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Impact of initial surgical treatment on survival of patients with differentiated thyroid cancer : Experience of an endocrine surgery center in an iodine-deficient region

This retrospective clinical study was designed to analyze the impact of the initial surgical procedure on the survival of 1000 patients with differentiated thyroid cancer of follicular cell origin who had a thyroid operation and were followed for the 30 years between 1968 and 1998 (median 14 years) in an iodine-deficient region where goiter is endemic. There were 753 women and 247 men with a mean age of 42.8 ± 6.7 years (range 17–86 years). Patients were divided into three groups. All patients had undergone thyroxine treatment and thyroid-stimulating hormone (TSH) suppression, and most had had iodine-131 treatment postoperatively. Group A consisted of 336 patients with differentiated thyroid cancer (DTC) who were treated with bilateral subtotal thyroidectomy in our institution or elsewhere. Group B consisted of 158 patients with DTC who were treated initially with unilateral total lobectomy and contralateral subtotal lobectomy in our institution or elsewhere and underwent reoperation in our department. Group C consisted of 506 patients with DTC who were treated initially with total or near-total thyroidectomy in our department. Kaplan-Meyer survival analysis was used. Recurrence was seen in 23% and death in 8% of the patients. The 20-year survival rates were 76%, 85%, and 92% for groups A, B, and C, respectively. The survival difference among the patients of group A and groups B and C was found to be statistically different (p < 0.001). Long-term survival of patients with differentiated thyroid cancer living in endemic areas for goiter can be influenced by the initial surgical treatment. Patients treated initially with total or near-total thyroidectomy appear to have a better prognosis.

BRAF(V600E) Mutation: Has It a Role in Cervical Lymph Node Metastasis of Papillary Thyroid Cancer?

Background: The BRAFV600E mutation is common in papillary thyroid cancer (PTC). Lymph node metastasis (LNM) may be associated with poor prognosis. However, the LNM mechanism remains unclear. Objectives: Our aim was to evaluate the prevalence of the BRAFV600E mutation in primary tumors and accompanying LNM at the time of diagnosis. Methods: This retrospective study included 51 PTC patients (40 women, 11 men; mean age 40.0 ± 16.5 years; range 6-81) who underwent total thyroidectomy accompanied by a lateral neck dissection due to preoperatively detected LNM. Real-time PCR was used for the detection of the BRAFV600E mutation in specimens from primary thyroid tumors and metastatic lymph node tumors. Results: The prevalence of the BRAFV600E mutation was 64.7% (n = 33) in primary tumors and 47.1% (n = 24) in metastatic lymph nodes. Of 33 patients with BRAFV600E-positive primary tumors, 18 (54.5%) had BRAFV600E-positive metastatic lymph nodes. Of 18 patients with BRAFV600E-negative primary tumors, 6 (33.3%) had BRAFV600E-positive metastatic lymph nodes. The presence of the BRAFV600E mutation in the primary tumor did not affect the tumor size, but the diameter of metastatic lymph nodes significantly increased (by nearly 3 mm) with the presence of BRAFV600E in LNM (p = 0.01). Conclusions: In our study, the BRAFV600E mutation did not show a one-to-one correspondence. This indicates that the presence of BRAFV600E in the primary tumor is not clonal and addresses the role of intratumor heterogeneity in PTC tumorigenesis. This supports the theses that mutations occur in the later stages of tumorigenesis, might be subclonal, and develop de novo, or that some other factors may be involved in the development of metastasis.

Videoendoscopic parathyroidectomy: gaseous or gasless technique?

ously, stimulation of either of these nerves should alert the anesthesiologist to redirect the needle accordingly. On the other hand, since a subclavian perivascular block is carried out at the level of the trunks, and since the suprascapular nerve arises from the superior trunk, it is obvious that if one evokes a paresthesia to the shoulder or illicits a twitch response to a nerve stimulator of the muscle innervated by C5, C6, as correctly stated in my text (2), it is difficult, if not impossible, to tell whether the needle is stimulating the suprascapular nerve outside the sheath or the superior trunk within it. Therefore, I still believe that with this technique a more distal paresthesia or twitch response is mandatory. To summarize, in view of all of the above, I must disagree with the conclusion of Sukhani and Candido that in performing an interscalene block one must seek a paresthesia distal to the shoulder, but I certainly agree with their conclusion that when performing an interscalene block using a peripheral nerve stimulator, a deltoid motor response is an appropriate end-point.

Proteomic analysis reveals differential protein expression in variants of papillary thyroid carcinoma

Graphical abstract

Transaksiller robotik tiroidektomi: Cerrahi teknik ve ilk iki olgunun bildirimi

GIRIŞ Tiroid cerrahisinde son on yilda uygulanan minimal invazif cerrahi, mini insizyonlu cerrahi, video yardimli cerrahi veya video-endoskopik cerrahiden farkli olarak, boyunda skar olusturmayan transaksiller yaklasim da uygulanabilmektedir. Konvansiyonel laparoskopik enstrumanlarla yapilan bu ameliyat, suresinin uzunlugu, uygulanan gaz insuflasyonuna bagli komplikasyonlar, fleksibil olmayan endoskopik enstrumanlarla calismanin guclugu ve iki boyutlu cerrahi gorus alani gibi nedenlerle yeterince kabul gormemistir (1,2).