Project description:Transoral robotic thyroidectomy (TORT) is well consistent with the primary goal of remote-access thyroid surgery, which is to avoid a visible cervical scar. Additionally, the extent of transoral thyroidectomy dissection is less than that of other remote-access surgical procedures. Owing to these merits of the transoral approach, several institutions around the world are now performing this procedure. Since transoral thyroidectomy is performed in a confined, narrow space, and is characterized by a close distance from the ports to the working space, more benefits can be derived from multiarticulation of robotic instruments. Especially when performing left lobectomy by TORT, the surgeon can use right-handed robotic instruments over the thyroid cartilage with the merits of multiarticulation. In this study, we present our unique procedure of left lobectomy by TORT in detail.
Project description:Currently, there is a lack of efficient recurrence prediction methods for papillary thyroid carcinoma (PTC). In this study, we enrolled 202 PTC patients submitted to total thyroidectomy and radioiodine therapy with long-term follow-up (median = 10.7 years). The patients were classified as having favorable clinical outcome (PTC-FCO, no disease in the follow-up) or recurrence (PTC-RE). Alterations in BRAF, RAS, RET, and TERT were investigated (n = 202) and the transcriptome of 48 PTC (>10 years of follow-up) samples was profiled. Although no mutation was associated with the recurrence risk, 68 genes were found as differentially expressed in PTC-RE compared to PTC-FCO. Pathway analysis highlighted a potential role of cancer-related pathways, including signal transduction and FoxO signaling. Among the eight selected genes evaluated by RT-qPCR, SLC2A4 and GADD45B showed down-expression exclusively in the PTC-FCO group compared to non-neoplastic tissues (NT). Increased expression of GADD45B was an independent marker of shorter disease-free survival [hazard ratio (HR) 2.9; 95% confidence interval (CI95) 1.2-7.0] in our cohort and with overall survival in the TCGA dataset (HR = 4.38, CI95 1.2-15.5). In conclusion, GADD45B transcript was identified as a novel prognostic marker candidate in PTC patients treated with total thyroidectomy and radioiodine therapy.
Project description:BACKGROUND:This study aimed to assess the appropriate number of sessions and interval of routine follow-up ultrasonography (US) in patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC). METHODS:Between January 2008 and December 2009, 569 patients underwent total thyroidectomy for PTC. Of the 569 patients, 44 were excluded from the study because of no US follow-up data for the neck (n = 43) or owing to indeterminate tumor recurrence/persistence (n = 1). The follow-up US for all the patients was performed by a single radiologist. Based on the cytohistopathological results, tumor recurrence/persistence was determined. RESULTS:In the 525 patients, the mean interval to the last follow-up US was 54.7 months, and the mean number of follow-up US sessions was 4.4. Of the 525 patients, 31 (5.9%) showed nodal (n = 30) and non-nodal (n = 1) tumor recurrence/persistence. Patient age and N stage were independently associated with tumor recurrence/persistence. Among patients showing tumor recurrence/persistence after total thyroidectomy, the time at first detection of suspicious US findings on follow-up US was ≤8 months in 2 patients, between 10 and 23 months in 21, and ≥ 25 months in 8. In a receiver operating characteristic curve analysis, the number of sessions and interval of the provided follow-up US were inappropriate for the detection of tumor recurrence/persistence. CONCLUSIONS:For the detection of tumor recurrence/persistence after total thyroidectomy in PTC patients, routine US follow-up with a 1- or 2-year interval may be excessive.
Project description:IntroductionThyroidectomy and thyrotropin suppressive therapy is the widely used surgical treatment for papillary thyroid carcinoma (PTC) patients. However, systematic metabolic changes of post-operative PTC patients were rarely reported.MethodsHere, untargeted metabolomic detection of cohorts from PTC before (t0) and 1-month-after (t1) thyroidectomy, were performed to characterize circulating metabolic signatures after surgical treatment.ResultsOur results showed PTC patients exhibited lower thyroid stimulating hormone degree, higher total thyroxine, and significant lipid-related metabolic alternations after thyroidectomy, which included 97 upregulations (including 93 lipids) and 5 downregulations (including 2 lipids and 3 nucleotides). Enrichment of metabolic pathways mainly included biosynthesis of fatty acids, purine metabolism, and linoleic acid metabolism. We also demonstrated that differential surgical approaches (hemi- and total thyroidectomy) and post-operative complication phenotypes (insomnia, fatigue), might lead to characteristic metabolic signatures.DiscussionThis study revealed dynamic changes of metabolite characteristics of PTC patients after surgical treatment, which were associated with clinical thyroid function parameters, surgical approaches, and complication occurrence. It enlightened us to pay more attention on the post-operative metabolic dysregulation of PTC patients and their long-term qualities of life, so as to provide cautious clinical decisions on surgical choices, treatments, and follow-up details.
Project description:To evaluate the expression profiles of circular RNAs (circRNAs) in papillary thyroid cancer (PTC) and to find new PTC biomarkers. Objective: The goal of this study was to characterize the expression profiles of circular RNAs (circRNAs) in papillary thyroid carcinoma (PTC), analyze their biological function, and discover new biomarkers for PTC. Methods: From June 2019 to July 2020, 68 patients admitted to Qilu Hospital and confirmed with PTC were included in this study. PTC and paired healthy tissue samples were collected and analyzed. The circRNA expression profiles of 4 pairs of samples were determined using high-throughput sequencing. Differentially expressed circRNAs were discovered to be associated with multiple related microRNAs (miRNAs) and messenger RNAs using bioinformatics analysis (mRNAs). Results: 89 upregulated and 14 downregulated circRNAs were identified in PTC tissues using high-throughput sequencing (fold change ≥ 2; p < 0.05). Among the upregulated circRNAs, we identified 14 significantly regulated circRNAs that play an important role in the pathogenesis of thyroid cancer using the network map of circRNA–miRNA–mRNA interactions. Following that, we validated the expression levels of seven candidate circRNAs (hsa_circ_0031584, hsa_circ_0082002, hsa_circ_0000660, hsa_circ_0067938, hsa_circ_0002483, hsa_circ_0003692, and hsa_circ_0006509) and discovered that among the circRNAs that we verified to be significantly differentially expressed Conclusions: The findings imply that dysregulated circRNAs may play an important role in the pathogenesis of PTC. We also discovered 14 circRNAs that were significantly upregulated and could be used to diagnose and treat PTC.
Project description:ImportancePapillary thyroid microcarcinomas (PTMCs) have been associated with increased thyroid cancer incidence in recent decades. Total thyroidectomy (TT) has historically been the primary treatment, but current guidelines recommend hemithyroidectomy (HT) for select low-risk cancers; however, the risk-benefit ratio of the 2 operations is incompletely characterized.ObjectiveTo compare surgical complication rates between TT and HT for PTMC treatment.Data sourcesSCOPUS, Medline via the PubMed interface, and the Cochrane Central Register of Controlled Trials (CENTRAL); through January 1, 2021, with no starting date restriction. Terms related to papillary thyroid carcinoma and its treatment were used for article retrieval. This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal.Study selectionOriginal investigations of adults reporting primary surgical treatment outcomes in PTMC and at least 1 complication of interest were included. Articles evaluating only secondary operations or non-open surgical approaches were excluded. Study selection, data extraction, and risk of bias assessment were performed by 2 independent reviewers and conflicts resolved by a senior reviewer.Data extraction and synthesisPooled effect estimates were calculated using a random-effects inverse-variance weighting model.Main outcomes and measuresCancer recurrence and site, mortality (all-cause and disease-specific), vocal fold paralysis, hypoparathyroidism, and hemorrhage/hematoma. Risk of bias was assessed using the McMaster Quality Assessment Scale of Harms scale.ResultsIn this systematic review and meta-analysis, 17 studies were analyzed and included 1416 patients undergoing HT and 2411 patients undergoing TT (HT: pooled mean [SD] age, 47.0 [10.0] years; 1139 [84.6%] were female; and TT: pooled mean [SD] age, 48.8 [10.0] years; 1671 [77.4%] were female). Patients undergoing HT had significantly lower risk of temporary vocal fold paralysis compared with patients undergoing TT (3.3% vs 4.5%) (weighted risk ratio [RR], 0.4; 95% CI, 0.2-0.7), temporary hypoparathyroidism (2.2% vs 21.3%) (weighted RR, 0.1; 95% CI, 0.0-0.4), and permanent hypoparathyroidism (0% vs 1.8%) (weighted RR, 0.2; 95% CI, 0.0-0.8). Contralateral lobe malignant neoplasm recurrence was 2.3% in the HT group, while no such events occurred in the TT group. Hemithyroidectomy was associated with a higher overall recurrence rate (3.8% vs 1.0%) (weighted RR, 2.6; 95% CI, 1.3-5.4), but there was no difference in recurrence in the thyroid bed or neck.Conclusions and relevanceThe results of this systematic review and meta-analysis help characterize current knowledge of the risk-benefit ratio of HT vs TT for treatment of PTMC and provide data that may have utility for patient counseling surrounding treatment decisions.