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The system of lymph node levels in the neck, as described by Robbins et al. 21 Level I: submental and submandibular group, lymph nodes within the boundary of the subdigastric muscles and the hyoid bone. Levels II/III/IV: Upper, middle, and lower jugular group, lymph nodes located around the internal jugular vein, sternohyoid muscle anteriorly, sternocleidomastoid muscle posteriorly, skull base superiorly, and clavicle inferiorly. Level V: Posterior triangle group, located between the sternocleidomastoid muscle and the trapezius muscle, including suprasternal lymph nodes. Level VI: Anterior compartment, located in the midline between the carotid sheets, from the hyoid bone superiorly to the suprasternal notch inferiorly. Level VII: Mediastinal lymph nodes. Image modified from de Groot et al. 20
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Background
In the Netherlands, differentiated thyroid cancer (DTC) is treated surgically in three different hospital types, including university, teaching, and non- teaching peripheral hospitals. This study evaluates postoperative complications and referral patterns in patients with DTC in the northern region of the Netherlands to gain an understan...
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Background: Hypocalcaemia is a common delayed complication after thyroidectomy. Several studies have identified risk factors and possible ways to prevent post-thyroidectomy hypocalcemia. The purpose of our study is to evaluate the effectiveness of an intraoperative methylene blue spray to identify parathyroid glands during thyroidectomy.
Materials...
Citations
... The Netherlands has an effective register based on pathology, and centralisation of care is seen as the best way forward to improve care for rare diseases [54]. Reimbursement by the hospitals can lead to limited clinical use of advanced testing tools; somatic genetic testing is available, but mainly as a part of panels used for other malignant tumors. ...
Thyroid cancer (TC) is the most common malignancy of the endocrine system that affects the thyroid gland. It is usually treatable and, in most cases, curable. The central issues are how to improve knowledge on TC, to accurately identify cases at an early stage that can benefit from effective intervention, optimise therapy, and reduce the risk of overdiagnosis and unnecessary treatment. Questions remain about management, about treating all patients in referral centres, and about which treatment should be proposed to any individual patient and how this can be optimised. The European Alliance for Personalised Medicine (EAPM) hosted an expert panel discussion to elucidate some of the challenges, and to identify possible steps towards effective responses at the EU and member state level, particularly in the context of the opportunities in the European Union’s evolving initiatives—notably its Beating Cancer Plan, its Cancer Mission, and its research funding programmes. Recommendations emerging from the panel focus on improved infrastructure and funding, and on promoting multi-stakeholder collaboration between national and European initiatives to complement, support, and mutually reinforce efforts to improve patient care.
... Furthermore, inclusion from only a single tertiary center may be considered a strength, although we could not exclude a selection of patients with more aggressive disease. 36 This study shows, according to our estimation, that low-risk patients were treated too aggressively when using current Dutch guidelines (NL-15), while the less aggressive approach of ATA-15 seems more adequate. This pleads for further de-escalation of treatment strategy in the Netherlands. ...
Objective:
Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch Thyroid Cancer Guidelines (NL-15) and American Thyroid Association Guidelines (ATA-15).
Design:
Retrospectively, the recommendations of the NL-15 and ATA-15 guidelines were evaluated to estimate potentially adequate, under- and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017.
Patients:
240 patients with a cT1-T3aN0-1aM0 DTC fulfilled the inclusion criteria.
Measurements:
After actual treatment was given, patients were again categorized according to both guidelines into low, intermediate, or high-risk based on tumor status. Next, they were categorized into a congruent low-risk (n=60), congruent high-risk (n=73), or incongruent risk group (n=107). Follow-up data were used to estimate the proportion of potentially adequate, under- and over- treatment according to both guidelines.
Results:
Comparing treatment recommended by NL-15 and ATA-15 showed significantly more over- and adequate treatment when following NL-15 recommendations, and more undertreatment following ATA-15 (all: P<0.001). Sub-analysis of the congruent low-risk group showed overtreatment in 64% when following NL-15 Guidelines (P<0.001). No treatment differences were found in the congruent high-risk group. Undertreatment was most often seen in the incongruent risk group when following ATA-15 (P<0.001).
Conclusions:
Low-risk patients were treated too aggressively when following NL-15 recommendations; where the less aggressive ATA-15 approach seemed more adequate. Treatment of intermediate risk DTC patients varies greatly, with a relative higher rate of undertreatment according to the recommendations of the ATA-15, advocating further refining of the risk classification in this patient group. This article is protected by copyright. All rights reserved.
... The American Association of Endocrine Surgeons guidelines for primary hyperparathyroidism management comment that if PC is encountered, en bloc resection should be performed if necessary to avoid capsular disruption, but prophylactic central or lateral neck dissection should be avoided [13]. Considering the lack of convincing data for or against RS, and the significant morbidity that may be associated with RS, especially in a re-operative setting, the role for RS warrants further evaluation [14,15]. We sought to compare outcomes of LR versus RS for localized PC using a large national database. ...
... Surgery is considered the cornerstone of treatment as radiotherapy and chemotherapy remain unproven with regards to disease control or survival [1][2][3]13]. However, RS can cause significant morbidity in the form of recurrent laryngeal nerve palsy and muscular dysfunction of the neck and shoulder [14,15]. Furthermore, the risk of morbidity is increased in a re-operative setting [15]. ...
... However, RS can cause significant morbidity in the form of recurrent laryngeal nerve palsy and muscular dysfunction of the neck and shoulder [14,15]. Furthermore, the risk of morbidity is increased in a re-operative setting [15]. This is often the case for RS, as many PC patients undergo RS as a second procedure after LR for a presumed benign indication [4][5][6][7]15]. ...
Introduction:
Parathyroid carcinoma (PC) is rare and often diagnosed incidentally after local resection (LR) for other indications. Although recommended treatment has traditionally been radical surgery (RS), more recent guidelines suggest that LR alone may be adequate. We sought to further investigate outcomes of RS versus LR for localized PC.
Materials and methods:
PC patients from 2004 to 2015 with localized disease were identified from the National Cancer Database, then stratified by surgical therapy: LR or RS. Demographic and clinicopathologic data were compared. Cox proportional hazard models were constructed to estimate associations of variables with overall survival (OS). OS was estimated from time of diagnosis using Kaplan-Meier curves.
Results:
A total of 555 patients were included (LR = 522, RS = 33). The groups were comparable aside from LR patients having higher rates of unknown nodal status (66.9% versus 39.4%; p = 0.003). By multivariable analysis, RS did not have a significant association with OS (hazard ratio (HR) = 0.43, 95% confidence interval (95%CI) = 0.10, 1.83; p = 0.255), nor did positive nodal status (HR = 0.66, 95%CI = 0.09, 5.03; p = 0.692) and unknown nodal status (HR = 1.30, 95%CI = 0.78, 2.17; p = 0.311). There was no difference in OS between the LR and RS groups, with median survival not reached by either group at 10 years (median follow-up = 60.4 months; p = 0.20).
Conclusions:
There was no difference in OS between LR and RS for localized PC. RS and nodal status may not impact survival as previously identified, and LR should remain a valid initial surgical approach. Future higher-powered studies are necessary to assess the effects of surgical approaches on morbidity and oncologic outcomes.
