástasis Linfática , Selección de Paciente , Pautas de la Práctica en Medicina , República de Corea , Procedimientos Quirúrgicos Robotizados/educación , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/patología , Tiroidectomía/educaciónRESUMEN
OBJECTIVE: Follicular variant of papillary thyroid carcinoma (FVPTC) is a common variant of papillary thyroid carcinoma (PTC), but the association between BRAF mutation and the clinicopathological and ultrasonographical characteristics of FVPTC has not been well studied. The aim of this study was to determine the significance of BRAF mutation in FVPTC. PATIENTS: The medical records of the 137 patients with >5 mm FVPTCs and known BRAF mutation status in the interested nodule were reviewed. BRAF mutation analysis was performed routinely and prospectively by Sanger sequencing. Clinicopathological and ultrasonographical characteristics were compared between BRAF mutation-positive and BRAF mutation-negative groups. RESULTS: BRAF mutation was detected in 35 (25·5%) patients. The BRAF mutation-positive group was associated with smaller tumour size (P = 0·022), extrathyroidal extension (P = 0·001), multifocality (P = 0·046) and higher (III/IV) TNM stages (P = 0·005). In multivariable analysis, higher (III/IV) TNM stage was an independent predictive factor for BRAF mutation-positive status (adjusted OR 2·966, 95% CI 1·321-6·663). In diagnosis of FVPTC, the presence of BRAF mutation was associated with malignant features on ultrasonography (P < 0·001) and higher incidence of suspicious for malignancy or malignant diagnosis on the fine needle aspiration cytology (P = 0·023). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US for detecting BRAF mutation were 82·9%, 57·8%, 40·3%, 90·8% and 64·2%, respectively. Conclusions BRAF mutation in FVPTC is associated with unfavourable clinicopathological characteristics and malignant features on ultrasonography and may be a potential prognostic factor as it is in classical PTC.
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Carcinoma Papilar Folicular/diagnóstico por imagen , Carcinoma Papilar Folicular/genética , Carcinoma/genética , Proteínas Proto-Oncogénicas B-raf/genética , Neoplasias de la Tiroides/genética , Adulto , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Carcinoma Papilar , Carcinoma Papilar Folicular/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mutación , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , UltrasonografíaRESUMEN
BACKGROUND: Delphian lymph node (DLN) metastasis is a recognized indicator of further lymph node involvement in papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the clinicopathological significance of and risk factors for DLN metastasis. METHODS: The medical records of 1,436 patients who underwent primary thyroidectomy for classical PTC with a tumor size of 2 cm or less were reviewed. Of these, 370 patients from whom the DLN was harvested were enrolled. Metastasis in DLN was present in 46 patients and absent in 324 patients. Clinicopathological features were compared according to DLN metastasis. RESULTS: In univariate analysis, DLN metastasis was associated with suspected lymph node metastasis on preoperative ultrasonography, tumor location in the isthmus or upper third of the thyroid, larger tumor size, extrathyroid extension, lymphovascular invasion, and further lymph node metastasis. Multivariable analysis revealed that DLN metastasis was associated with tumor location in the isthmus or upper third of the thyroid (odds ratio [OR] = 2.420; 95 % confidence interval [CI] 1.193-4.910) and further lymph node metastasis (OR = 4.746; 95 % CI 2.065-10.908). CONCLUSIONS: DLN metastasis in PTC is associated with tumor location in the isthmus or upper third of the thyroid and unfavorable clinicopathological characteristics. Careful consideration and patient management are warranted when preoperative ultrasonography indicates that the tumor is located in the isthmus or upper third of the thyroid.
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Carcinoma/secundario , Ganglios Linfáticos/patología , Recurrencia Local de Neoplasia/patología , Glándula Tiroides/patología , Neoplasias de la Tiroides/patología , Adulto , Análisis de Varianza , Biopsia con Aguja , Carcinoma/diagnóstico por imagen , Carcinoma/cirugía , Carcinoma Papilar , Estudios de Cohortes , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Invasividad Neoplásica/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Oportunidad Relativa , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Medición de Riesgo , Cáncer Papilar Tiroideo , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/secundario , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
BACKGROUND: The purposes of the present study were to assess (1) the correlation between the weight of the postoperative thyroid specimen and the spiral computed tomography (CT) volumetry results of the thyroid gland in patients with Graves' disease, and (2) the utility of CT volumetry for determining the operative approach. METHODS: From 2009 to 2010, a total of 56 patients with Graves' disease underwent total or subtotal thyroidectomy. An enhanced spiral CT was taken in all patients prior to the operation. From 2.5 mm-thick slices of the thyroid gland, the surface area was calculated to measure the volume of the thyroid gland. The glandular volume was compared to the weight of the postoperative thyroid specimen. RESULTS: A total of 42 and 14 patients underwent total and subtotal thyroidectomy, respectively. The mean weight of the postoperative thyroid specimen was 43.9 ± 33.4 g, and the mean volume obtained by CT volumetry was 44.2 ± 32.8 mL. A good correlation was observed between the weight of the postoperative thyroid specimen and the volume calculated by CT (r = 0.98, p < 0.001). When 100 mL was set as the higher cut-off value of the thyroid volume for minimally invasive thyroid surgery, the estimated blood loss showed a significant difference between the >100 mL and the ≤100 mL groups (608.3 ± 540.8 vs. 119.7 ± 110.4 mL; p = 0.036). CONCLUSIONS: Spiral CT volumetry may be used to measure the thyroid volume reliably in patients with Graves' disease. For cases in which surgery is indicated in patients with Graves' disease, CT volumetry provides useful information from which to determine the operative approach. One hundred milliliter or less of thyroid volume in CT volumetry is recommended to perform minimally invasive thyroid surgery.
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Tomografía Computarizada de Haz Cónico , Enfermedad de Graves/diagnóstico por imagen , Cuidados Preoperatorios/métodos , Tiroidectomía/métodos , Tomografía Computarizada Espiral , Adolescente , Adulto , Anciano , Femenino , Enfermedad de Graves/patología , Enfermedad de Graves/cirugía , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Adulto JovenRESUMEN
BACKGROUND: On occasion, a microscopic anaplastic focus (MAF) is discovered in papillary thyroid carcinoma (PTC). The relevance of MAF has not been well studied with regard to its clinical implications. MAF is defined as the microscopic presence of focally dedifferentiated follicular cells within the PTC. METHODS: A total of 3,606 patients who underwent primary thyroid surgery between 1995 and 2007 were selected from the database of Seoul National University Hospital. Patients were divided into 3 groups based on histology: PTC without MAF (3,574 patients), PTC with MAF (13 patients), and anaplastic thyroid carcinoma (19 patients). RESULTS: Mean ± standard deviation age was 48 ± 12 years (range, 17-83) in the PTC without MAF group, 57 ± 14 years (range, 29-76) in the PTC with MAF group, and 64 ± 14 years (range, 24-86) in the ATC group (P < .001). Mean tumor sizes were 1.2 ± 0.9 cm (range, 0.5-13), 2.1 ± 1.2 cm (range, 0.7-5), and 3.7 ± 1.4 cm (range, 0.4-6), respectively (P < .001). The median follow-up was 32 months. The cause-specific survival at 5 years was 98% in the PTC without MAF group, 64% in the PTC with MAF group, and 11% in the ATC group (P < .001). Multivariate analysis showed that MAF was a prognostic factor for the outcome of PTC patients (hazard ratio, 12.9; 95% confidence interval, 3.1-54.1; P < .001). CONCLUSION: MAF negatively influenced the prognosis of patients with PTC. Further research and the design of more aggressive treatment strategies for MAF might be helpful for patients with PTC.
Asunto(s)
Carcinoma/patología , Neoplasias de la Tiroides/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/mortalidad , Carcinoma Papilar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/mortalidadRESUMEN
BACKGROUND: Bilateral axillo-breast approach (BABA) robotic thyroidectomy has shown excellent cosmetic and surgical outcomes. The aim of the present study was to evaluate the safety, feasibility, and initial outcome of this procedure in patients with Graves' disease. METHODS: From June 2008 to July 2001, a total of 30 patients with Graves' disease were reviewed retrospectively. Patient demographics, operative indications, and surgical variables, including operative time, blood loss, excised thyroid weight, and complications, were collected and investigated. RESULTS: The thyroidectomies were classified as total (n = 21), near-total (n = 6), or subtotal (n = 3). There were five indications for surgery: concomitant thyroid carcinoma or suspicious nodule (n = 22), recurrence after antithyroid medication (n = 2), local compressive symptoms (n = 1), patient's preference (n = 4), and side effects of antithyroid medication (n = 1). The mean operative time, console time, blood loss, and excised thyroid weight were 190 min (range: 105-298 min), 113 min (range: 60-227 min), 229 mL (range: 50-550 mL), and 36.6 g (range: 7.8-123.0 g), respectively. There were no cases of postoperative bleeding or conversions to open surgery. Postoperative transient hypoparathyroidism and vocal cord palsy occurred in 13 (43.3 %) and 4 (13.3 %) cases. Permanent hypoparathyroidism occurred in 1 (3.3 %) case. All patients were satisfied with the cosmetic outcomes. CONCLUSIONS: BABA robotic thyroidectomy is a feasible and safe treatment for Graves' disease. It is recommended as an alternative for patients who are concerned by the cosmetic effects of traditional thyroidectomy.
Asunto(s)
Endoscopía/métodos , Enfermedad de Graves/cirugía , Robótica , Tiroidectomía/métodos , Adulto , Axila , Mama , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Good postoperative and excellent cosmetic results have been achieved with bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT). This study was performed to analyze the surgical outcomes and evaluate the surgical completeness and safety of BABA RoT. METHODS: Between February 2008 and February 2012, a total of 1026 cases of BABA RoT were performed. The clinicopathologic characteristics, operation types, and postoperative outcomes of patients were analyzed. RESULTS: Of the 1026 cases analyzed, 968 cases were a malignant tumor and 58 cases were benign thyroid disease. Mean operating times for BABA total RoT with central lymph node dissection included 38 ± 13 min (range 20-90 min) of working space creation and 75 ± 26 min (range 25-175) of console time. Among the 872 patients who underwent total thyroidectomy with central lymph node dissection, transient hypoparathyroidism occurred in 39.1 %, transient vocal cord palsy occurred in 14.2 %, and permanent hypoparathyroidism and permanent vocal cord palsy occurred in 1.5 % and 0.2 % of patients, respectively. The median stimulated thyroglobulin (Tg) level of patients after their first radioactive iodine therapy was 0.4 ng/mL, with 65.1 % of patients having a stimulated Tg level of <1.0 ng/mL. The median suppressed Tg level at 3 postoperative months of patients without radioactive iodine therapy was <0.1 ng/mL, with 99.4 % of patients showing a suppressed Tg level of< 1.0 ng/mL. There was no recurrence or mortality after a median follow-up of 23 months. CONCLUSIONS: BABA RoT is a safe and effective method that provides good surgical completeness and has low rates of postoperative complications and recurrence.
Asunto(s)
Robótica , Enfermedades de la Tiroides/cirugía , Tiroidectomía/métodos , Adolescente , Adulto , Anciano , Axila , Mama , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The bilateral axillo-breast approach for endoscopic/robotic thyroid surgery (BABA) shows good oncologic and surgical outcomes and does not result in neck scars. However, there is concern about potential sensory changes of the skin flaps after BABA, especially of the breast areas. This prospective study was undertaken to evaluate sensory changes in the skin flaps after BABA. PATIENTS AND METHODS: A total of 19 women (mean age 36.9 ± 8.7; age range 21-51 years) who underwent BABA were enrolled. Skin flap sensory assessments were performed for each patient preoperatively and again at 1 and 3 months postoperatively. The Semmes-Weinstein monofilament test was used to evaluate the cutaneous light-pressure thresholds, a biothesiometer was used to evaluate the vibration thresholds, and an infrared thermometer was used to measure skin temperatures of the skin flaps. RESULTS: There were changes in the sensations of the anterior chest areas over time, as determined by the Semmes-Weinstein monofilament test (1.5 vs 4.3 versus 1.4; P < 0.05) and the biothesiometer (26.8 vs 31.2 vs 22.3; P < 0.05). The sensations in the anterior chest areas normalized to preoperative levels at 3 months postoperatively. No significant differences were seen in the infrared thermometer test at any of the time points (36.2 vs 36.2 vs 36.3 °C; P = 0.9927). CONCLUSIONS: While anterior chest area sensations were changed at 1 month postoperatively, the sensations normalized at 3 months after BABA. These results suggest that BABA has minimal adverse effects on anterior chest area sensation.