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Cancers
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Updates in Thyroid Cancer Surgery
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Updates in Thyroid Cancer Surgery

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 38608

Special Issue Editors

Prof. Dr. Pietro Giorgio Calò

E-Mail Website
Guest Editor
Department of Surgical Sciences, University of Cagliari, 40-09124 Cagliari, Italy
Interests: thyroid; thyroidectomy; thyroid cancer; endocrine surgery; thyroid surgery; parathyroid; parathyroid surgery; parathyroidectomy; lymph node dissection; sentinel lymph node
Special Issues, Collections and Topics in MDPI journals
Dr. Salvatore Sorrenti

E-Mail Website
Guest Editor
Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy
Interests: thyroid cancer; breast cancer; surgical oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thyroid cancer is the most common endocrine malignancy, and its incidence has been steadily increasing in recent years.

It has different histological types and presentations that necessitate the use of more or less aggressive surgical treatments.

Today, surgical treatment is becoming increasingly tailored in relation to the type and histological characteristics of the tumour, the needs and characteristics of the patient, and the presence of locoregional and/or distant diffusion.

Surgery has undergone important and noteworthy developments in recent years, in connection with the emergence of new knowledge, in particular biological knowledge, and the availability of new technologies, which have emerged in an attempt to ensure, together with aoncological radicality, an acceptable aesthetic result.

However, to date, the guidelines have not always been uniform and unambiguous, a phenomenon which has led to diversity of opinion and practice in various areas of the globe.

This Special Issue seeks to present a comparison of current surgical modalities applied in the field of thyroid cancer and focus on state-of-the-art treatments as well as suggesting the best treatment modalities to adopt in light of current knowledge in this area.

Dr. Pietro Giorgio Calò
Dr. Salvatore Sorrenti
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thyroid
  • thyroid cancer
  • papillary carcinoma
  • differentiated carcinoma
  • medullary cancer
  • thyroidectomy
  • lymph node dissection

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Published Papers (10 papers)

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Editorial

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3 pages, 194 KiB  
Editorial
Updates in Thyroid Cancer Surgery
by Salvatore Sorrenti and Pietro Giorgio Calò
Cancers 2023, 15(12), 3102; https://doi.org/10.3390/cancers15123102 - 8 Jun 2023
Viewed by 1482
Abstract
This Special Issue of Cancers entitled “Updates in thyroid surgery” is a collection of nine articles that covers a wide range of topics, providing a comprehensive picture of the latest developments in thyroid surgery [...] Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)

Research

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11 pages, 272 KiB  
Article
Risk of Complications in Patients Undergoing Completion Thyroidectomy after Hemithyroidectomy for Thyroid Nodule with Indeterminate Cytology: An Italian Multicentre Retrospective Study
by Gian Luigi Canu, Fabio Medas, Federico Cappellacci, Alessio Biagio Filippo Giordano, Angela Gurrado, Claudio Gambardella, Giovanni Docimo, Francesco Feroci, Giovanni Conzo, Mario Testini and Pietro Giorgio Calò
Cancers 2022, 14(10), 2472; https://doi.org/10.3390/cancers14102472 - 17 May 2022
Cited by 10 | Viewed by 2316
Abstract
There is still controversy as to whether patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery. The main aim [...] Read more.
There is still controversy as to whether patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery. The main aim of this study was to investigate this topic. Patients undergoing a thyroidectomy for thyroid nodular disease with an indeterminate cytology in four high-volume thyroid surgery centres in Italy, between January 2017 and December 2020, were retrospectively analysed. Based on the surgical procedure performed, four groups were identified: the TT Group (total thyroidectomy), HT Group (hemithyroidectomy), CT Group (completion thyroidectomy) and HT + CT Group (hemithyroidectomy with subsequent completion thyroidectomy). A total of 751 patients were included. As for the initial surgery, 506 (67.38%) patients underwent a total thyroidectomy and 245 (32.62%) a hemithyroidectomy. Among all patients submitted to a hemithyroidectomy, 66 (26.94%) were subsequently submitted to a completion thyroidectomy. No statistically significant difference was found in terms of complications comparing both the TT Group with the HT + CT Group and the HT Group with the CT Group. The risk of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology was comparable to that of patients submitted to primary thyroid surgery (both a total thyroidectomy and hemithyroidectomy). Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
10 pages, 1906 KiB  
Article
Radioiodine Refractory Follicular Thyroid Cancer and Surgery for Cervical Relapse
by Costanza Chiapponi, Milan J. M. Hartmann, Matthias Schmidt, Michael Faust, Anne M. Schultheis, Christiane J. Bruns and Hakan Alakus
Cancers 2021, 13(24), 6230; https://doi.org/10.3390/cancers13246230 - 11 Dec 2021
Cited by 3 | Viewed by 2443
Abstract
Compared to its more common counterpart papillary thyroid cancer (PTC), follicular thyroid cancer (FTC) has a less favorable outcome, due to its higher incidence of distant metastases and advanced stages at diagnosis. Despite radioiodine (RAI) avidity, metastatic FTC often progresses after radioiodine treatment [...] Read more.
Compared to its more common counterpart papillary thyroid cancer (PTC), follicular thyroid cancer (FTC) has a less favorable outcome, due to its higher incidence of distant metastases and advanced stages at diagnosis. Despite radioiodine (RAI) avidity, metastatic FTC often progresses after radioiodine treatment (RAIT). We aimed at evaluating the indications and outcomes of surgery for cervical relapse of radioiodine refractory FTC. Patients receiving RAIT between 2005 and 2015 at the University Hospital of Cologne, Germany, were screened. Patients with FTC were identified. Demographics, clinic-pathologic characteristics, treatment, and outcome of patients diagnosed with RAI refractory FTC, who underwent cervical surgery in the course of disease, were analyzed. FTC accounted for 8.8% of all thyroid carcinomas undergoing RAIT. In 35.2% of FTC patients, disease persisted or recurred despite a cumulative mean RAI activity of 18.7 GBq ± 11.6 (follow-up 83.5 ± 56.7 months). Distant metastases were diagnosed in 75% of these patients, as bone (57.6%), lung (54.6%), and liver metastases (12.1%). Cervical relapse occurred in 63.6% of these patients and was treated in 57.1% with surgery with, and without, external beam radiation therapy (EBRT). Despite surgery and EBRT, in 75% of patients, cervical relapse recurred again. In conclusion, surgery for cervical radioiodine refractory FTC relapse is often performed in metastatic setting. With and without EBRT, cure is rare, although metastases can appear radioiodine avid. Early biological marker and systemic treatments for these patients are still needed. Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
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13 pages, 999 KiB  
Article
How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice
by Tzu-Yen Huang, Wing-Hei Viola Yu, Feng-Yu Chiang, Che-Wei Wu, Shih-Chen Fu, An-Shun Tai, Yi-Chu Lin, Hsin-Yi Tseng, Ka-Wo Lee and Sheng-Hsuan Lin
Cancers 2021, 13(21), 5379; https://doi.org/10.3390/cancers13215379 - 27 Oct 2021
Cited by 10 | Viewed by 2428
Abstract
Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection [...] Read more.
Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection RLN(R2) signal <50%, 50–90% and >90% decrease from pre-dissection RLN(R1) signal were classified into Group A-no/mild, B-moderate, and C-severe RLN dysfunction, respectively. Demographic characteristics, RLN injury mechanisms(mechanical/thermal) and voice analysis parameters were recorded. More patients in the group with higher severity of RLN dysfunction had malignant pathology results (A/B/C = 35%/48%/55%, p = 0.017), received neck dissection (A/B/C = 17%/31%/55%, p < 0.001), had thermal injury (p = 0.006), and had asymmetric vocal fold motion in long-term postoperative periods (A/B/C = 0%/8%/62%, p < 0.001). In postoperative periods, Group C patients had significantly worse voice outcomes in several voice parameters in comparison to Group A/B. Thermal injury was associated with larger voice impairments compared to mechanical injury. This report is the first to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who received monitored thyroidectomy. To optimize voice and swallowing outcomes after thyroidectomy, avoiding thermal injury is mandatory, and mechanical injury must be identified early to avoid a more severe dysfunction. Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
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Review

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15 pages, 2047 KiB  
Review
Artificial Intelligence for Thyroid Nodule Characterization: Where Are We Standing?
by Salvatore Sorrenti, Vincenzo Dolcetti, Maija Radzina, Maria Irene Bellini, Fabrizio Frezza, Khushboo Munir, Giorgio Grani, Cosimo Durante, Vito D’Andrea, Emanuele David, Pietro Giorgio Calò, Eleonora Lori and Vito Cantisani
Cancers 2022, 14(14), 3357; https://doi.org/10.3390/cancers14143357 - 10 Jul 2022
Cited by 51 | Viewed by 5830
Abstract
Machine learning (ML) is an interdisciplinary sector in the subset of artificial intelligence (AI) that creates systems to set up logical connections using algorithms, and thus offers predictions for complex data analysis. In the present review, an up-to-date summary of the current state [...] Read more.
Machine learning (ML) is an interdisciplinary sector in the subset of artificial intelligence (AI) that creates systems to set up logical connections using algorithms, and thus offers predictions for complex data analysis. In the present review, an up-to-date summary of the current state of the art regarding ML and AI implementation for thyroid nodule ultrasound characterization and cancer is provided, highlighting controversies over AI application as well as possible benefits of ML, such as, for example, training purposes. There is evidence that AI increases diagnostic accuracy and significantly limits inter-observer variability by using standardized mathematical algorithms. It could also be of aid in practice settings with limited sub-specialty expertise, offering a second opinion by means of radiomics and computer-assisted diagnosis. The introduction of AI represents a revolutionary event in thyroid nodule evaluation, but key issues for further implementation include integration with radiologist expertise, impact on workflow and efficiency, and performance monitoring. Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
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14 pages, 2357 KiB  
Review
Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls
by Tsung-Jung Liang, I-Shu Chen and Shiuh-Inn Liu
Cancers 2022, 14(4), 1031; https://doi.org/10.3390/cancers14041031 - 17 Feb 2022
Cited by 9 | Viewed by 5728
Abstract
Transoral thyroidectomy is a novel technique that uses three small incisions hidden in the oral vestibule to remove the thyroid gland. It provides excellent cosmetic results and outcomes comparable to the open approach. One of the main obstacles for this technique is the [...] Read more.
Transoral thyroidectomy is a novel technique that uses three small incisions hidden in the oral vestibule to remove the thyroid gland. It provides excellent cosmetic results and outcomes comparable to the open approach. One of the main obstacles for this technique is the creation of a working space from the lip and chin to the neck. The anatomy of the perioral region and the top-down surgical view are both unfamiliar to general surgeons. As a result, inadequate manipulation might easily occur and would lead to several unconventional complications, such as mental nerve injury, carbon dioxide embolism, and skin perforation, which are rarely observed in open surgery. Herein, we summarize the basic concepts, techniques, and rationales behind working space creation in transoral thyroidectomy to assist surgeons in obtaining an adequate surgical field while eliminating preventable complications. Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
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19 pages, 866 KiB  
Review
Papillary Thyroid Cancer Prognosis: An Evolving Field
by Salvatore Ulisse, Enke Baldini, Augusto Lauro, Daniele Pironi, Domenico Tripodi, Eleonora Lori, Iulia Catalina Ferent, Maria Ida Amabile, Antonio Catania, Filippo Maria Di Matteo, Flavio Forte, Alberto Santoro, Piergaspare Palumbo, Vito D’Andrea and Salvatore Sorrenti
Cancers 2021, 13(21), 5567; https://doi.org/10.3390/cancers13215567 - 7 Nov 2021
Cited by 70 | Viewed by 6838
Abstract
Over the last few years, a great advance has been made in the comprehension of the molecular pathogenesis underlying thyroid cancer progression, particularly for the papillary thyroid cancer (PTC), which represents the most common thyroid malignancy. Putative cancer driver mutations have been identified [...] Read more.
Over the last few years, a great advance has been made in the comprehension of the molecular pathogenesis underlying thyroid cancer progression, particularly for the papillary thyroid cancer (PTC), which represents the most common thyroid malignancy. Putative cancer driver mutations have been identified in more than 98% of PTC, and a new PTC classification into molecular subtypes has been proposed in order to resolve clinical uncertainties still present in the clinical management of patients. Additionally, the prognostic stratification systems have been profoundly modified over the last decade, with a view to refine patients’ staging and being able to choose a clinical approach tailored on single patient’s needs. Here, we will briefly discuss the recent changes in the clinical management of thyroid nodules, and review the current staging systems of thyroid cancer patients by analyzing promising clinicopathological features (i.e., gender, thyroid auto-immunity, multifocality, PTC histological variants, and vascular invasion) as well as new molecular markers (i.e., BRAF/TERT promoter mutations, miRNAs, and components of the plasminogen activating system) potentially capable of ameliorating the prognosis of PTC patients. Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
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10 pages, 665 KiB  
Review
Surgical Skills and Technological Advancements to Avoid Complications in Lateral Neck Dissection for Differentiated Thyroid Cancer
by Aldo Bove, Maira Farrukh, Adele Di Gioia, Velia Di Resta, Angelica Buffone, Claudia Melchionna and Paolo Panaccio
Cancers 2021, 13(14), 3379; https://doi.org/10.3390/cancers13143379 - 6 Jul 2021
Cited by 7 | Viewed by 3347
Abstract
Neck dissection is a surgical procedure reserved for thyroid cancer cases with clinically evident lymphatic invasion. Although neck dissection is a reliable and safe procedure, it can determine a significant morbidity involving a variety of structures of nervous, vascular and endocrine typology. A [...] Read more.
Neck dissection is a surgical procedure reserved for thyroid cancer cases with clinically evident lymphatic invasion. Although neck dissection is a reliable and safe procedure, it can determine a significant morbidity involving a variety of structures of nervous, vascular and endocrine typology. A careful pre-operative study is therefore essential to better plan surgery. Surgical experience, combined with accurate surgical preparation and merged with adequate and specific techniques, can certainly help reduce the percentage of complications. In recent years, however, technology has also proved to be useful. Its crucial role was already recognized in the safeguard of the integrity of the laryngeal nerve through neuro-monitoring, but new technologies are emerging to help the preservation also of the parathyroid glands and other structures, such as the thoracic duct. These surgical skills combined with the latest technological advancements, that allow us to reduce the incidence of complications after neck dissection for thyroid cancer, will be reported in the present article. This topic is of significant interest for the endocrine and metabolic surgeons’ community. Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
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Other

9 pages, 251 KiB  
Commentary
The Role of Vitamin D as a Prognostic Marker in Papillary Thyroid Cancer
by Ashank Bains, Taha Mur, Nathan Wallace and Jacob Pieter Noordzij
Cancers 2021, 13(14), 3516; https://doi.org/10.3390/cancers13143516 - 14 Jul 2021
Cited by 13 | Viewed by 3066
Abstract
The role of vitamin D in modulating several cancer-related pathways has received an increasing amount of attention in the past several years. Previous literature has found an abundance of evidence of vitamin D exerting an anti-proliferative, anti-inflammatory, and pro-differentiation effect in various types [...] Read more.
The role of vitamin D in modulating several cancer-related pathways has received an increasing amount of attention in the past several years. Previous literature has found an abundance of evidence of vitamin D exerting an anti-proliferative, anti-inflammatory, and pro-differentiation effect in various types of cancers including breast, colon, prostate, and pancreatic cancer. Although the link between vitamin D and thyroid cancer remains controversial, both biochemical evidence and clinical studies have attempted to establish a link between papillary thyroid carcinoma (PTC) and vitamin D status. Furthermore, the use of vitamin D as a prognostic marker has received increased attention, both in regards to clinical outcomes and cancer staging. In this review, we briefly discuss the metabolism and proposed mechanism of action of vitamin D in the context of PTC, and explore links between modulators in the vitamin D pathway and progression of PTC. We provide evidence from both clinical studies as well as molecular studies of metabolic targets, including vitamin D receptor and activating enzymes exerting an effect on PTC tissue, which indicate that vitamin D may play a significant prognostic role in PTC. Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
10 pages, 732 KiB  
Brief Report
The Value of Intraoperative Ultrasound in Selective Lateral Cervical Neck Lymphadenectomy for Papillary Thyroid Cancer: A Prospective Pilot Study
by Giovanna Di Meo, Francesco Paolo Prete, Giuseppe Massimiliano De Luca, Alessandro Pasculli, Lucia Ilaria Sgaramella, Francesco Minerva, Francesco Antonio Logoluso, Giovanna Calculli, Angela Gurrado and Mario Testini
Cancers 2021, 13(11), 2737; https://doi.org/10.3390/cancers13112737 - 31 May 2021
Cited by 9 | Viewed by 2776
Abstract
(1) Background: Lymph node metastases from papillary thyroid cancer (PTC) are frequent. Selective neck dissection (SND) is indicated in PTC with clinical or imaging evidence of lateral neck nodal disease. Both preoperative ultrasound (PreUS) and intraoperative palpation or visualization may underestimate actual lateral [...] Read more.
(1) Background: Lymph node metastases from papillary thyroid cancer (PTC) are frequent. Selective neck dissection (SND) is indicated in PTC with clinical or imaging evidence of lateral neck nodal disease. Both preoperative ultrasound (PreUS) and intraoperative palpation or visualization may underestimate actual lateral neck nodal involvement, particularly for lymph-nodes located behind the sternocleidomastoid muscle, where dissection may also potentially increase the risk of postoperative complications. The significance of diagnostic IOUS in metastatic PTC is under-investigated. (2) Methods: We designed a prospective diagnostic study to assess the diagnostic accuracy of IOUS compared to PreUS in detecting metastatic lateral neck lymph nodes from PTC during SND. (3) Results: There were 33 patients with preoperative evidence of lateral neck nodal involvement from PTC based on PreUS and fine-needle cytology. In these patients, IOUS guided the excision of additional nodal compartments that were not predicted by PreUS in nine (27.2%) cases, of which eight (24.2%) proved to harbor positive nodes at pathology. The detection of levels IIb and V increased, respectively, from 9% (PreUS) to 21% (IOUS) (p < 0.0001) and from 15% to 24% (p = 0.006). (4) Conclusions: In the context of this study, IOUS showed higher sensitivity and specificity than PreUS scans in detecting metastatic lateral cervical nodes. This study showed that IOUS may enable precise SND to achieve oncological radicality, limiting postoperative morbidity. Full article
(This article belongs to the Special Issue Updates in Thyroid Cancer Surgery)
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