Introduction of day care thyroid surgery in a Dutch non-academic hospital.

OBJECTIVE: Hemithyroidectomy is the most common endocrine surgical procedure and is performed with low complication rates. Multiple international reports indicate that thyroid surgery in the day care setting is feasible and safe. Despite these results, day care thyroid surgery has not yet been implemented in the Netherlands. The objective of this study is to assess the safety of thyroid surgery in our institution and, when deemed safe, implement day care thyroid surgery. METHODS: All patients who underwent hemithyroidectomy in our institution between January 2010 and December 2014 were included in the retrospective analysis. Hypothetical candidates for day care surgery were identified. All patients undergoing thyroid surgery in 2015 were included in a prospective cohort. Data regarding baseline characteristics, surgical procedures, complications and adherence to the day care schedule are presented. RESULTS: A total of 210 patients were included in the retrospective cohort; 149 patients complied with the day care criteria. No complications occurred that would prevent day care surgery, or make it unsafe. Day care thyroid surgery was implemented from January 2015. In one year 43 patients underwent hemithyroidectomy. Thirty-one patients were eligible for day care surgery of which 18 patients were treated in day care. Failure of the day care regimen was due to the patient's own choice (n = 5), large retrosternal goitre (n = 2) or failure of logistics (n = 6). Besides transient hoarseness, no complications occurred in this group. CONCLUSION: Based on a retrospective safety analysis we successfully introduced day care thyroid surgery in our clinic. Hemithyroidectomy can safely be conducted in day care setting. However, patient selection is of vital importance to minimise the risk of complications.

Lymph node metastasis after a soft tissue sarcoma of the leg: a case report and a review of the literature.

Introduction. Soft tissue sarcomas (STSs) represent 1 percent of all adult malignancies and sarcomas only rarely spread to the regional lymph nodes. Case Presentation. We present a case of a woman with a dermatofibrosarcoma protuberans and a sarcoma not therwise specified of the lower extremity. The patient had no distant metastasis during follow-up, but did develop a regional lymph nodemetastasis (RLNM) in the groin. We reviewed the literature about RLNM in STSs. Discussion. Reviewing the literature we see that within specific histological types RLNM occurs as often as distant metastasis. Furthermore RLNM occurs in over 10% for specific histological types and in 24% of all patients with a soft tissue sarcoma of the lower extremity. Except for radical lymphadenectomy with a 5-year survival rate of 46% there is no appropriate treatment. Conclusion. The risk for a RLNM in certain histological types and anatomical locations might transcend the risk for a distant lung metastasis.

Prevention of futile sentinel node procedures in breast cancer: ultrasonography of the axilla and fine-needle aspiration cytology are obligatory.

AIMS: To determine the value of ultrasonography (US) and fine-needle aspiration (FNA) of the axilla in preventing futile sentinel node procedures (SNP) in breast cancer. METHODS: Between July 2004 and June 2005, 209 female patients were evaluated and treated in our clinic for histologically proven breast carcinoma. We analysed the results of axillary staging by US and FNA retrospectively. Furthermore, we correlated the histopathologic outcome of operative procedures with the preoperative findings during examination of the axilla. RESULTS: Of the 209 patients, 195 underwent US of the axilla. In 67 patients, US was followed by FNA because of suspect lymph nodes in the axilla. Ninety-three of these 195 patients had axillary metastases. In 52 of these 93 patients, the metastases were detected prior to surgery, so that these 52 patients could be scheduled immediately for axillary lymph node dissection (ALND) and a futile SNP could be prevented. US/FNA yielded false-negative results in 41 cases, 13 of which had only a micrometastasis. CONCLUSIONS: By preoperative US and FNA of the axilla in patients with breast cancer, half of the axillary metastases can be detected prior to surgery. In more than a quarter of breast cancer patients, a futile SNP can be prevented. Therefore, preoperative US of the axilla plus FNA are obligatory in patients with breast carcinoma.