Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study)

Background Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence.Methods Patients undergoing thyroidectomy in seven high-volume thyroid surgery centers in Europe, between January 2020 and December 2022, were retrospectively analysed. Based on the onset of cervical haematoma, two groups were identified: Cervical Haematoma (CH) Group and No Cervical Haematoma (NoCH) Group. Univariate analysis was performed to compare these two groups. Moreover, employing multivariate analysis, all potential independent risk factors for the development of this complication were assessed.Results Eight thousand eight hundred and thirty-nine patients were enrolled: 8,561 were included in NoCH Group and 278 in CH Group. Surgical revision of haemostasis was performed in 70 (25.18%) patients. The overall incidence of postoperative cervical haematoma was 3.15% (0.79% for cervical haematomas requiring surgical revision of haemostasis, and 2.35% for those managed conservatively). The timing of onset of cervical haematomas requiring surgical revision of haemostasis was within six hours after the end of the operation in 52 (74.28%) patients. Readmission was necessary in 3 (1.08%) cases. At multivariate analysis, male sex (P < 0.001), older age (P < 0.001), higher BMI (P = 0.021), unilateral lateral neck dissection (P < 0.001), drain placement (P = 0.007), and shorter operative times (P < 0.001) were found to be independent risk factors for cervical haematoma.Conclusions Based on our findings, we believe that patients with the identified risk factors should be closely monitored in the postoperative period, particularly during the first six hours after the operation, and excluded from outpatient surgery

L'IMPATTO DELL'UTILIZZO DEGLI ENERGY BASED DEVICES NELLA CHIRURGIA DELLA TIROIDE IN ETA' PEDIATRICA

Le complicanze della chirurgia tiroidea sono a eziopatogenesi multifattoriale, ma spesso collegate all’efficacia dell’emostasi. Gli energy based devices (EBD) sono strumenti chirurgici, sempre di più utilizzati nella chirurgia della tiroide poiché sono in grado di ottenere un’emostasi rapida e sicura riducendo, così, i tempi operatori, le perdite ematiche intraoperatorie e l’incidenza delle complicanze. Lo scopo di questo studio è quello di valutare se l’uso degli EBD può ridurre l’incidenza delle complicanze nella chirurgia tiroidea in età pediatrica. METODI: Sono stati identificati 177 pazienti pediatrici consecutivi (Gruppo A) sottoposti a tiroidectomia totale utilizzando EBD e 237 pazienti (Group B) trattati con tecnica tradizionale e da chirurghi esperti. Abbiamo confrontato tra i due gruppi il tasso delle complicanze transitorie e definitive, durata dell’intervento e degenza postoperatoria. RISULTATI: I pazienti del gruppo A presentano tasso di complicanze più basso rispetto al gruppo B; In particolare, in maniera statisticamente significativa l’incidenza dell’ipoparatiroidismo postoperatorio temporaneo (11.3 vs 19% p<0,05) e definitivo (1,7 vs 5,5% p<0,05). Inoltre, la durata dell’intervento si è ridotta con l’uso degli EBD nella tiroidectomia totale senza e con linfadenectomia del comparto centrale. Anche la degenza è ridotta nel gruppo A, ma statisticamente significativa nelle lesioni microfollicolari (p<0,05). CONCLUSIONI: L’utilizzo degli EBD nella chirurgia della tiroide in età pediatrica eseguita da chirurghi esperti riduce le complicanze postoperatorie, in particolare l’ipoparatiroidismo temporaneo e permanente, la durata dell’intervento e la degenza in ospedale. Background: Energy-based devices are surgical devices being increasingly utilized for thyroid surgery, due to reduction of operative time and surgical related complications. The aim of the study is to evaluate if the use of energy-based devices could improve the complications rate in in pediatric thyroid surgery. Methods: This is a retrospective observational study. We identified 177 consecutive pediatric patients (Group A) with thyroid diseases, surgically treated by energy-based devices and 237 patients (Group B) treated by conventional clamp and tie technique and matched for sex, age and indication for surgery. Transient and permanent complications rate, operative time and length of hospital stay were compared between the two groups. Results: Patients of group A experienced less complication rate compared to group B. Particularly, transient (11.3 vs. 19% p<0.05) and permanent post-operative hypoparathyroidism (1.7 vs. 5.5%, p<0.05) were lower in Group A. Moreover, also operative time was shorter in Group A compared to Group B and this difference was statistically significant in patients who performed total thyroidectomy alone and total thyroidectomy associated with central compartment neck dissection (p<0.05). Length of hospital stay was lower in Group A than in Group B, but this difference was statistically significant only for microfollicular lesion (p<0.05). Conclusion: The use of energy-based devices has a key role in reducing surgical related complications, particularly transient and permanent hypoparathyroidism, operative time and length of hospital stay in pediatric patients treated with thyroid surgery

Surgical Management of Adrenocortical Carcinoma: A Literature Review

Background: Adrenocortical carcinoma (ACC) is a rare malignant tumor with a poor prognosis. Radical surgical resection with negative margins represents the only opportunity for a potential cure. This review provides a critical assessment of the existing studies regarding the surgical approaches for the treatment of ACC. Methods: This review was performed according to criteria reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The research was carried out using the PubMed electronic library. This review is limited to comparative studies evaluating minimally invasive adrenalectomy (MIA) and open adrenalectomy (OA) in adult patients affected by ACC. Results: A total of 14 studies were selected for the review, reporting that 2574 patients underwent adrenal surgery for ACC: 1779 (69.1%) by means of OA and 795 (30.8%) by means of MIA. Six studies considered OA to be superior to MIA, whereas eight studies reported that MIA is as effective as OA in highly selected cases. All studies were retrospective with a heterogenous selection of patients. Conclusions: Data regarding the management of MIA are scarce, heterogenous, and mainly based on retrospective studies. OA remains the gold standard approach for the management of ACC; however, MIA may play a role in selected cases treated in high volume institutions with experienced surgeons

Robotic transaxillary thyroidectomy: time to expand indications?

In 2016, the American Thyroid Association published a statement on remote-access thyroid surgery claiming that it should be reserved to patients with thyroid nodule &lt;= 3 cm, thyroid lobe &lt; 6 cm and without thyroiditis. We retrospectively enrolled all patients who underwent robotic transaxillary thyroidectomy between February 2012 and March 2022. We compared surgical outcomes between patients who presented a thyroid gland with a nodule &lt;= 3 cm, thyroid lobe &lt; 6 cm and without thyroiditis (Group A) and patients without these features (Group B). The rate of overall complications resulted comparable (p = 0.399), as well as the operative time (p = 0.477) and the hospital stay (p = 0.305). Moreover, bleeding resulted associated to thyroid nodule &gt; 3 cm (p = 0.015), although all bleedings but one occurred in the remote-access site from the axilla to the neck. In experienced hands, robotic transaxillary thyroidectomy is feasible and safe even in patients with large thyroid nodules or thyroiditis

An adrenal cortical adenoma with neuroendocrine-type granules mimicking pheochromocytoma

Clinical and biochemical presentation of adrenal tumors may rarely conflict with their histologic features. In the present report, we describe a rare case of adrenal neoplasm clinically and biochemically labeled as pheochromocytoma which at histologic examination resulted adrenal cortical tumor. The neoplasm was examined with the electron microscope which revealed the presence of electron-dense neuroendocrine-type granules next to intracytoplasmic lipid droplets. The patient underwent laparoscopic left adrenalectomy which leads to normalization of 24 h urinary metanephrine and normetanephrine. This exceptional entity should be taken into consideration when the clinical and laboratory features conflict with the histological examination. The pathologist can clarify the mixed nature of the tumor by means of the identification of neuroendocrine granules at the electron microscope examination

Impact of COVID-19 pandemic on thyroidectomy for malignant diseases in high-volume referral centers

IntroductionThe COVID-19 pandemic has limited the availability of healthcare resources for non-COVID patients and decreased elective surgeries, including thyroidectomy. Despite the prioritization of surgical procedures, it has been reported that thyroidectomy for thyroid cancer (TCa) was adversely impacted. We assessed the impact of the pandemic on the surgical activities of two high-volume referral centers. Materials and methods Patients operated at two National Referral Centers for Thyroid Surgery between 03/01/2020 and 02/28/2021 (COVID-19 period) were included (P-Group). The cohort was compared with patients operated at the same Centers between 03/01/2019 and 02/29/2020 (pre-COVID-19 pandemic) (C-Group). Results Overall, 7017 patients were included: 2782 in the P-Group and 4235 in the C-Group. The absolute number of patients with TCa was not significantly different between the two groups, while the rate of malignant disease was significantly higher in the P-Group (1103/2782 vs 1190/4235) (P &lt; 0.0001). Significantly more patients in the P-Group had central (237/1103 vs 232/1190) and lateral (167/1103 vs 140/1190) neck node metastases (P = 0.001). Overall, the complications rate was significantly lower (11.9% vs 15.1%) and hospital stay was significantly shorter (1.7 +/- 1.5 vs 1.9 +/- 2.2 days) in the P-Group (P &lt; 0.05). Conclusion The COVID-19 pandemic significantly decreased the overall number of thyroidectomies but did not affect the number of operations for TCa. Optimization of management protocols, due to limited resource availability for non-COVID patients, positively impacted the complication rate and hospital stay