The outbreak of the COVID-19 pandemic has led to a disruption of surgical care. The aim of this multi-centric, retrospective study was to evaluate the impact of the pandemic on surgical activity for thyroid disease among the Italian Units of Endocrine Surgery. Three phases of the pandemic were identified based on the epidemiological situation and the public measures adopted from the Italian Government (1st phase: from 9th March to 3rd May 2020; 2nd phase: from 4th May to 14th June; 3rd phase: from 15th June to 31st). The patients operated upon during these phases were compared to those who underwent surgery during the same period of the previous year. Overall, 3892 patients from 28 Italian endocrine surgical units were included in the study, 1478 (38%) operated upon during COVID-19 pandemic, and 2414 (62%) during the corresponding period of 2019. The decrease in the number of operations was by 64.8%, 44.7% and 5.1% during the three phases of COVID-19 pandemic, compared to 2019, respectively. During the first and the second phases, the surgical activity was dedicated mainly to oncological patients. No differences in post-operative complications were noted between the two periods. Oncological activity for thyroid cancer was adequately maintained during the COVID-19 pandemic.
The role of prophylactic central lymph node dissection (pCLND) in the treatment of differentiated thyroid cancer (DTC) is controversial and still a matter of debate. The primary outcome of our study was to assess whether pCLND is effective in reducing the incidence of recurrent disease, and the secondary goal was to estimate the incidence of postoperative complications in patients who underwent pCLND and to evaluate the prognostic value of occult node metastases. In this retrospective study, we included patients with preoperative diagnosis of DTC and clinically uninvolved lymph nodes (cN0). The patients were divided into two groups, depending on the surgical approach: total thyroidectomy alone (TT group) or total thyroidectomy and pCLND (pCLND group). Three hundred and ninety-nine patients were included in this study, 320 (80.2%) in the TT group and 79 (19.8%) in the pCLND group. There were no significant differences in morbidity among the two groups. Histopathological evaluation demonstrated a similar distribution of aggressive features, especially regarding multicentricity, extrathyroidal extension, and angioinvasivity between the two groups. Occult lymph node metastases were found in 20 (25.3%) patients in the pCLND group. Prophylactic CLND was effective in improving disease-free survival in patients with intermediate and high risk of disease recurrence (p = 0.0392); occult lymph node metastases resulted as a significant negative prognostic factor (p < 0.001).
The aim of this study was to assess the seroprevalence of SARS-Cov-2 in the setting of a non-dedicated COVID-19 hospital in a low CoV-2 incidence area. We analysed the data of the patients admitted at our surgical department during the period 31st March - June 30, 2020. Among 86 patients included in the study, we found 2 (2.3%) patients positive for both SARS-CoV-2 specific IgM and IgG, 2 (2.3%) for only SARS-CoV-2 specific IgM, and 1 for only SARS-CoV-2 specific IgG. Thus, seroprevalence for SARS-CoV-2 was 5.8%; nasopharyngeal swab was negative in all the cases. Considering the current limitations in sensitivity of nasopharyngeal swab, the uncertainty in the natural history of SARS-CoV2, and the reported prevalence of CoV-2, we think that careful preadmission triage and tests, the use of personal protective equipment and safe management of surgical smoke are mandatory also in our context of low CoV-2 incidence area.
Thyroid cancer is the fifth most common cancer in the USA, with differentiated subtype accounting for more than 95% of neoplasm. Surgery remains the mainstay of treatment, either with lobectomy or total thyroidectomy. In the last decades, many technological innovations have been introduced in this field. The aim of this review is to illustrate the most recent advances regarding the classical surgical approach, particularly regarding hemostatic devices, parathyroid identification with fluorescence systems, intraoperative identification of lymph node metastases, and intraoperative neuromonitoring.
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