Minerva chirurgica
-
The incidence of well-differentiated thyroid cancers is rising. Follicular cancer represents 10-20% of these lesions. While the vast majority of thyroid nodules of follicular origin are benign, fine needle aspiration cannot provide cytologic evidence of capsular and/or vascular invasion; therefore, patients should undergo surgical excision. ⋯ Patients deemed to have follicular cancer require near-total or total thyroidectomy and postoperative (131)I ablation. The optimal management of minimally invasive follicular cancer remains an area of controversy, but long-term prognosis for these patients is excellent. Areas of research should focus on identification of molecular markers of malignancy and aggressiveness of follicular neoplasia.
-
Papillary thyroid cancer (PTC) is the most common endocrine malignancy and commonly metastasizes to regional lymph nodes. Surgical treatment of cervical lymph nodes in PTC remains controversial. It has traditionally been accepted that regional lymph node metastases in PTC may increase local recurrence rates but do not ultimately affect survival. ⋯ Thus, there has been renewed interest in operative control of nodal disease for PTC. A systematic review of central lymph node dissection (CLND) in the recent literature using evidence-based criteria permitted formation of the following five recommendations: 1) limited data suggest benefit with the addition of prophylactic CLND to thyroidectomy (grade C); 2) systematic compartment-oriented CLND may decrease recurrence of PTC and improve disease-specific survival (no grade); 3) the addition of CLND to total thyroidectomy can significantly reduce levels of serum thyroglobulin and increase rates of athyroglobulinemia (no grade); 4) there may be a higher rate of permanent hypoparathyroidism and unintentional permanent nerve injury when CLND is performed with total thyroidectomy than for total thyroidectomy alone (grade C); 5) reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury when compared to total thyroidectomy with or without CLND, supporting a more aggressive initial operation by experienced endocrine surgeons (grade C). Taken together, these recommendations support the application of routine CLND at the initial operation for papillary thyroid cancer in expert hands.
-
Case Reports
Successful stent-grafting for iatrogenic aortic rupture and life-threatening hemoptysis.
Bronchiectasis presenting as massive hemoptysis and iatrogenic lesions of the thoracic aorta are life-threatening processes with very difficult management. We report a case of massive hemoptysis from bronchiectasis complicated with contained rupture of the descending thoracic aorta during bronchial artery embolization. Both lesions were confirmed by angiography and successfully treated by implantation of an endovascular stent-graft in the thoracic aorta. As far as we know, there are no previous reports of successful management of massive hemoptysis from bronchiectasis with an endovascular covered stent-graft prosthesis.