Patients with head and neck malignancy with locally advanced disease often require chemoradiation, and those patients who undergo chemoradiation encounter more endocrine/metabolic-related complications after surgery.
Materials and methods: We evaluated 36 locally advanced head and neck cancer patients who had undergone chemoradiation, followed by surgery during the period from February 2021 to June 2022 for various endocrine-related abnormalities, such as hyponatremia, hypokalemia, hypothyroidism, hypocalcemia, and complications associated with surgery in relation to these endocrine abnormalities.
Results: Among these 36 patients, 20 patients developed hyponatremia, four patients developed hypokalemia, and nine patients developed hypocalcemia at some point of time after the surgery, and their preoperative (pre-OP) values were normal. A total of 13 patients had subclinical hypothyroidism even before the surgery. Wound morbidity was more among these patients.
Conclusion: If all patients with head and neck cancers who are all undergoing surgery after chemoradiation are evaluated for electrolyte abnormalities, such as hyponatremia, hypocalcemia, and hypothyroidism, it may reduce the perioperative and postoperative (post-OP) complications and it may shorten the hospital stay, help in early recovery, and may avoid life-threatening conditions.
DOI: 10.5005/jp-journals-10002-1436 |
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Park B, Xia W, Karalus M, Moss D, Rahman H, Biggar M. Adrenalectomy and Abdominal Paraganglioma Surgery at an Ethnically Diverse New Zealand Center: Māori Ethnicity Frequent amongst Paraganglioma Patients. World J Endoc Surg 2022; 14 (3):73-78.
Aim: To identify the indications for adrenal and abdominal paraganglioma operations by ethnicity in an ethnically diverse New Zealand tertiary hospital catchment area. The secondary aims were to outline a surgical practice in this setting.
Materials and methods: All patients who underwent adrenalectomy or surgical removal of paraganglioma between January 2008 and December 2020 in the Manukau SuperClinic™ area in Auckland, New Zealand, were included. Demographic information, indications for surgery, operative technique, and outcomes were collected.
Results: A total of 78 patients were identified (64 adrenalectomy patients and 14 paraganglioma patients). Functional lesions were most common (n = 45, 70%), with Conn's being most frequent (n = 30). Most adrenalectomies were laparoscopic by transabdominal approach (n = 53, 82%). Paraganglioma patients had more functional lesions (n = 11, 79%), experienced higher rates of open surgery (n = 11, 79%), and overall complications. Māori represented 64% (n = 9) of the 14 patients undergoing surgery for paraganglioma. 56% of these patients had the Succinate dehydrogenase [ubiquinone] iron-sulfur subunit, mitochondrial (SDHB) gene mutation.
Conclusion: Functional lesions were the most common indication to perform an adrenalectomy, with Conn's being the most common. There was a seeming overrepresentation of Māori in the paraganglioma group with a high number of SDHB mutations. Given that SDHB gene mutation is associated with malignancy and poorer prognosis, this merits further study.
Reyaz M Singaporewalla,
Geraldine Y Lei,
Anil D Rao
Aim: While the need for thyroidectomy in symptomatic retrosternal goiters (RSG) is indisputable, the management of asymptomatic image-detected RSG remains controversial. We compared outcomes and complications of performing thyroidectomy for patients with symptomatic and asymptomatic RSG to create a management algorithm.
Materials and methods: Data of patients with RSG between 2011 and 2019 was collected from our prospective electronic thyroid surgery database. Patient comorbidities, risk stratification, symptoms and signs, modality of diagnosis, surgery details, complications, and outcomes were compared between the symptomatic and asymptomatic groups.
Results: A total of 42 out of 477 thyroidectomies (8.8%) had RSG based on our definition, with 26 patients (62%) being truly asymptomatic. Detection of RSG was mainly on imaging (88%), with physical examination accurate in only five patients (12%). Six patients (14%) with image-detected incidental RSG on closer questioning had neck tightness and dysphagia that resolved after thyroidectomy. The surgery involved 23 total thyroidectomies and 19 hemithyroidectomies, with no statistically significant differences between the two groups in terms of operative time, nerve injury, hypocalcemia, or blood loss. The overall incidence of malignancy was 9.5%. Cervical thyroidectomy was successful in all asymptomatic patients, whereas two patients in the symptomatic arm needed an additional extracervical approach.
Conclusion: Early thyroidectomy can be safely performed in surgically fit asymptomatic RSG patients with excellent outcomes.
Clinical Significance: This paper highlights the issue of asymptomatic RSG, the management of which is controversial. A management algorithm is provided to facilitate a treatment plan and shows that excellent surgical outcomes can be achieved with early thyroidectomy.
Luis S Castro,
Goiter, Superior vena cava syndrome, Thyroid tumor, Venous compression
DOI: 10.5005/jp-journals-10002-1438 |
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Castro LS, Timóteo J, Aparício D, Girão J, Rocha J. Features of Superior Vena Cava Syndrome Secondary to Noninvasive Thyroid Tumor: A Case Report. World J Endoc Surg 2022; 14 (3):84-86.
This case report highlights both an extremely rare form of goiter presentation with venous compressive symptoms and also some challenges in the treatment of such extreme cases. Compressive symptoms secondary to thyroid gland enlargement are related in most cases to its position in the thoracic inlet. Retrosternal goiter incidence varies widely depending on its definition but can be found in up to 45% of all thyroidectomies. A 57-year-old man presented with goiter and features of superior vena cava syndrome. Neck imaging by computed tomography (CT) showed an increased thyroid gland volume centered to its right lobe and isthmus measuring 87 × 57 × 110 mm with bilateral compression of the venous brachiocephalic trunks as well as left side cervical tracheal deviation. Thyroidectomy was complicated by hemorrhagic shock secondary to laceration of the anterior jugular and thyroid veins during thyroid gland mobilization. The patient was monitored in an intensive care setting during the early postoperative period and was eventually discharged on postoperative day 5. Symptomatic bilateral brachiocephalic venous compression is an extremely rare form of presentation of goiter. Thyroid gland enlargement with compressive symptoms should prompt a thorough evaluation of neighboring structures, and preoperative planning is key to minimizing complications. Life-threatening complications can occur in complex cases such as this one. A rare presentation of goiter with some features of superior vena cava syndrome secondary to external bilateral compression of the venous brachiocephalic trunks is presented. Some technical challenges concerning the surgical approach are also discussed, with a focus on intraoperative bleeding due to venous congestion of cervical and thyroid veins.
Amit S Nachankar,
Introduction: Here we describe six cases of primary hyperparathyroidism presenting initially as acute pancreatitis. Further evaluation of our cases not only confirmed primary hyperparathyroidism on the biochemical investigation but also localized the parathyroid adenoma by nuclear imaging.
Discussion: A thorough literature search confirmed that pancreatitis is a rare initial manifestation of primary hyperparathyroidism. We also tried to compare previously published case series of pancreatitis and primary hyperparathyroidism both in India and across the world. Young age, male sex, and presence of normocalcemia or hypercalcemia at diagnosis of pancreatitis need to be further evaluated for primary hyperparathyroidism after initial acute management of pancreatitis.
Conclusion: Though hypercalcemia due to primary hyperparathyroidism is mainly responsible for the development of pancreatitis, the role of other genetic and environmental influences also exists as per multihit hypothesis to manifest as pancreatitis in addition to the main role of hypercalcemia.
The diagnosis of acromegaly is still a difficult task, as the disease has a slow onset and progression, and some of its symptoms may resemble those of other common conditions. Delays in diagnosis are common. Moreover, due to the continuous requirement for mask-wearing in many healthcare settings to prevent the spread of COVID-19, it is crucial to conduct a comprehensive examination of each patient without a face mask.