Stanley H. Chia

Meta-analysis of endoscopic versus sublabial pituitary surgery†‡

To determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates.

Surgeon Experience and Complications with Transoral Robotic Surgery (TORS)

Objective To investigate surgeon preferences for perioperative management of transoral robotic surgery (TORS) and explore the frequency of postoperative complications. Study Design Retrospective survey. Setting Multi-institutional. Subjects and Methods An electronic survey was sent to over 300 TORS-trained surgeons in the United States identified by Intuitive Surgical, Inc. Participation was voluntary and solicited by email invitations to participate 3 times over a 1-month period. Results A total of 2015 procedures were reported by 45 respondent TORS-trained surgeons: 67% academic, 33% nonacademic. A minority of TORS procedures (n = 214, 10.6%) were performed on previously irradiated patients. Neck dissections were performed concurrently (58%) or staged (42%). Fewer than 6% of TORS procedures required tracheotomy or reconstruction. Most surgeons (62%) initiated oral intake on postoperative day 0-1. Of the patients who required readmission, bleeding (n = 62, 3.1%) was the most common cause followed by dehydration (n = 26, 1.3%). Other complications of surgery included tooth injury (n = 29, 1.4%), percutaneous endoscopic gastrostomy (PEG) dependency >6 months (n = 21, 1.0%), temporary hypoglossal nerve injury (n = 18, 0.9%), and lingual nerve injury (n = 11, 0.6%). A total of 6 deaths (0.3%) were reported within 30 days of TORS. All reported deaths were due to postoperative hemorrhage. The complication rate decreased significantly with higher surgeon case volume (>50 cases). Conclusions TORS is associated with a low major complication rate, early initiation of oral intake, and a low rate of long-term PEG dependency. Postoperative hemorrhage was the most common cause of hospital readmission and postoperative mortality.

Salivary gland malignancy and radioiodine therapy for thyroid cancer.

BACKGROUND The risk of second primary malignancies in patients with well-differentiated thyroid cancer is of special interest because of the common use of radioactive iodine (RAI) ablation and/or treatment of these patients and the theoretical risk of subsequent nonthyroid malignancies associated with the radiation exposure. This brief report focuses specifically on the occurrence of second primary malignancies of the salivary glands. RAI residency within salivary tissues is known to have both acute and chronic consequences on salivary function, but secondary neoplasia is quite unusual. SUMMARY We present a very rare case of a patient with papillary thyroid cancer treated with 600 mCi of RAI, who subsequently developed salivary gland cancer. CONCLUSIONS We recommend salivary gland protection to diminish potential side effects after the exposure to radioiodine. On the basis of our experience we suggest administration of sialogogues (such as lemon juice) continuously, every 30-60 minutes for 24 hours, after RAI administration.

Meta-analysis of Endoscopic vs Sublabial Pituitary Surgery

Objective: Determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates. Method: A Medline search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta-analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach. Results: A total of 21 endoscopic studies (n = 2335) and 17 sublabial studies (n = 2565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs 65%, P < .0001), as well as lower rates of cerebral spinal fluid leak (5% vs 7%, P < .01), septal perforation (0% vs 4%), and postoperative epistaxis (1% vs 4%, P < .0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the 2 techniques in the incidence of meningitis, diabetes insipidus, or resolution of hormonal abnormality. Hospital stay (P = .01) and length of operation were shorter for endoscopic surgery compared to sublabial surgery. Conclusion: The sublabial transsphenoidal approach has been the gold standard for pituitary surgery for many years. However, meta-analysis of the recent literature demonstrates superior outcomes and decreased postoperative complications with the endoscopic approach, potentially justifying a shift toward endoscopic pituitary surgery.

Malignant Thyroid Teratoma

ABSTRACT Objective: Malignant teratomas of the thyroid are very rare, with less than 30 cases reported in adults. Presentation of a recent patient and a review of the literature have provided insight into the usual clinical presentation and histopathologic characteristics of malignant teratomas of the thyroid gland in adults and the available management options for this disease process. Methods: A healthy 33-year-old woman presented with a rapidly growing right neck mass. Fine-needle aspiration demonstrated poorly differentiated carcinoma favoring thyroid origin. The patient underwent total thyroidectomy, bilateral central compartment neck dissection, and right lateral neck dissection. Histopathologic analysis confirmed the diagnosis of malignant teratoma of the thyroid gland with metastases to the neck bilaterally. Results: Malignant teratomas are exceedingly rare tumors of the thyroid gland. These masses are typically diagnosed after thyroidectomy by histopathologic criteria. Fine-needle biopsy generall...