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1.
Anticancer Res ; 40(2): 1127-1133, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32014964

RESUMEN

AIM: To investigate the association between survival outcomes and clinicopathological factors, including pathological restaging based on the UICC8th, among patients with recurrence differentiated thyroid carcinoma undergoing salvage surgery of local site. PATIENTS AND METHODS: A total of 54 patients who underwent salvage surgery of local site for recurrence differentiated thyroid carcinoma were enrolled. The optimal cutoff ages at salvage surgery for predicting death and cancer-specific death were determined by receiver operating curve analysis. Overall and cancer-specific survivals were determined using log-rank test and Cox's proportional hazards model. RESULTS: Univariate analysis showed that age and the presence of distant metastasis at salvage surgery were significantly associated with overall survival (p=0.01 and p<0.05, respectively) and cancer-specific survival (p=0.02 and p=0.01, respectively). The optimal cutoff age at salvage surgery for predicting the detection of both death (p=0.01) and cancer-specific death (p=0.02) was 65 years. Multivariate analysis showed that age ≥65 years and the presence of distant metastasis were significantly associated with shorter overall survival (p<0.01 and p=0.03, respectively) and shorter cancer-specific survival (p<0.01 and p=0.01, respectively). CONCLUSION: Older age and the presence of distant metastasis at salvage surgery of local site were identified as predictors for poor survival outcomes in recurrence differentiated thyroid carcinoma.


Asunto(s)
Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Curva ROC , Terapia Recuperativa , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Adulto Joven
2.
Medicine (Baltimore) ; 99(6): e19073, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028431

RESUMEN

BACKGROUND: This systematic review and meta-analysis collected data for evaluating the effect of surgical extent on overall survival (OS) and recurrence-free survival (RFS) in patients with papillary thyroid cancer (PTC). METHODS: We searched the PubMed, Embase, and Cochrane Library databases. The included studies compared two groups of patients with PTC: the total thyroidectomy (TT) group and the lobectomy (LT) group. The combined hazard ratio (HR) was calculated. RESULTS: Thirteen studies were included in the present study. The TT and LT groups had similar OS results (HR = 1.04; 95% CI: 0.90-1.21; P = .60). In the subgroup analysis, the combined HR of the ≤1 cm group and the 1.0 to 2.0 cm group showed that TT had no advantage with regard to OS compared to LT. In the 2.0 to 4.0 cm group, TT provided better OS than LT (HR = 0.88; 95% CI: 0.79-0.99; P = .03). Patients who underwent TT had a better RFS outcome than those who underwent LT (HR = 0.56; 95% CI: 0.41-0.77; P < .0001). In the subgroup analysis, both the ≤1 cm group and >1 cm group that underwent TT were associated with better RFS. CONCLUSIONS: Our meta-analysis suggested that LT increased the risk of recurrence in PTC patients with tumors ≤1.0 cm and in PTC patients with tumors >1.0 cm. More importantly, LT was associated with higher mortality in PTC patients with 2.0 to 4.0 cm tumors. Caution is warranted when LT is performed in this group of patients.


Asunto(s)
Cáncer Papilar Tiroideo/cirugía , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Supervivencia sin Enfermedad , Humanos , Análisis de Supervivencia , Cáncer Papilar Tiroideo/mortalidad , Neoplasias de la Tiroides/mortalidad
3.
Artículo en Chino | MEDLINE | ID: mdl-32074752

RESUMEN

Objective: To compare the efficacies of the two techniques of "micro-hemostasis and micro-cutting" with straight bipolar electrocoagulation forceps and traditional clamp-ligation for hemostasia in thyroid surgery. Methods: A total of 228 patients who underwent surgical treatment for thyroid neoplasms in our hospital between January 2015 and December 2018 were retrospectively analyzed, including 50 males and 178 females, aged 23-68 years old. Of those, 150 cases as electric knife group received traditional thyroid surgery between January 2015 and December 2018 and 78 cases as bipolar electrocoagulation group received thyroid surgery by using the technique of bipolar electrocoagulation with meticulous anatomy between January 2018 and December 2018. The total operation time, single operation time, intraoperative hemorrhage, postoperative drainage volume on the first day, postoperative hoarseness and hypocalcemia were compared between the two groups. SPSS 16.0 was used to analyze the data. Results: The total operation time and intraoperative hemorrhage in the bipolar electrocoagulation group were significantly lower than those in the electric knife group ((59.33±18.29)min vs (77.21±25.39)min, (14.83±9.22)ml vs (36.86±11.80)ml, all P<0.01). The single operation time of the bipolar electrocoagulation group was shorter than that of the electric knife group((10.25±6.16) min vs (20.34±7.24)min, (16.25±7.15)min vs (35.68±8.25)min, (12.12±5.25)min vs (20.68±7.26)min, t value was 3.948,16.262,8.238, all P<0.01).There was no significant difference between the two groups in postoperative drainage volume on the first day (P>0.05) and the incidence of postoperative hoarseness (P>0.05), while the incidence of hypocalcemia in the bipolar electrocoagulation group(10.26%) was lower than that in the electric knife group(21.33%,χ(2)=4.353, P<0.05). Conclusions: The fine dissection for thyroid operation can be achieved by using straight bipolar electrocoagulation tweezers. The use of "micro-hemostasis" and "micro-cutting" technique with bipolar electrocoagulation tweezers can greatly reduce intraoperative bleeding, operation time and postoperative complication.


Asunto(s)
Electrocoagulación , Instrumentos Quirúrgicos , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
4.
Artículo en Chino | MEDLINE | ID: mdl-32086925

RESUMEN

Objective:The aim of this study is to evaluate the application of carbon nanoparticle lymphatic tracer in total thyroidectomy and bilateral Central District's thyroidectomy for papillary thyroid carcinoma. Method:Sixty-four patients with cN0 papillary thyroid carcinoma that primary treated were random divided into two groups: Trial group and control group. Carbon nanoparticles suspension was injected into the thyroid gland of trial group patients.After ten minutes, total thyroidectomy plus bilateral central neck dissection was performed in the all patients. The black stained tissue in the dissection specimen of trial group was separated. The control group underwent total thyroidectomy plus bilateral central neck dissection. Total lymph node and parathyroid gland in the black stained tissue,and non-black stained tissue in the central compartment dissection specimen of trial group and central compartment dissection specimen of control group were counted respectively.Total lymph node, the mis-cut parathyroid glands in the adipose tissue of central lymph node,post-operative blood calcium and parathyroid hormone(PTH)of two groups were contrasted and analyzed. Result:There are 235 lymph nodes in the black-stained tissue of central compartment dissection specimen of trial group.No parathyroid gland was found in the black-stained tissue.Five lymph nodes and 2 parathyroid glands were found in the non-black stained tissue of central compartment dissection specimen of trial group. There were 164 lymph nodes and 9 parathyroid glands in central compartment dissection specimen of control group. There is statistic difference between the number of lymph nodes in black stain tissue and that of control group(t=8.291, P=0.000).Rate of staining lymph node were 97.9 percent. No parathyroid glands were found in the black stained tissue. Nine mis-cut parathyroid glands(7.0%) were observed in the control group,while 2(1.6%) in the trial group(P<0.05).None permanent hypocalcemia and PTH decrease were observed in the two groups.There were 10 patients(31.3%) with temporary hypocalcemia and 9 patients(28.1%)with temporary PTH decrease respectively in the control group,and there was 1 patient(3.1%) and 1 patient(3.1%) respectively in the trial group(P<0.05). Conclusion:The effect of nano-carbon is ideal, and the parathyroid gland can not be stained black. It can distinguish the thyroid tissue from the surrounding lymphoid adipose tissue and clearly mark the Central District lymph nodes, reduce the risk of parathyroid gland injury during thyroid cancer. Neck dissection in the central region can improve the efficiency of lymph node dissection, protect the parathyroid gland and reduce the risk of postoperative complications.


Asunto(s)
Nanopartículas , Coloración y Etiquetado , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Carbono , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos , Disección del Cuello , Estudios Retrospectivos
5.
BMC Surg ; 20(1): 4, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31907042

RESUMEN

BACKGROUND: To evaluate the efficacy of a sensitive, real-time tool for identification and protection for parathyroid glands during thyroidectomy. METHODS: Near-infrared (NIR) auto-fluorescence was measured intraoperatively from 20 patients undergoing thyroidectomy. Spectra were measured from suspicious parathyroid glands and surrounding neck tissues during the operation with a NIR fluorescence system. Fast frozen sections were performed on the suspicious parathyroid glands. Accuracy was evaluated by comparison with histology and NIR identification. Data were attracted for Fisher's linear discriminant analysis. RESULTS: The auto-fluorescence intensity of parathyroid was significantly higher than that of thyroid, fat and lymph node. The peak intensity of auto-fluorescence from parathyroid was 5.55 times of that from thyroid at the corresponding wave number. Of the 20 patients, the parathyroid was accurately detected and identified in 19 patients by NIR system, compared with their histologic results. One suspicious parathyroid did not exhibit typical spectra, and was proved to be fat tissue by histology. The NIR auto-fluorescence method had a 100% sensitivity of parathyroid glands identification and a high accuracy of 95%. The positive predictive value was 95%. The parathyroid gland have specific auto-fluorescence spectrum and can be separated from the other three samples through the Fisher's linear discriminant analysis. CONCLUSIONS: NIR auto-fluorescence spectroscopy can accurately identify normal parathyroid gland during thyroidectomy. The Fisher's linear discriminant analysis demonstrated the specificity of the NIR auto-fluorescence of parathyroid tissue and its efficacy in parathyroid discrimination.


Asunto(s)
Glándulas Paratiroides/diagnóstico por imagen , Espectrometría de Fluorescencia/métodos , Espectroscopía Infrarroja Corta/métodos , Cirugía Asistida por Computador/métodos , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Anciano , Análisis Discriminante , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Curva ROC , Neoplasias de la Tiroides/diagnóstico
6.
J Surg Res ; 246: 535-543, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31711613

RESUMEN

BACKGROUND: A growing body of evidences shows that systemic inflammatory responses are involved in patient prognosis in multiple cancers. Combinations of peripheral leukocyte fractions have been shown to be useful markers for the inflammatory responses. However, significance of such systemic inflammatory responses is still unknown in thyroid cancer. Accordingly, we aimed to clarify clinical impact of peripheral leukocyte fractions in papillary thyroid cancer (PTC). METHODS: Clinicopathological analyses were performed including preoperative leukocyte fractions in 570 patients with curatively resected PTC. Receiver operating characteristic curves were used to determine cutoffs of leukocyte fraction or inflammation indexes such as lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio. A Kaplan-Meier analysis and a Cox's proportional hazard model were used to conduct prognostic analysis. A multivariable logistic regression analysis was performed for correlation assay. RESULTS: Preoperative low LMR predicted recurrence with high sensitivity (63.3%) and specificity (68.7%) (P = 0.002). The multivariable prognostic analyses revealed that preoperative low LMR (P = 0.025), pathological N1b (P = 0.019), high metastatic lymph node ratio (node density) (P = 0.014), and high thyroglobulin level (P = 0.002) independently predicted worse prognosis. The combination of these independent parameters clearly enriched high-risk patients (P < 0.001). Of note, low LMR was dramatically associated with recurrence especially in patients with advanced PTC. CONCLUSIONS: Preoperative low LMR dramatically predicts high-risk patients for recurrences. The results in this study give rational to focusing on immune cell profiles to tackle advanced PTC.


Asunto(s)
Linfocitos , Monocitos , Recurrencia Local de Neoplasia/diagnóstico , Cáncer Papilar Tiroideo/sangre , Neoplasias de la Tiroides/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/prevención & control , Periodo Preoperatorio , Pronóstico , Curva ROC , Estudios Retrospectivos , Cáncer Papilar Tiroideo/mortalidad , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Adulto Joven
7.
Ann R Coll Surg Engl ; 102(2): e33-e35, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31530165

RESUMEN

Spindle epithelial tumour with thymus-like differentiation (SETTLE) is a very rare neck malignancy arising from thymic tissue or branchial pouch, mostly seen in the early decades of life. SETTLE is thought to be a low-grade neoplasm but distant metastases have been reported. Fewer than 50 cases have been reported in the PubMed database. We report on the four-year follow-up for a 13-year-old boy, with no signs of recurrence or distant metastasis. In addition, a 45-year-old woman was admitted to hospital with neck mass. Fine-needle aspiration biopsy was compatible with medullary thyroid carcinoma but serum levels of calcitonin were normal. Total thyroidectomy and central compartment lymph node dissection was planned with an initial diagnosis of medullary thyroid carcinoma. At surgery, frozen section analysis converted our diagnosis to SETTLE and the intraoperative strategy was changed. SETTLE should be considered in a patient with normal serum calcitonin levels in the presence of suspicious medullary thyroid carcinoma at fine-needle aspiration biopsy. Frozen section analysis may help to manage the intraoperative strategy. This report describes the first case of SETTLE successfully diagnosed by frozen section analysis.


Asunto(s)
Neoplasias de Células Germinales y Embrionarias/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Adolescente , Biomarcadores de Tumor/sangre , Biopsia con Aguja Fina , Calcitonina/sangre , Carcinoma Neuroendocrino/diagnóstico , Diferenciación Celular , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Secciones por Congelación , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos
8.
Ann R Coll Surg Engl ; 102(3): e63-e66, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31841033

RESUMEN

Calcitonin-negative medullary thyroid carcinoma is a rare, poorly understood primary neuroendocrine carcinoma of the thyroid characterised by classic medullary thyroid carcinoma morphology without raised serum calcitonin. A 24-year-old woman presented with a slow-growing, right-sided neck swelling. She underwent an ultrasound scan, cytopathological and histopathological examination, and tests for alternative diagnoses. The ultrasound showed a heterogeneous, hyperechoic nodule in the right thyroid lobe. Serum calcitonin was normal. Cytopathology and histopathology showed typical medullary thyroid carcinoma morphology but without calcitonin upon immunostaining and mRNA in situ hybridisation. A 'triple-negative' calcitonin-negative medullary thyroid carcinoma was diagnosed. A completion thyroidectomy with bilateral central lymph node dissection was performed. The patient remains well three-years post-surgery. When cytopathology suggests a medullary thyroid carcinoma, serum calcitonin, pro-calcitonin, carcinoembryonic antigen and calcitonin-gene-related peptide should be measured to identify cases of calcitonin-negative medullary thyroid carcinoma. They should also be measured post-treatment for monitoring purposes. This will aid future calcitonin-negative medullary thyroid carcinoma diagnoses and will inform prognostic stratification and influence treatment decisions.


Asunto(s)
Calcitonina/sangre , Carcinoma Neuroendocrino/sangre , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/sangre , Biomarcadores de Tumor/sangre , Biopsia , Carcinoma Neuroendocrino/diagnóstico , Carcinoma Neuroendocrino/cirugía , Femenino , Humanos , Fenotipo , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Tomografía Computarizada por Rayos X , Ultrasonografía , Adulto Joven
9.
Ann R Coll Surg Engl ; 102(1): 43-48, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31865760

RESUMEN

INTRODUCTION: The diagnostic performance of ultrasound-fine needle aspiration to identify thyroid nodules harbouring malignancy remains variable. The aim of this study was to determine thyroid nodule size and cytological classification as predictors of malignancy risk. MATERIALS AND METHODS: We conducted a retrospective cohort analysis at an academic hospital involving 499 consecutive patients who underwent thyroid surgery between 2004 and 2015. RESULTS: A total of 503 thyroid nodules (499 patients, 84% female; mean age 50.8 years, standard deviation, SD, 15.4 years) were analysed. Of these, 19.5% were malignant. The mean (± SD) nodule size was 3.28 ± 1.63 cm and 3.27 ± 1.54 cm for benign and malignant nodules, respectively. The odds of malignancy for thyroid nodules less than 3.0 cm was similar to those for nodules of 3.0 cm or greater (0.26 compared with 0.29; p=0.77). Overall, the sensitivity and specificity of fine-needle aspiration in this cohort were 71.4% and 100%, respectively. The overall false negative rate was 5.4%. When the cut-off of 3.0 cm was used, the false negative rate in thyroid nodules less than 3.0 cm was 0% compared with 7.0% in nodules of 3.0 cm or greater. Thus, class (p<0.01) but not nodule size (p=0.49), was associated with higher malignancy risk. CONCLUSIONS: Our results suggest that thyroid nodule size did not accurately predict the risk of thyroid malignancy irrespective of fine-needle aspiration cytology. Routine diagnostic thyroid lobectomy solely owing to thyroid nodule size of 3.0 cm or greater is currently not justified.


Asunto(s)
Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina/métodos , Biopsia con Aguja Fina/normas , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Biopsia Guiada por Imagen/normas , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Estudios Retrospectivos , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas , Adulto Joven
10.
Bioengineered ; 10(1): 383-389, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31791180

RESUMEN

Downregulation of lncRNA H19 (H19) expression is associated with an unfavorable prognosis in some cancers. However, little was known as to whether there was an association between H19 and minimally invasive follicular thyroid carcinoma (MI-FTC). In our study, we used quantitative real-time polymerase chain reaction (qRT-PCR) to determine H19 expression in 186 patients with MI-FTC who underwent initial surgery. Of the 186 patients with MI-FTC, 21 patients show distant metastasis (M+)at the initial operation established the diagnosis of MI-FTC. Of the 165 patients who did not show distant metastasis at diagnosis during the follow-up period (≥10 years), 28 patients undergone M+ and 137 patients has no distant metastasis(M-)after the initial operation. Low H19 expression was associated with large tumor size, vascular invasion, and distant metastasis. Univariate analysis showed that gender (male), age (45 years or older), primary tumor size (4 cm or more), vascular invasion and H19 level (<1.12) were significant prognostic factors related to postoperative distant metastases. Multivariate analysis showed that age, primary tumor size (4 cm or more) and vascular invasion was a significant prognostic factor for survival. Patients with low H19 expression showed a poorer outcome in MI-FTC patients. Receiver-operating characteristic (ROC) curve analysis demonstrated H19 could distinguish M+ from M- patientswith a value of area under the curve (AUC). Our findings suggest that H19 is a potential prognostic factor for evaluating prognosis and the metastatic potential of MI-FTC at an initial operation stage.


Asunto(s)
Adenocarcinoma Folicular/diagnóstico , Regulación Neoplásica de la Expresión Génica , ARN Largo no Codificante/genética , Neoplasias de la Tiroides/diagnóstico , Adenocarcinoma Folicular/genética , Adenocarcinoma Folicular/mortalidad , Adenocarcinoma Folicular/cirugía , Adulto , Anciano , Área Bajo la Curva , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Metástasis de la Neoplasia , Pronóstico , ARN Largo no Codificante/sangre , Curva ROC , Estudios Retrospectivos , Factores Sexuales , Análisis de Supervivencia , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/cirugía , Carga Tumoral
11.
Khirurgiia (Mosk) ; (12): 18-27, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31825339

RESUMEN

OBJECTIVE: To analyze own initial experience of transoral thyroid surgery. MATERIAL AND METHODS: There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm. RESULTS: Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days. CONCLUSION: Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.


Asunto(s)
Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/métodos , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Adulto , Carcinoma Papilar/cirugía , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Boca/cirugía , Neoplasias de la Tiroides/cirugía
13.
Medicine (Baltimore) ; 98(50): e18213, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852078

RESUMEN

We aimed to investigate the association between excess body mass index (BMI) and papillary thyroid cancer (PTC) in an operative population, and the impact of higher BMI on clinicopathological aggressiveness of PTC.Charts of 10,844 consecutive patients with thyroid nodules undergoing partial or total thyroidectomy between 1993 and 2015 were reviewed. Patients diagnosed with PTC were stratified in 4 groups: BMI < 18.5 (underweight), 18.5 ≤ BMI < 24 (normal-weight), 24 ≤ BMI < 28 (overweight) and BMI ≥ 28(obese). The impacts of high BMI on prevalence and clinicopathological parameters of PTC were retrospectively analyzed in both univariate and multivariate binary logistic regression analysis.For every 5-unit increase in body mass, the odds of risk-adjusted malignance increased by 36.6%. The individuals who were obese and overweight were associated with high risk of thyroid cancer [odds ratio (OR)= 1.982, P < .001; OR= 1.377, P < .001; respectively] compared to normal weight patients, and this positive association was found in both genders. Obesity was independent predictors for tumors larger than 1 cm (OR = 1.562, P < .001) and multifocality (OR = 1.616, P < .001). However, there was no difference in cervical lymph node (LN) metastasis among BMI groups. Crude analysis showed BMI was associated with advanced tumor-node-metastasis (TNM) stage (relative risk, approximately 1.23 per 5 BMI units, P < .001), but this association disappeared after adjusting for confounding factors.Obesity was significantly associated with the risk of PTC in a large, operative population. Higher BMI was significantly associated with larger tumor size and multifocal tumor.


Asunto(s)
Índice de Masa Corporal , Obesidad/complicaciones , Cáncer Papilar Tiroideo/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Tiroidectomía/métodos , Estudios de Casos y Controles , China/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Estudios Retrospectivos , Cáncer Papilar Tiroideo/etiología , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/etiología , Neoplasias de la Tiroides/cirugía
14.
Medicine (Baltimore) ; 98(51): e18309, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860980

RESUMEN

This study aimed to investigate the application of the healthcare failure mode and effect analysis (HFMEA) to reduce the incidence of posture syndrome of thyroid surgery (PSTS).Subjects before (n = 78, July 2017-December 2017) and after (n = 114, January 2018-June 2018) HFMEA implementation (The Second Hospital of Nanjing, Nanjing University of Chinese Medicine) were selected. The training for PSTS was optimized using HFMEA.The occurrence of PSTS was reduced from 59% to 18% after HFMEA (P < .001). Symptoms of pain and nausea and vomiting were also decreased after HFMEA (all P < .001). The critical thinking ability of 34 medical personnel to evaluate the reduction of thyroid postoperative posture syndrome increased from 246 ±â€Š19 to 301 ±â€Š14 (P < .001) after HFMEA.HFMEA was used to create preoperative posture training procedures for PSTS, bedside cards for training, innovative preoperative posture training equipment, and a diversified preoperative posture training health education model.


Asunto(s)
Análisis de Modo y Efecto de Fallas en la Atención de la Salud , Posicionamiento del Paciente/métodos , Complicaciones Posoperatorias/prevención & control , Glándula Tiroides/cirugía , Tiroidectomía/efectos adversos , Adolescente , Adulto , Anciano , Análisis de Modo y Efecto de Fallas en la Atención de la Salud/métodos , Humanos , Incidencia , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Síndrome , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía , Tiroidectomía/educación , Tiroidectomía/métodos , Adulto Joven
15.
Chirurgia (Bucur) ; 114(5): 586-593, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31670634

RESUMEN

Background: All patients undergoing thyroid operations should be subjected to preoperative neck ultrasound (US) followed by fine needle aspiration cytology (FNAC) of suspicious lesions. In Western countries, thyroid surgeons routinely perform neck ultrasound. The role of prophylactic central neck dissection (PCND) remains a topic of debate. For treatment of papillary thyroid carcinoma (PTC), in 2014 we introduced two new adjuncts: PCND based on criteria of the European Society of Endocrine Surgeons (ESES) consensus group and surgeon-performed US (S-US). Methods: In order to better understand the role of these two adjuncts in our shift of strategy we aimed to evaluate the outcomes of our patients in two successive 5-year time periods based on a retrospective analysis of our prospectively maintained database (total of 286 patients were included in this study). Results: The two groups were similar regarding epidemiological and clinical data. FNAC was done in only 21.66% of all PTC cases. PTC diagnosis was done in the majority of suspicious cases by FS. S-US guided the selective lateral node dissections (LND), leading to more lymph node metastases detections and it also surpassed endocrinologist performed US (E-US) in terms of PPV. PCND rate of complications was significantly higher due only to transient hypoparathyroidism. Conclusions: Preoperative surgeon-performed ultrasonography is a useful tool in the arsenal of PTC treatment. The systematic preoperative FNAC diagnosis and intraoperative frozen sections in uncertain cases are mandatory. PCND is a safe method of treatment and staging in PTC.


Asunto(s)
Disección del Cuello/métodos , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , Humanos , Escisión del Ganglio Linfático/métodos , Estadificación de Neoplasias , Estudios Retrospectivos , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Tiroidectomía , Resultado del Tratamiento , Ultrasonografía
16.
Int J Surg Oncol ; 2019: 2715260, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31737363

RESUMEN

Background: Despite a large amount of data, the optimal surgical management of differentiated thyroid cancer remains controversial. Current guidelines recommend total thyroidectomy if primary thyroid cancer is >4 cm, while for tumors that are between 1 and 4 cm in size, either a bilateral or a unilateral thyroidectomy may be appropriate as surgical treatment. In general, total thyroidectomy would seem to be preferable because subtotal resection can be correlated with a higher risk of local recurrences and cervical lymph node metastases; on the other hand, total thyroidectomy is associated with more complications. Methods: This is a retrospective study conducted on 359 patients with differentiated thyroid cancer, subjected to total thyroidectomy. Our aim was to correlate clinical and pathological features (extrathyroid tumor growth, bilaterality, nodal and distant metastasis) with patient (gender and age) and tumor (size and histotype) characteristics. Moreover, we recorded postoperative complications, including hypoparathyroidism and laryngeal nerve damage. Results: In our study, we found a high occurrence of pathological features indicating cancer aggressiveness (bilaterality, nodal metastases, and extrathyroid invasion). On the other hand, total thyroidectomy was associated with relatively low postsurgical complication rates. Conclusions: Our data support the view that total thyroidectomy remains the first choice for the routine treatment of differentiated thyroid cancer.


Asunto(s)
Neoplasias de la Tiroides/patología , Tiroidectomía , Adenocarcinoma Folicular/patología , Adenocarcinoma Folicular/cirugía , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Complicaciones Posoperatorias , Estudios Retrospectivos , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/cirugía
17.
Am Surg ; 85(11): 1265-1268, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31775969

RESUMEN

We investigated whether laryngoscopy should be performed before total thyroidectomy on all patients without a history of neck surgery. A total of 2523 patients who underwent total thyroidectomy between January 1, 2013, and March 18, 2018, were retrospectively examined. Preoperative vocal cord examination was performed on 2070 of these patients by the otorhinolaryngology department using indirect laryngoscopy. Patients with a history of neck or thyroid surgery were not included in the study. The patients were evaluated in terms of age, gender, symptom (hoarseness/dyspnea), comorbidity, surgical history, biopsy, nodule diameter, pathological diagnosis, and tracheal deviation. Preoperative vocal cord paralysis was detected in 0.8 per cent of the patients (17/2070). Four patients (23.5%) were male and 13 patients (76.5%) were female. The mean age was 62 (range, 25-82) years. Seven of the 17 patients (41%) were symptomatic, with complaints of dyspnea in five and hoarseness in two. The univariate analysis revealed that a nodule diameter >30 mm and the presence of dyspnea were associated with vocal cord damage. Furthermore, the multivariate analysis showed that dyspnea alone was an independent variable (P = 0.011). It is recommended that preoperative vocal cord evaluation should be performed only in patients with severe symptoms, such as dyspnea.


Asunto(s)
Laringoscopía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Parálisis de los Pliegues Vocales/diagnóstico , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Disnea/etiología , Femenino , Ronquera/etiología , Humanos , Laringoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Factores Sexuales , Evaluación de Síntomas/métodos , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/cirugía , Parálisis de los Pliegues Vocales/complicaciones
19.
Medicine (Baltimore) ; 98(38): e17033, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31567939

RESUMEN

RATIONALE: Compared with most malignant tumors, papillary thyroid carcinoma (PTC) is usually associated with favorable survival and low recurrence rate. The prognostic factors of PTC include age, sex, tumor size, enlarged lymph nodes, and extrathyroidal extension. Among the extrathyroidal extension, upper aerodigestive tract (ADT) invasion by PTC is a marker of more aggressive tumor behavior, defining a subpopulation of patients at a greater risk of recurrence and death. PATIENT CONCERNS: A 61-year-old woman had a cervical mass that was slowly growing for three years. Additionally, she had haemoptysis of 1-year duration. During the month prior to her visit, she had difficulty breathing. DIAGNOSIS: Neck ultrasonography (US) and thyroid computed tomography (CT) images both showed a well-defined calcified mass on the left lobe of the thyroid gland. Additionally, the thyroid CT revealed that part of the mass protruded into the lumen which resulted in the thickening on the left side of the trachea. Accordingly, her diagnoses were as follows: firstly, a solid mass on the left lobe of the thyroid gland with tracheal compression; and finally, the space-occupying airway lesion. INTERVENTIONS: She underwent a bronchoscopic examination, which revealed a mass blocking most of the upper endoluminal trachea. Thus, the mass was resected at the upper tracheal segment, followed by electrotome and argon plasma coagulation treatment. She was then transferred to the Thyroid Surgery Department. Thyroid surgeons took the surgical type of bilateral subtotal thyroidectomy + exploration of bilateral recurrent laryngeal nerve + dissection of the lymph node in neck central area + circumferential sleeve resection + end-to-end anastomosis + tracheotomy in the patient. OUTCOMES: After surgery, she recovered well without any local recurrence or distant metastasis. LESSONS: When patients with PTC have haemoptysis, hoarseness, dyspnea, or any other symptoms, and the imaging examinations reveal a space-occupying lesion in the thyroid and airway, clinicians should focus on PTC with tracheal invasion, a bronchoscopic examination must be immediately performed because the subsequent surgical management depends on the degree of tracheal invasion.


Asunto(s)
Cáncer Papilar Tiroideo/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tráquea/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Hemoptisis/etiología , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Cáncer Papilar Tiroideo/complicaciones , Cáncer Papilar Tiroideo/secundario , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tomografía Computarizada por Rayos X , Neoplasias de la Tráquea/complicaciones , Neoplasias de la Tráquea/secundario , Neoplasias de la Tráquea/cirugía , Ultrasonografía
20.
Ann Saudi Med ; 39(5): 345-349, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31580696

RESUMEN

BACKGROUND: Thyroid malignancy, the most diagnosed cancer of the endocrine system, represents 2% of all malignancies worldwide. The increasing incidence of thyroid cancer has been linked to the increasing sensitivity of modern diagnostic methods which overdiagnosis small thyroid tumors. OBJECTIVES: Assess the distribution and trends in thyroid cancer among thyroidectomy patients. DESIGN: Descriptive, based on medical record review. SETTINGS: Two tertiary care centers in Riyadh. PATIENTS AND METHODS: We included patients who underwent thyroid surgery from January 1, 2004 to December 31, 2016 who ranged in age from 9-90 years regardless of initial diagnosis. MAIN OUTCOME MEASURES: Distribution of thyroid carcinomas by type, age and sex and trends over the time period. SAMPLE SIZE: 979 patients. RESULTS: Of 979 patients, 84.5% were <55 years old, with the majority being female. Thyroid malignancy ranked second to benign tumors, and the most common type of thyroid cancer was papillary thyroid carcinoma (91% of malignant tumors), followed by follicular thyroid cancer (4.7% of malignant tumors). After thyroid microcarcinomas were isolated from the sample and studied separately, we found the overall trend for thyroid cancer to be stable, and that the annual increases in rates were due to increased diagnosis of thyroid microcarcinoma in the period from 2010 to 2016. CONCLUSION: Our study shows that increases in thyroid cancers may be attributed to a rise in the rates of diagnosis of thyroid microcarcinomas. LIMITATIONS: The main limitation is the retrospective nature of this design. Also, a multicenter collaboration would prove beneficial in evaluating the trends of thyroid cancer in Saudi Arabia on a much larger scale. CONFLICT OF INTEREST: None.


Asunto(s)
Carcinoma Papilar/epidemiología , Neoplasias de la Tiroides/epidemiología , Tiroidectomía/métodos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Arabia Saudita , Distribución por Sexo , Centros de Atención Terciaria , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Adulto Joven
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