Candinas, D

Herden, U

Schmid, S

Seiler, C

Bern Open Repository and Information System (BORIS)

source: https://doi.org/10.48350/24240 | downloaded: 17.2.2023Background: We evaluated, if preoperative, single-dose steroidapplication reduces nausea, pain and voice disturbances afterthyroid surgery.Patients and methods: Sixty patients (m=16, w=44) with medianage 55 years (range 18–80) entered a two-arm, randomized, double-blinded, controlled study receiving either dexamethasone 8mg (D)(n=30) or NaCl 0.9% (C) (n=30) i/v 30 min before anaesthesia. At6 timepoints (4–48 h) after the operation nausea (verbal responsescale (0–3), use of antiemetic medication), pain (visual analoguescale (VAS), analgesic use) and vocal function was registered.Results: Groups did not differ in demographics. Nausea andantiemetic use was significantly less in group D compared to C.Over 48 h the difference in nausea and vomiting was significant(p<0.001; ANOVA repeated measures). There was a significantreduction in antiemetic use, too (D=16.1%/C=28.1%) (p<0.009).Mean scores for pain during the first 48 h after operation were17.5/25.1 in group D and C, respectively (p<0.001) with areduction in total opioid requirement (p<0.001). Changes in voicemean frequency over a 48 h period after surgery was significantlyless in the dexamethasone group than in the placebo group (p<0.02). No potential steroid related complications occurred.Conclusion: Preoperative single-dose steroid not only reducespostoperative nausea/vomiting and pain within 48 h afterthyroid resection but decreases voice dysfunction, too.12IN VITRO EVALUATION OF PROTEASOME INHIBITONBY BORTEZOMIB AS A NEWOPTION OF ANTIPROLIFERATIVETHERAPY IN ANAPLASTIC THYROID CANCERSabine Zimmer1, Sabine Teichler2, Annette Wunderlich1,Susanne Lingelbach1, Andreas Neubauer2,Matthias Rothmund1, Sebastian Hoffmann11Department of Surgery, Philipps University of Marburg, Germany2Department of Medicine, Division of Haematology,Philipps University of Marburg, GermanyBackground: Anaplastic thyroid cancer (ATC) is characterized byuncontrolled tumor cell proliferation. Because of failure of usualtherapy, patients with undifferentiated thyroid cancer are indesperate need of new therapeutic strategies. Bortezomib is aninhibitor of the proteasome that has been approved for thetreatment of multiple myeloma. The aim of this study was toevaluate the effect of Bortezomib alone and in combinations onanaplastic thyroid cancer cell lines as a possible new therapeuticoption for ATC.Patients and methods: Three anaplastic thyroid cancer cell lines(Hth74,C643,KAT4) were evaluated in vitro. The antiproliferativeeffect of Bortezomib (0.1–100 nM) alone, or in combination withvalproic acid (0.125–4 mM) or AEE788, a dual tyrosine kinaseinhibitor (TKI) of EGF-R/VEGF-R, (AEE788 4 μM) on thyroidcancer cell lines was quantified by MTT assay. The proapoptoticeffect was asessed by flowcytometric analysis (FACS) after PIstaining and cell cycle analysis. Single and combination therapy ofcompounds were analyzed.Results: Administration of Bortezomib (B) and valproic acid (V)inhibited tumor cell numbers as follows: 92% inhibition in Hth74(B) 87,5%(V), 98% in C643(B) 44%(V) and 98% in KAT4(B)50%(V). The IC50 of Bortezomib was 8 nM in Hth74, 10 nM inC643 and 10 nM in Hth74. Combinations of IC50 concentrationsof Bortezomib with valproic acid or AEE788 displayed relevantsynergistic effects with an increased antiproliferative activity of upto 100% compared to the single agents. An increase of apoptoticcells of some 10–15% occurred by AEE788 and not byBortezomib or valproic acid administration.Conclusion: Proteasome inhibiton leads to significant decreasedtumor cell proliferation of anaplastic thyroid cancer cell lines invitro. Combination of Bortezomib with TKI of EGF-R/VEGF-Ror with valproic acid seems to be more effective than single agentstrategies. It is suggested that proteasome inhibiton may havetherapeutic potential in some anaplastic thyroid cancers.13MORBIDITY OF SECONDARY COMPLETE THYROIDRESECTION IN PATIENTS WITH DIFFERENTIATEDTHYROID CARCINOMA DEPENDSON THE TIME OF SURGERYAyman Agha, Gabriel Glockzin, Nabil Ghali, Hans J. SchlittDepartment of Surgery, University of Regensburg Medical Center,Regensburg, GermanyBackground: Secondary complete thyroidectomy (and lymph nodedissection) in patients with differentiated thyroid carcinoma areassociated with high morbidity and complication rates. However,the optimal time of surgery is discussed controversially. In thepresent study we evaluated patient outcome depending on the timeof secondary surgery.Patients and methods: Between 1996 and 2004 87 patients withdifferentiated thyroid carcinomas (PTC:58, FTC: 29) underwentsecondary completion of surgery at the University of RegensburgMedical Center. These patients were divided in three groupsdepending on the time between initial and secondary surgery: groupA: 0–3 days and >3 months, group B: 3–7 days and 7 weeks—3 months, group C: 1–7 weeks. The median follow-up time was60.5 months.Results: Operation procedures were comparable in all groups.There was a significant lower number of persistent hypocalcemiain group A compared with group B and C (p<0.042). Moreover,recurrent laryngeal nerve paresis was significantly decreased ingroup A (p<0.003). Five patients developed local recurrence(5.7%). Overall mortality rate was 5.7%.Conclusion: Our data suggest that completion of surgery inpatients with differentiated thyroid carcinoma within 3 days ormore than 3 months after initial surgery reduces morbidity andimproves patient outcome.14RECURRENT GOITER—THE BOOMERANG OF INITIALSURGERYUta Herden, Stefan W. Schmid, Daniel Candinas,Christian A. SeilerClinic of Visceral and Transplant Surgery, University Hospital,Berne, SwitzerlandLangenbecks Arch Surg (2007) 392:839–855 843Background: Recurrent goiter is a common problem after partialthyroid resection at the initial operation. Reoperations result inharbouring an increased morbidity with a 5–10 fold risk forrecurrent laryngeal nerve palsy and hypoparathyroidism. Theobjective of this study is to analyze the sequelae of patients (pts)reoperated for benign recurrent disease.Patients and methods: Prospective analysis of all cases undergo-ing thyroid gland surgery at our institution (1997–2006). Ptsoperated for recurrent goiter were identified and evaluated withregard to number/type of primary operations, time/localization ofrecurrence, type of reoperation and incidence of newly diagnosedthyroid malignancy.Results: Between 1997 and 2006 105 (8.5%) of overall 1,241 ptsunderwent reoperation for recurrent goiter. In 94 of these 105cases a complete follow-up was obtained, including 112 “initial”operations. In 84% the primary operation was a partial resection,in 16% a radical unilateral resection. No patient underwent totalthyroidectomy. The median time to reoperation was 22 years(range 1–63 years). Ipsilateral recurrence occurred after median27 years, contralateral after median 19 years. However, in 70%recurrence occurred at the side initially already operated on. In96% of the pts with recurrent disease a radical resection wasperformed. Scaringly in 14 of the 94 pts (14.9%) a newly detectedthyroid cancer was diagnosed at reoperation.Conclusion: Patients with only partial initial resection of benigngoiter disease were brought to reoperation after median 22 years.70% of the recurrences occurred on the same side as the previousoperation. A newly detected thyroid cancer was diagnosed duringreoperation in 14.9%. Our data strengthen the evidence that in anendemic region initial radical thyroid resection reduces overallmorbidity in preventing recurrences and therefore avoidingreoperations with increased morbidity and further decreases theincidence of thyroid cancer.15PERSISTING AND RECURRENT MEDULLARY THYROIDCARCINOMAAxel Lötzbeier, Maike Eden, Robert H. Lienenlüke,Christian Vorländer, Robert A. WahlChirurgische Klinik, Bürgerhospital Frankfurt am Main, Frankfurt/Main, DeutschlandBackground: A wide variety in the natural course of MTC notcured by first operation is followed by a variety of consequentreoperations, with questionable curative intention.Patients and methods: Data of all patients with MTC from 1986 to2006 were documented prospectively, with consequent follow-up,including the markers Calcitonin and CEA, from 6 to 306 months.Reoperations were performed diagnostic or therapeutic, curative orpalliative.Results: Out of 168 patients operated on for MTC (120 spor., 48fam.) 26 underwent 1–8 reoperations, ranging from selectiveextirpation of lymph nodes to radical dissection of all compart-ments (including transsternal) and, with respect to the liver,ranging from diagnostic laparoscopy up to intended livertransplantation. The clinical course can be characterised as 2types with 2 subtypes: (a) 1. biochemical cure (n=5); 2. stable(occult) disease or slow progression (n=7); (b) 1. rather rapid,clinical progression (n=7); 2. tumour-related death (n=5) (missingdata in 2 patients). Liver metastases do not exclude type (a) 2.Conclusion: Multiple radical reinterventions are of questionablevalue, but for patients with inadequate first operation. On the otherhand, targeted operations in order of long-time control of locoregionaldisease are indicated and, sometimes, can be followed be definitecure.16THE EVALUATION OF INTRAOPERATIVE NEUROMONITORINGIN REOPERATIVE THYROID SURGERYNicole Müller, Bernd KochKlinik für Viszeralchirurgie mit endokriner und endoskopischerChirurgie, Westpfalz-Klinikum, Kaiserslautern, DeutschlandBackground: Reoperation in recurrent goiter shows an elevatedmorbidity, especially an increase in recurrent laryngeal nerve palsybetween 2 and >20%. The benefit of intraoperative neuromonitor-ing (IONM) in reoperative surgery with relation to the recurrentlaryngeal nerve palsy rate isn’t shown clearly.Patients and methods: In our retrospective study (1995–2005) of430 nerves at risk (NAR) in reoperative thyroid surgery by usingneuromonitoring (223 NAR) or only visual nerve identification(207 NAR) we had the same transient recurrent laryngeal nervepalsy rate (11.5 and 12%). But we find a clear reduction inpermanent recurrent laryngeal nerve palsy by using neuromonitor-ing from 11.2 to 4.3%.After standardizing IONM in our clinic we started a prospectivestudy to check this result and to find out the influence of IONM onthe transient recurrent laryngeal nerve palsy rate. We analysed thereoperations in thyroid diseases by using neuromonitoring (52NAR) from 2006 (January 1) in relation to the transient andpermanent recurrent laryngeal nerve paralysis rate.Results: The prospective evaluation of 52 NAR in reoperativethyroid surgery shows a decreased transient (8.16%) and per-manent (2.04%) recurrent laryngeal nerve palsy rate by usingIONM.Conclusion: In reoperative thyroid surgery IONM decreases thetransient and permanent recurrent laryngeal nerve palsy rate.17REOPERATIONS IN THE CENTRAL NECK FOR RECURRENTPAPILLARY THYROID CARCINOMARumen Pandev, T. Hadieva, I. Tersiev, E. HadievGerman Clinic Bulgaria, Medical University Sofia, BulgariaBackground: A retrospective review of patients with recurrentPTC, who underwent reoperation in the central compartment wasperformed to analyze the risk of hypoparathyroidism andRecurrent Laryngeal Nerve injury.844 Langenbecks Arch Surg (2007) 392:839–855

Recurrent goiter - the boomerang of initial surgery

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