Chika Sakimura

Total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer: Comparative analysis after propensity score matching: A multicenter study

BACKGROUND In patients with papillary thyroid carcinoma (PTC), the role of total thyroidectomy (TT) versus that of thyroid lobectomy (TL) has been controversial. METHODS This retrospective study was approved by our institutional review board, and the requirement to obtain informed consent was waived. In total, 173 patients with 1- to 5-cm stage cN0 and cM0 PTC tumors treated by curative surgery from 1994 to 2008 were evaluated. Clinicopathologic features and adverse events were compared between patients who underwent TT and those who underwent TL. After adjustment for differences in baseline clinicopathologic factors using propensity score matching, we compared recurrence-free survival (RFS) and OS. RESULTS TL was performed in 120 patients and TT in 53 patients. Patients who underwent TT were older; had larger tumors; more frequently had nodal metastasis, multifocal tumors, and extracapsular invasion; and more frequently underwent radioactive iodine ablation than patients who underwent TL. Hypocalcemia requiring medication and recurrent laryngeal nerve paralysis were more frequent in TT than TL. The 10-year RFS and OS of all patients were 93.3% and 96.7%, respectively. There was no significant difference in RFS (90.6% vs 93.0% in TT and TL groups, respectively) or OS (96.2% vs 96.9% in TT and TL groups, respectively) according to the extent of surgical resection after propensity score matching. CONCLUSION Equivalent prognoses were observed for patients with 1- to 5-cm stage cN0 and cM0 PTC tumors treated by TL or TT after propensity score matching. Adverse events occurred less frequently in patients who underwent TL than TT.

Increase in Operator’s Sympathetic Nerve Activity during Complicated Hepatobiliary Surgery: Evidence for Surgeons’ Mental Stress

Surgeons often experience stress during operations. The heart rate variability (HRV) is the variability in the beat-to-beat interval, which has been used as parameters of stress. The purpose of this study was to evaluate mental stress of surgeons before, during and after operations, especially during pancreaticoduodenectomy (PD) and living donor liver transplantation (LDLT). Additionally, the parameters were compared in various procedures during the operations. By frequency domain method using electrocardiograph, we measured the high frequency (HF) component, representing the parasympathetic activity, and the low frequency (LF)/HF ratio, representing the sympathetic activity. In all 5 cases of PD, the surgeon showed significantly lower HF component and higher LF/HF during operation, indicating predominance of sympathetic nervous system and increased stress, than those before the operation (p < 0.01) and these did not return to the baseline level one hour after the operation. Out of the 4 LDLT cases, the value of HF was decreased in two and the LF/HF increased in three cases (p < 0.01) during the operation compared to those before the operation. In all cases, the value of HF was decreased and/or the LF/HF increased significantly during the reconstruction of the vessels or bile ducts than during the removal of the liver. Thus, sympathetic nerve activity increased during hepatobiliary surgery compared with the level before the operation, and various procedures during the operations induced diverse changes in the autonomic nervous activities. The HRV analysis could assess the chronological changes of mental stress by measuring the autonomic nervous balances.

Can the use of intraoperative intact parathyroid hormone monitoring be abandoned in patients with hyperparathyroidism

BACKGROUND Ultrasound (US) and technetium-99m sestamibi scintigraphy (MIBI) are used to determine the localization of abnormal glands in cases of primary hyperparathyroidism (PHPT). Intraoperative intact parathyroid hormone (iPTH) monitoring is a reliable examination used to cure PHPT. The aim was to assess the necessity of intraoperative iPTH monitoring. METHODS Sixty patients were examined using preoperative MIBI and US. iPTH was measured at 3 time points: (1) at the start of surgery; (2) 10 minutes after gland resection; and (3) more than 60 minutes after surgery. We defined a decreased iPTH level as an iPTH measured 10 minutes after resection that was less than 50% of the preoperative level. RESULTS The iPTH of 55 patients with concordant lesions decreased to within the normal range more than 60 minutes after surgery. CONCLUSIONS It is not necessary to monitor intraoperative iPTH when single concordant lesions are preoperatively identified on both MIBI and US.

Awareness of dysgeusia and gustatory tests in patients undergoing chemotherapy for breast cancer

PurposeWe analyzed the prevalence of gustatory test abnormalities in breast cancer (BC) patients undergoing chemotherapy.MethodsWe enrolled 43 BC patients undergoing chemotherapy and 38 BC patients who had never undergone chemotherapy (control group). Two gustatory tests were conducted: an instillation method examining the threshold for four basic taste stimuli and an electrogustometry method measuring the threshold for perception with electric stimulation at the front two-thirds of the tongue (cranial nerve VII) and at the back third of the tongue (cranial nerve IX). The results of the two gustatory tests and clinicopathological factors were compared between the chemotherapy and control groups and between patients with and without awareness of dysgeusia in the chemotherapy group.ResultsIn the chemotherapy group, 19 (44%) patients were aware of dysgeusia and 8 (19%) had hypogeusia using the instillation method. Although more patients had parageusia in the chemotherapy than control group, no significant differences in the results of the two gustatory tests were observed. Patients with dysgeusia awareness had a higher threshold at cranial nerve IX using the electrogustometry method than those without dysgeusia awareness; no significant differences in hypogeusia were observed using the instillation method. In fact, 74% (14/19) of patients with dysgeusia awareness could identify the four tastes accurately using the instillation method. Similar results were observed for the instillation and electrogustometry methods at cranial nerve VII.ConclusionsWhile approximately half of the chemotherapy patients were aware of dysgeusia, 81% (35/43) of them could accurately identify the four basic tastes using the instillation method.

The Preservation and Autotransplantation of the Parathyroid Glands in Total Thyroidectomy in Patients With Thyroid Cancer—A Strategy for Avoiding Permanent Hypoparathyroidism

Hypoparathyroidism is a complication that occurs after total thyroidectomy (TT) in patients with thyroid cancer. We tried to determine a strategy for avoiding permanent hypoparathyroidism. A total ...

Adherence to Adjuvant Endocrine Therapy in Women With Breast Cancer: A Prospective Observational Study in Japanese Women

Introduction: Nonadherence to adjuvant endocrine therapy has been poorly studied in Asian patients with breast cancer. We therefore assessed adherence to endocrine therapy among women with breast cancer in Japan. Patients and Methods: We conducted a prospective observational study among Japanese women with hormone receptor‐positive breast cancer. Patients brought their pill packets to visits for 1 year and answered a questionnaire. We also examined prescription records during the study period. Adherence to endocrine therapy was defined as patients who had taken > 80% of the pills according to the packets during the study. Clinicopathologic features and questionnaires were compared between adherent and nonadherent patients. Results: A total of 234 patients completed the trial, of whom 85% demonstrated adherence based on pill packets, and 98% demonstrated adherence based on prescription records. Mastectomy, higher stage, nodal metastasis and adjuvant chemotherapy were correlated with adherence based on pill packets. Adjuvant chemotherapy was an independent factor associated with adherence. According to the questionnaire, adherent patients were more likely to consult a nurse when they had trouble with their medication. These patients also emphasized the efficacy rather than the side effects of the medication. Nonadherent patients were aware that they were being nonadherent. Conclusion: The results of this study revealed that 85% of patients were adherent to endocrine therapy, but physicians were unaware of the nonadherent patients. Raised awareness of nonadherence and information sharing between patients and medical teams might increase adherence to endocrine therapy.

The first report of the thyroid function of haemophilic patients with HIV/HCV co-infection in Japan.

A high incidence of thyroid dysfunction is reported in patients with HIV or HCV mono‐infection. We have conducted a periodic medical examination including the thyroid function for haemophilic patients with HIV/HCV co‐infection due to contaminated blood products.

1034PTOTAL VERSUS HEMITHYROIDECTOMY FOR WELL DIFFERENTIATED THYROID CANCER

ABSTRACT Aim: United States and European guidelines recommend total thyroidectomy for well-differentiated thyroid cancer (WDTC) >1 cm. On the other hand, in Japan, lobectomy is the preferred treatment for patients with WDTC without high risk. The selection criteria used for lobectomy and whether lobectomy should be performed on patients without high risk WDTC are still unclear. This study compared the outcome of patients with WDTC treated with either a total thyroidectomy or lobectomy. Methods: We reviewed records of patients with tumors smaller than 5 cm, cN0 and cM0 WDTC treated at Nagasaki University between 1994 and 2007. Data on clinicopathological features and adverse events were compared between total thyroidectomy and lobectomy-treated patients. Recurrence-free survival (RFS) and disease-specific survival (DSS) were determined using the Kaplan-Meier method. Results: Of 268 patients with WDTC, 190 had available detailed data and were eligible for this study. The median follow-up period was 9.2 years. Total thyroidectomy was carried out in 58 (31%) and lobectomy in 132 (69%) patients. The proportion of patients over 45 years old, with papillary carcinoma and who had undergone lymph node dissection (total thyroidectomy, 86%; lobectomy, 58%) was significantly higher in the total thyroidectomy group than in the lobectomy group. Gender, tumor size and incidence of pathological lymph node metastases in patients who underwent lymph node dissection did not significantly differ with the extent of surgical resection. Adverse events differed by total thyroidectomy and lobectomy; permanent or temporary hypocalcemia with use of medicine was 43% and 0%, respectively, and permanent or temporary recurrent laryngeal nerve paralysis was 16% and 4%, respectively. The 10-year RFS and DSS were 96% and 100%, respectively. There was no significant difference in RFS with the extent of surgical resection. RFS varied between patients with multiple and single lesions, 88% and 99%, respectively (p = 0.002). Conclusions: Equivalent prognoses were observed for patients with tumors smaller than 5cm, cN0 and cM0 WDTC treated with lobectomy or total thyroidectomy. Adverse events were fewer in patients who underwent lobectomy than in those who underwent total thyroidectomy. Disclosure: All authors have declared no conflicts of interest.