Lee JK, et al. Ann Surg Treat Res. 2024 Jan;106(1):19-30. https://doi.org/10.4174/astr.2024.106.1.19

Introduction: BMI has been shown to predict perioperative outcomes in patients undergoing surgery. Most studies assessing the role of body habitus in thyroid surgery have focused on open surgery, with few studies assessing patients undergoing robotic surgery. The present study evaluated the effects of BMI on surgical outcomes in patients undergoing bilateral axillo-breast approach (BABA) robotic thyroidectomy. Materials and methods: This study included patients who underwent BABA robotic thyroidectomy between January 2013 and September 2021 at Seoul National University Bundang Hospital. Patients were categorized into six groups based on the WHO classification of overweight and obesity. Clinicopathological characteristics, postoperative complications, and surgical outcomes were evaluated. Results: A total of 1921 patients were included. Comparisons of the six BMI groups showed no statistically significant differences in postoperative stay, resection margin involvement, postoperative complications, and recurrence. Subgroup analysis showed that hypocalcemia rates differed among BMI groups in patients who underwent lobectomy, with underweight and class II obese patients being at the highest risk (P=0.006). However, the actual number of complications was relatively small and similar among the groups. In patients who underwent total thyroidectomy and isthmectomy, BMI was not correlated with postoperative complications, including hypocalcemia, recurrent laryngeal nerve palsy, postoperative bleeding, and chyle leakage. Conclusion: Body habitus was not significantly associated with operative time and postoperative complications in patients undergoing BABA robotic thyroidectomy, indicating that this approach is safe and feasible in obese patients.

Background: This study investigated the prevalence and subtype distribution of circulating tumor cells (CTCs) in patients with papillary thyroid cancer (PTC) before and after thyroidectomy to determine the potential of CTC count as a noninvasive marker of the efficacy of surgical treatment in PTC. Materials and methods: Between January 2021 and January 2022, 62 PTC patients who underwent thyroidectomy at Seoul National University Bundang Hospital were prospectively evaluated. Peripheral blood samples (7.5 ml) were collected from each patient for CTC analysis before surgery and at 2 weeks and 3 months after surgery. CTC count and the distribution of CTC subtypes, including epithelial, epithelial-mesenchymal, and mesenchymal phenotypes, were analyzed using the negative selection method and immunofluorescence staining. The relationship between CTC count and clinicopathological characteristics was analyzed before and after surgery. Results: Before surgery, CTCs were detected in 87% (54/62) of patients; the mean CTC count was 8.0 and the median was 5.0 in 7.5 ml of peripheral blood. The mesenchymal or epithelial-mesenchymal phenotypes were predominant. After thyroidectomy, the mean and median CTC count values decreased to 5.3 and 2.5, respectively, at 2 weeks and to 4.3 and 3.0, respectively, at 3 months. This postoperative reduction in CTCs was more pronounced in patients with lymphatic invasion, lymph node metastasis, or BRAF V600E mutation. Conclusion: CTCs were detected in patients with PTC with a predominance of cells undergoing epithelial-mesenchymal transition. The CTC count decreased postoperatively, suggesting that liquid biopsy with CTC detection could be a valuable noninvasive tool for monitoring the efficacy of surgery in PTC.

Purpose: This study aimed to investigate the effectiveness of a novel wound protector in enhancing the cosmetic outcomes of thyroidectomy. Material and methods: This multicenter, double-blinded randomized controlled trial enrolled 129 patients undergoing open thyroidectomy. The patients were divided into a wound protector group and a control group. Subjective patient assessments were conducted, measuring wound satisfaction, pain, and itchiness. Additionally, blinded observers evaluated scars using the Vancouver Scar Scale. Results: The Vancouver Scar Scale revealed significant advantages for the wound protector group, demonstrating improvements in pigmentation (P=0.002), vascularity (P=0.014), pliability (P=0.001), and height (P=0.001). Conclusion: The thyroid wound protector offers a potential to improve postoperative cosmetic outcomes. Further research is warranted to explore patient experiences and optimize the application of this innovative wound protector across diverse surgical contexts.

Background: The optimal surgical extent for isthmus-confined papillary thyroid carcinoma (PTC) remains unclear. We aimed to evaluate the clinicopathological characteristics, surgical complications, and recurrence rates based on the extent of resection. Methods: This retrospective cohort study included 345 patients who underwent thyroidectomy for solitary isthmus-confined PTC at two affiliated tertiary centers from 2013 to 2022. Patients were excluded if they had multifocal PTC with lobar involvement, large tumors (>4 cm), suspected extrathyroidal extension (ETE), clinically positive lymph nodes (LNs), or aggressive histological subtypes. Clinicopathological features, surgical complication rates, and recurrence rates were compared among the total thyroidectomy (TT), lobectomy (L), and isthmusectomy (I) groups. This retrospective cohort study used propensity score matching (PSM), resulting in two groups of 85 patients: TT/L and I. Results: Among the 345 included patients, 89 underwent TT, 30 underwent L, and 226 underwent I. After PSM, 170 patients were analyzed. The mean age was 48.2 years, and the mean tumor size was 0.8 cm. Microcarcinoma accounted for 71.8% of cases. The rates of ETE (65.3%), multifocality (9.4%), BRAF mutation (75.3%), and Hashimoto’s thyroiditis (19.4%) were observed without significant differences between the TT/L and I groups. Risk stratification for central LN metastasis showed no significant difference (high-risk: 21.2% vs. 27.1%, p = 0.353). No recurrence or distant metastasis was observed in either group during a median follow-up of 4.3 years. Median follow-up was longer in the TT/L group (6.1 years [interquartile range (IQR): 4.0–8.5] vs. 3.6 years [IQR: 2.1–4.9], p < 0.001). Major complications were more frequent in TT/L group: transient/permanent hypocalcemia (14.1%/1.2% vs. 0%/0%) and transient vocal cord palsy (3.5% vs. 0%). Levothyroxine dependency was significantly higher in the TT/L group in terms of usage (90.6% vs. 34.1%, p < 0.001), average administered dose (85.5 ± 45.1 µg vs. 21.9 ± 33.2 µg, p < 0.001), and duration (5.2 ± 3.1 years vs. 0.9 ± 1.3 years, p < 0.001). Newly noted thyroid lesions occurred more frequently in the I group (1.3% vs. 10.6%, p = 0.039). Conclusions: Isthmusectomy may be considered for carefully selected patients with isthmus-confined PTC. Validation in long-term prospective studies is warranted.

Choi JB, et al. Ann Surg Treat Res. 2024 Apr;106(4):203-210. https://doi.org/10.4174/astr.2024.106.4.203