Background: To evaluate the current indications, resection strategies and short-term outcomes of surgery for benign goitre in a country with endemic goitre. Methods: Data of patients who underwent surgery for benign goitre were retrieved from the prospective StuDoQ/Thyroid registry and retrospectively analysed regarding the patient’s demographics, indications for surgery, surgical procedures, histology, and perioperative outcomes. Results: In a 15-month period, 12,888 patients from 83 departments underwent thyroid resections for benign conditions. Main indications for surgery were exclusion of malignancy (68%), compression symptoms (20.7%) and hyperthyroidism (9.7%). Preoperative fine needle aspiration cytology was performed in only 12.2% of patients with the indication “exclusion of malignancy”. Thyroidectomy (49.8%) or hemithyroidectomy (36.9%) were performed in 86.7% of patients. Minimally invasive or alternative surgical techniques were applied in only 2.2%. Intraoperative neuromonitoring was used in 98.4% of procedures, in 97.5% of patients at least one parathyroid gland was visualized, and in 15.3% of patients parathyroid tissue was autografted, respectively. The rates of unilateral and bilateral transient recurrent nerve palsy were 3.6% and 0.07% of nerves at risk, the rate of transitory hypoparathyroidism was 15.3%. The rates of postoperative bleeding and wound infections requiring reoperation were 1.4% and 0.07%, respectively. Conclusions: The indication “exclusion of malignancy” is made too liberally, and there is a strong attitude to perform complete thyroid resections. Postoperative hypoparathyroidism is the major complication after surgery for benign thyroid disease, thus requiring more awareness.

Thyroid stimulating hormone (TSH) causes differentiation and epidermal growth factor (EGF) causes dedifferentiation of thyroid cells in vitro. In undifferentiated thyroid cancer cell lines, TSH stimulates tumor cell migration and invasion, a dedifferentiated function, presumably due to an escape of tumor cells from the control of differentiating growth factors. In a highly differentiated thyroid carcinoma cell line of Hiirthle cell origin (XTC), we tested the hypothesis that TSH would stimulate thyroglobulin secretion (a differentiated function) more than EGF, and EGF would stimulate invasion (a de-differentiated function) more than TSH. Proliferation, adhesion, cell migration and invasion were measured by the MTT assay, human thyroglobulin by RIA and protease activity by substrate-gel zymography. TSH induced differentiated morphologic changes in XTC cells and stimulated secretion of human thyroglobulin in a dose dependent manner, whereas EGF did not. The effects of TSH on growth, adhesion, migration and invasion were dose dependent and biphasic, with an increase at low and a decrease at high concentrations of TSH. These effects were always more pronounced than those observed with EGF. Gelatino-lytic activity, consistent with metalloproteinase activity was revealed by zymography, but the pattern of secretion was not altered by neither TSH nor EGF. These results suggest, that TSH has pleiotropic effects on differentiated thyroid cancer cells in vitro that involve differentiated morphology and function but also affect features commonly associated with the malignant in vitro phenotype.

Background: Surgical treatment of Graves’ disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. Methods: Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student’s t-test or Fisher’s exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. Results: A total of 1808 patients with GD with a median age of 44 (range 14–85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. Conclusion: Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.

Purpose: Bilateral vocal cord dysfunction (bVCD) is a rare but feared complication of thyroid surgery. This long term retrospective study determined the effect of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgeries with regard to the rate of bVCD and evaluated the frequency as well as the outcome of staged operations. Methods: Retrospective analysis of prospectively documented data (2000–2019) of a tertiary referral centers’ database. IONM started in 2000 and, since 2010, discontinuation of surgery was encouraged in planned bilateral surgeries to prevent bVCD, if non-transient loss of signal (ntLOS) occurred on the first side. Datasets of the most recent 40-month-period were assessed in detail to determine the clinical outcome of unilateral ntLOS in planned bilateral thyroid procedures. Results: Of 22,573 patients, 65 had bVCD (0.288%). The rate of bVCD decreased from 0.44 prior to 2010 to 0.09% after 2010 (p < 0.001, Chi2). Case reviews of the most recent 40 months period identified ntLOS in 113/3115 patients (3.6%, 2.2% NAR), of which 40 ntLOS were recorded during a planned bilateral procedure (n = 952, 2.1% NAR). Of 21 ntLOS occurring on the first side of the bilateral procedure, 15 procedures were stopped, subtotal contralateral resections were performed, and thyroidectomy was continued in 3 patients respectively, with the use of continuous vagal IONM. Eighteen cases of VCD were documented postop, and all but one patient had a full recovery. Seven patients had staged resections after 1 to 18 months (median 4) after the first procedure. Conclusion: IONM facilitates reduced postoperative bVCD rates. IONM is, therefore, recommendable in planned bilateral procedures. The rate of non-complete bilateral surgery after intraoperative non-transient LOS was 2%.

Hintergrund und Fragestellung: Neuroendokrine Pankreastumoren (NPTs) machen etwa 5 - 10 % aller Pankreastumoren aus. Ihre Prognose ist heterogen. Benigne Insulinome werden fast immer kurativ behandelt. Gastrinome und nicht-funktionelle neuroendokrine Pankreastumoren (NFPTs) dagegen metastasieren in 50 - 80 %. Bei 30 % der Patienten liegen schon bei Diagnosestellung Lymphknoten- bzw. Fernmetastasen vor. Die Resektion des Tumors ist die einzige Chance auf Heilung. In der vorliegenden Arbeit werden die chirurgische Therapie und das Langzeitüberleben bei über 140 Patienten mit NPTs analysiert und diskutiert. Patienten und Methoden: In einer prospektiven Beobachtungsstudie wurden die Daten von 144 Patienten (75 Frauen, 69 Männer, Durchschnittsalter 50 Jahre), die zwischen 1987 und 2005 in der Klinik für Visceral-, Thorax- und Gefäßchirurgie wegen eines NPTs operiert wurden, gesammelt und retrospektiv analysiert. Die Diagnose eines NPTs wurde anhand klinischer Symptome, biochemischer Tests und der Histopathologie gestellt. Ergebnisse: 144 Patienten wurden wegen eines NPTs, dessen Lymphknoten- und/oder Fernmetastasen operiert, jeder Fünfte wegen eines MEN1-Syndroms. 47 % aller Patienten hatten Lymphknoten- und/oder Fernmetastasen bei der Erstoperation. Es wurden insgesamt 172 Operationen durchgeführt, 122 Ersteingriffe und 50 Reoperationen. Die häufigsten Operationsverfahren waren die Tumorenukleation und die Pankreaslinksresektion. 23-mal wurden Lebermetastasen reseziert. Nach einer mittleren Nachbeobachtungszeit von 67 Monaten (Spannbreite 1 - 339) lebten 74 (51 %) Patienten ohne Anzeichen einer Tumorerkrankung. Die 5, 10, und errechnete 20-Jahres-Überlebensrate für alle Patienten mit malignen Tumoren lag bei 75 %, 70 % und 65 %. Kein Patient mit einem benignen Tumor und auch kein MEN1-Patient ist an seinem Tumorleiden verstorben. Die Überlebensrate korrelierte signifikant mit der Tumorentität, dem genetischen Hintergrund der Tumorgenese, dem Alter der Patienten bei Erstoperation und dem Auftreten von Metastasen. Folgerung: Durch einen aggressiven chirurgischen Therapieansatz kann neben einer dauerhaften Heilung von Patienten mit benignen NPTs ein Langzeitüberleben bei Patienten mit malignen NPTs erzielt werden. Background and objective: To evaluate the outcome of patients with pancreatic endocrine tumors (PETs) in a tertiary referral centre. Methods: 144 patients with PETs that underwent surgery between 1987 and 2005 at our institution were retrospectively evaluated. The diagnosis of gastrinoma, insulinoma, vipoma and non-functioning PETs was based on clinical symptoms, biochemical tests and histopathology. Results: 144 patients were identified for this study, 20 % with a MEN1-syndrome. 172 operations were performed, 122 initial operations and 50 reoperations. Enucleation of the tumor and distal pancreatic resections were the main type of operations. In 23 patients liver metastases were resected. After a median follow up of 67 months (range 1 - 339), 74 of 144 (51 %) patients are still alive without evidence of disease. No patient with a benign tumor and no MEN1-patients died because of PETs. The 5, 10, and actuarial 20-year survival rate for patients with malignant tumors were 75 %, 70 % and 65 %, respectively. The survival rate was significantly related to the type of tumor (benign vs. malignant: p = 0.0002), the patients age at time of initial operation (50 years: p = 0.0007), the genetic background of the tumor (sporadic vs. MEN1: p = 0.0312) and the development of metastases after the initial operation (none or lymph node metastases vs. distant metastases: p = 0.01). Conclusion: We show that an aggressive surgical approach leads to cure in patients with benign PETs. Although long-term cure can only be achieved in a proportion of patients with malignant PETs, significant long-term palliation can be achieved.