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Neuß, Germany

Dralle H.,Martin Luther University of Halle Wittenberg | Musholt T.J.,Johannes Gutenberg University Mainz | Schabram J.,St. Josefs Krankenhaus Giessen | Steinmuller T.,DRK Kliniken Berlin Westend | And 22 more authors.
Langenbeck's Archives of Surgery | Year: 2013

Introduction: Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable ("low risk") papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages. Methods: The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization. Results: The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases. Conclusion: These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk. © 2013 Springer-Verlag Berlin Heidelberg. Source

Iacobone M.,University of Padua | Jansson S.,Sahlgrenska University Hospital | Barczynski M.,Jagiellonian University | Goretzki P.,Lukaskrankenhaus Neuss
Langenbeck's Archives of Surgery | Year: 2014

Background: Multifocal papillary thyroid carcinoma (MPTC) has been reported in literature in 18-87 % of cases. This paper aims to review controversies in the molecular pathogenesis, prognosis, and management of MPTC. Methods: A review of English-language literature focusing on MPTC was carried out, and analyzed in an evidence-based perspective. Results were discussed at the 2013 Workshop of the European Society of Endocrine Surgeons devoted to surgery of thyroid carcinoma. Results: Literature reports no prospective randomized studies; thus, a relatively low level of evidence may be achieved. Conclusions: MPTC could be the result of either true multicentricity or intrathyroidal metastasis from a single malignant focus. Radiation and familial nonmedullary thyroid carcinoma are conditions at risk of MPTC development. The prognostic importance of multifocal tumor growth in PTC remains controversial. Prognosis might be impaired in clinical MPTC but less or none in MPTC <1 cm. MPTC can be diagnosed preoperatively by FNAB and US, with low sensitivity for MPTC <1 cm. Total or near-total thyroidectomy is indicated to reduce the risk of local recurrence. Prophylactic central node dissection should be considered in patients with total tumor diameter >1 cm, or in cases with high number of cancer foci. Completion thyroidectomy might be necessary when MPTC is diagnosed after less than near-total thyroidectomy. Radioactive iodine ablation should be considered in selected patients with MPTC at increased risk of recurrence or metastatic spread. © 2013 Springer-Verlag. Source

Background. Due to the relatively low incidence of the diseases the diagnostic procedures for tumors of the vulva and vagina are continually under discussion. Aim. Diagnostic procedures should lead to the most effective and safe treatment plan with as little stress as possible. Methods. The appropriate literature and clinical experience are combined for optimizing the diagnostic schedule. Results and discussion. The main tool for examination is clinical inspection and palpation. The histological results of the primary tumor and, if necessary imaging of lymph nodes, are essential for deciding on the treatment plan. The diagnostic procedures should be indicated depending on the position and the dimensions of the primary tumor whereby the position in relation to the middle line, surface diameter of the tumor and depth of infiltration are of special interest. Radiological examinations, such as computed tomography (CT), magnetic resonance imaging (MRI) and endosonography should be used to clarify the local topography of the primary towards urethra, bladder, rectum and anus/ sphincter. Investigations should concentrate on the regional inguinofemoral lymph nodes as the first site of metastasis followed by the pelvic nodes and in advanced primary tumors the para-aortic and mediastinal lymph nodes should also be clarified. Distant metastases may occur in advanced tumors. In these cases CT is indicated for examination of the para-aortic and mediastinal lymph nodes as well as the liver and the lungs. © Springer-Verlag 2014. Source

Wirowski D.,Lukaskrankenhaus Neuss | Goretzki P.E.,Lukaskrankenhaus Neuss | Schwarz K.,Lukaskrankenhaus Neuss | Lammers B.J.,Lukaskrankenhaus Neuss | And 2 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2013

Introduction: Advanced preoperative imaging of parathyroid adenomas and intraoperative parathyroid hormone determination optimized the results in the surgical treatment of primary hyperparathyroidism patients. We asked, whether reasons for failure have changed during the last 25 years. Materials and methods: We retrospectively analyzed operations for persistent primary hyperparathyroidism in our department between 2001 and 2011 (n=67), and compared these results to our experience between 1986 and 2001 (n=80). Results: From 2001 to 2011, 765 primary hyperparathyroidism patients were operated on at our department. All but 4 patients were cured (761/765, 99.5%). 67 operations were performed for persistent primary hyperparathyroidism. Main reasons for failure were a misdiagnosed sporadic multiple gland disease in our own patients (18/29, 62.1%), and an undetected solitary adenoma in patients referred to us after initial operation in another hospital (22/38, 57.9%) (statistically significant). From 1986 to 2001 (1 105 primary hyperparathyroidism patients), main indications for re-operation due to persistent disease were an undiagnosed sporadic multiple gland disease in our own patients (15/24, 62.5%), and a missed solitary adenoma in patients being operated on primarily somewhere else (38/56, 67.9%) (statistically significant). Conclusions: Comparing our experience in 147 patients with persistent primary hyperparathyroidism being operated on between 2001-2011 and 1986-2001, not much has changed with the modern armamentarium of improved preoperative imaging or intraoperative biochemical control. Whereas sporadic multiple gland disease was the most common reason for unsuccessful surgery in experienced hands, other units mainly failed due to an undetected solitary adenoma. Re-operations for persistent primary hyperparathyroidism performed by us were successful in 93.8% (2001-2011) and 96.0% (1986-2001), respectively. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart . New York. Source

Musholt T.J.,University Hospital Freiburg | Clerici T.,Kantonsspital St. Gallen | Dralle H.,Martin Luther University of Halle Wittenberg | Frilling A.,Imperial College London | And 17 more authors.
Langenbeck's Archives of Surgery | Year: 2011

Introduction: Benign thyroid disorders are among the most common diseases in Germany, affecting around 15 million people and leading to more than 100,000 thyroid surgeries per year. Since the first German guidelines for the surgical treatment of benign goiter were published in 1998, abundant new information has become available, significantly shifting surgical strategy towards more radical interventions. Additionally, minimally invasive techniques have been developed and gained wide usage. These circumstances demanded a revision of the guidelines. Methods: Based on a review of relevant recent guidelines from other groups and additional literature, unpublished data, and clinical experience, the German Association of Endocrine Surgeons formulated new recommendations on the surgical treatment of benign thyroid diseases. These guidelines were developed through a formal expert consensus process and in collaboration with the German societies of Nuclear Medicine, Endocrinology, Pathology, and Phoniatrics & Pedaudiology as well as two patient organizations. Consensus was achieved through several moderated conferences of surgical experts and representatives of the collaborating medical societies and patient organizations. Results: The revised guidelines for the surgical treatment of benign thyroid diseases include recommendations regarding the preoperative assessment necessary to determine when surgery is indicated. Recommendations regarding the extent of resection, surgical techniques, and perioperative management are also given in order to optimize patient outcomes. Conclusions: Evidence-based recommendations for the surgical treatment of benign thyroid diseases have been created to aid the surgeon and to support optimal patient care, based on current knowledge. These recommendations comply with the Association of the Scientific Medical Societies in Germany requirements for S2k guidelines. © Springer-Verlag 2011. Source

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