Hang-Seok Chang

Postoperative Complications of Thyroid Cancer in a Single Center Experience

The aim of this study was to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. A total of 2,636 patients who underwent surgery due to thyroid cancer were retrospectively reviewed to identify surgical complications. Complication rates were assessed according to the extent of surgery, which was classified as follows; less-than-total thyroidectomy with central compartment node dissection (CCND) (Group I, n=636), total thyroidectomy with CCND (Group II, n=1,390), total thyroidectomy plus ipsilateral neck dissection (Group III, n=513), and total thyroidectomy plus bilateral neck dissection (Group IV, n=97). The most common surgical complication was symptomatic hypoparathyroidism, of which 28.4% of cases were transient and 0.3% permanent. The other surgical complications included vocal cord palsy (0.7% transient, and 0.2% permanent), hematoma (0.5%), seroma (4.7%), chyle fistula (1.8%), and Horners syndrome (0.2%). The complication rates increased significantly with increasing the extent of surgery from Group I to Group IV. The more extensive surgery makes more complications, such as hypoparathyroidism, seroma, and others.

Effects of nurse navigators on health outcomes of cancer patients.

Background: Care coordination has received increased attention in recent years because it critically affects patient safety and care quality across services and settings. Objective: The effectiveness of systematically developed nurse navigator interventions for newly diagnosed cancer patients was evaluated. Methods: Seventy-eight patients participated in a nonequivalent control group pretest-posttest design study. The study design spanned a 3-month period for all participants. Patient outcome measures included quality of life, satisfaction with care, and length of hospital stay. Results: Participants in the experimental program reported significant increases in several components of quality of life and with satisfaction with care and experienced fewer hospital stay days compared with the control group. Conclusion: This study provides evidence that standardized nurse navigator programs can improve patient outcomes in cancer care. Implications for Practice: Positive outcomes of the reduced length of stay and improved quality of life and patient satisfaction may help transform the cancer care delivery model toward more nurse-initiated cost-effective model.

Positive predictive values of sonographic features of solid thyroid nodule.

AIM The purpose of this study was to assess the positive predictive value of the suspicious sonographic features of solid nodules of the thyroid. MATERIALS AND METHODS After approval by our institutional review board, we evaluated 594 sonographically detected nodules on which fine needle aspiration biopsy had been performed from January to December 2005. Among these, pure cystic lesions and inadequate pathologic results were excluded. The remaining 530 solid thyroid nodules were analyzed by two radiologists. Each lesion was classified based on four sonographic features that suggested malignancy: microcalcifications; an irregular or microlobulated margin; marked hypoechogenicity; and a shape that was taller than wide. The sensitivity, specificity, positive predictive value, and negative predictive value of the each sonographic feature were calculated. RESULTS Final pathologic results showed that 97 (18.3%) of 530 nodules were malignant. The positive predictive values for malignancy in each sonographic feature were microcalcifications, 38.6% (39/101); an irregular or microlobulated margin, 28.2% (70/248); marked hypoechogenecity, 49.4% (38/77); taller than wide shape, 59.8% (49/82). In terms of relative risk, microcalcification [P<.01, relative risk (RR)=3.115, 95% CI: 1.724-5.628], hypoechogenecity (P<.01, RR=2.510, 95% CI: 1.290-4.881). The shape of nodule which was taller than wide (P<.01, RR=7.624, 95% CI: 4.156-13.986) revealed the highest predictive sonographic finding suggesting malignancy. However, margin is the least significant feature of detection of thyroid malignancy (P=.27, RR=1.395, 95% CI: 0.777-2.505). CONCLUSION The three sonographic features of solid thyroid nodule, that is, microcalcifications, marked hypoechogenecity, and a taller than wide shape are meaningful findings in the diagnosis of thyroid malignancy. The shape that was taller than wide was the most reliable sonographic feature for predicting malignancy.

Anaplastic Thyroid Carcinoma: A Therapeutic Dilemma

Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3,088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8 cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n = 10), 2.1 months, Group 2 (n = 8); 3.6 months; Group 3 (n = 7), 3.0 months; Group 4 (n = 14), 3.5 months, Group 5 (n = 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.

Ultrasonographic Mass Screening for Thyroid Carcinoma: A Study in Women Scheduled to Undergo a Breast Examination

Abstract This study was carried out to clarify the sensitivity of ultrasonographic mass screening for thyroid carcinoma. Between December 1997 and July 1998, a total of 1 401 subjects who were scheduled to undergo either a breast examination or a follow-up examination for breast cancer were enrolled in this study. Patients with thyroid nodules were classified into two groups according to their potential risk for malignancy based on the ultrasonographic findings. Ultrasonographic high-risk patients for thyroid cancer underwent an ultrasound guided fine-needle aspiration biopsy (FNAB) and were advised to undergo a thyroidectomy based on the FNAB results. The characteristics of the thyroid cancer patients detected by mass screening were then compared with those of 106 consecutive female patients with clinical thyroid cancer during the same period. Thyroid nodules were detected in 353 (25.2%) of the subjects, 94 (26.6%) of whom were placed in the high-risk group for thyroid cancer. Among the 94 high-risk patients, 43 underwent a thyroidectomy and 37 turned out to have thyroid carcinomas. The detection rate for thyroid cancer was 2.6% for all subjects. The tumor size was significantly smaller than that of the clinically detected cancer group (P < 0.05). Ultrasonographic mass screening for thyroid carcinoma in women who require breast examinations is thus considered to be effective for the detection of subclinical thyroid carcinoma.

Sonographic Screening for Thyroid Cancer in Females Undergoing Breast Sonography

OBJECTIVE The purpose of our prospective study was to evaluate incidental thyroid cancer diagnosed by screening sonography in a population who underwent breast sonography and the differences in the incidences of thyroid cancer between those with and those without breast cancer. SUBJECTS AND METHODS Between January 2003 and March 2004, we examined thyroid glands during routine diagnostic or follow-up breast sonography. A total of 5,549 females underwent breast and thyroid screening sonography (n = 4,864) or sonography for diagnosis or follow-up of breast cancer (n = 685). When a thyroid lesion was suspicious for malignancy, sonographically guided fine-needle aspiration was performed. We compared the cases of pathologically proven thyroid cancer in two groups: a cancer group, including patients with breast cancer, and a noncancer group, including patients with negative or benign breast disease. RESULTS Among the 5,549 cases, 42 (0.76%) were diagnosed as thyroid cancer; all were papillary carcinomas. Pathologically proven thyroid cancers were identified in 13 (1.9%) of the 685 breast cancer patients and in 29 (0.6%) of the 4,864 non-breast-cancer patients. The diameters of the 13 thyroid masses were 0.1-3.0 cm; the mean diameters in the cancer and noncancer groups were 9.9 and 8.6 mm, respectively. CONCLUSION The incidence of thyroid cancer was significantly higher in the group with breast cancer than in the group who did not have breast cancer. The results of routine concurrent sonographic breast and thyroid examinations were helpful in detecting small thyroid tumors in both patient groups.

Risk factors for hypertrophic surgical scar development after thyroidectomy.

Postoperative neck scarring is a major concern for patients who undergo thyroid surgery; however, the treatments for hypertrophic scars are generally considered by patients to provide unsatisfactory outcomes. Therefore, risk factors should be identified and prevention of these factors is considered to be critical in management. We reviewed the medical records of 96 thyroidectomy patients who were divided into two groups based on scar type: patients with hypertrophic (n = 61) and linear flat scars (n = 35). Multivariable logistic regression model was developed to identify risk factors for developing hypertrophic scar. There was no significant difference between the two groups in terms of age, gender ratio, tumor type, and type of operation. Multivariable analysis showed that hypertrophic scar development was associated with scars located within 1 cm above the sternal notch (odds ratio [OR] = 5.94, p = 0.01), prominent sternocleidomastoid muscles (OR = 12.03, p < 0.01), and a high body mass index (OR = 1.33, p = 0.01). The area under the receiver operating characteristic curve for risk factors was 0.85. Development of hypertrophic scar after thyroidectomy was found to be associated with specific preoperative factors such as incision site near the sternal notch, prominent sternocleidomastoid muscles, and high body mass index.

Robot-assisted posterior retroperitoneoscopic adrenalectomy: single port access

Laparoscopic adrenalectomy has become a gold standard in adrenal gland surgery. More recently, some minimally invasive trials have been conducted on single access surgery on the adrenal gland. In this study, we introduce our first experiences of robot-assisted posterior retroperitoneoscopic adrenalectomy using single-port access and the da Vinci system.

Relationship between Negative Mental Adjustment to Cancer and Distress in Thyroid Cancer Patients

Purpose Previous studies have reported that over a third of cancer patients experience significant psychological distress with diagnosis and treatment of cancer. Mental adjustment to cancer as well as other biologic and demographic factors may be associated with their distress. We investigated the relationship between mental adjustment and distress in patients with thyroid cancer prior to thyroidectomy. Materials and Methods One hundred and fifty-two thyroid cancer patients were included in the final analysis. After global distress levels were screened with a distress thermometer, patients were evaluated concerning mental adjustment to cancer, as well as demographic and cancer-related characteristics. A thyroid function test was also performed. Regression analysis was performed to discern significant factors associated with distress in thyroid cancer patients. Results Our regression model was significant and explained 38.5% of the total variance in distress of this patient group. Anxious-preoccupation and helpless-hopeless factors on the mental adjustment to cancer scale were significantly associated with distress in thyroid cancer patients. Conclusion Negative emotional response to cancer diagnosis may be associated with distress in thyroid cancer patients awaiting thyroidectomy. Screening of mental coping strategies at the beginning of cancer treatment may predict psychological distress in cancer patients. Further studies on the efficacy of psychiatric intervention during cancer treatment may be needed for patients showing maladaptive psychological responses to cancer.

Computed Tomography Is Useful for Preoperative Identification of Nonrecurrent Laryngeal Nerve in Thyroid Cancer Patients

Objective. Nonrecurrent laryngeal nerve (NRLN) is a risk factor for nerve injury during thyroid or parathyroid surgery and is usually associated with vascular anomalies. This study investigated the usefulness of computed tomography (CT) scans for preoperative identification of NRLN in thyroid cancer patients. Study Design. Case series with chart review. Setting. Academic university hospital. Subjects and Methods. Of the 6546 patients, 20 (0.3%) were intraoperatively identified with NRLN, and the medical records of 20 patients were reviewed retrospectively, with particular focus on preoperative CT findings. Results. All 20 cases were right-sided NRLN, and no clinical symptoms were observed preoperatively in any patient. Two patients had type I NRLN and 18 had type II NRLN. NRLN injury occurred in 1 patient at a point where the nerve was close to the superior thyroid artery. Prior to surgery, surgeons identified only 5 suspected NRLN cases based on identification of vascular anomalies on CT scans. However, this review of CT scans revealed that vascular anomalies could be identified on the scans of all patients. Conclusions. Neck CT scanning appears to be an excellent method for predicting NRLN cases. However, thorough examination of the scans, with particular attention to the neck and mediastinum vascular structures, is required.