28 results on '"Steinmüller, T"'
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2. Fallvolumen und Komplikationen nach Schilddrüsenoperationen in Deutschland: eine Routinedatenanalyse von 48.387 AOK-Patienten
- Author
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Maneck, M., Dotzenrath, C., Dralle, H., Fahlenbrach, C., Steinmüller, T., Simon, D., Tusch, E., Jeschke, E., and Günster, C.
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- 2021
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3. Logopädie nach Schilddrüsenoperationen in Deutschland: eine Routinedatenanalyse von 50.676 AOK-Patienten
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Maneck, M., Dotzenrath, C., Dralle, H., Fahlenbrach, C., Paschke, R., Steinmüller, T., Tusch, E., Jeschke, E., and Günster, C.
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- 2019
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4. Komplikationen nach Schilddrüsenoperationen in Deutschland: Eine Routinedatenanalyse von 66.902 AOK-Patienten
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Maneck, M., Dotzenrath, C., Dralle, H., Fahlenbrach, C., Paschke, R., Steinmüller, T., Tusch, E., Jeschke, E., and Günster, C.
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- 2017
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5. Komplikationen nach Schilddrüsenoperationen in Deutschland: Weiterführende Angaben und Routinedatenanalysen
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Maneck, M., Dotzenrath, C., Dralle, H., Fahlenbrach, C., Paschke, R., Steinmüller, T., Tusch, E., Jeschke, E., and Günster, C.
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- 2017
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6. Intermittierendes versus kontinuierliches Neuromonitoring in der komplexen Chirurgie benigner Schilddrüsenerkrankungen
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Caffier, PP, Sedlmaier, A, Hermanns, M, Nawka, T, Weikert, S, and Steinmüller, T
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund In der komplexen benignen Schilddrüsenchirurgie ist das Risiko der intraoperativen Verletzung des N. recurrens erhöht, weshalb der routinemäßige Einsatz des intraoperativen Neuromonitorings (IONM) empfohlen wird. Das Hauptziel unserer Arbeit bestand in einem retrospektiven[zum vollständigen Text gelangen Sie über die oben angegebene URL], Phoniatrisch-pädaudiologische Aspekte 2020
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- 2020
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7. Fallvolumen und Komplikationen nach Schilddrüsenoperationen in Deutschland: eine Routinedatenanalyse von 48.387 AOK-Patienten
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Maneck, M., primary, Dotzenrath, C., additional, Dralle, H., additional, Fahlenbrach, C., additional, Steinmüller, T., additional, Simon, D., additional, Tusch, E., additional, Jeschke, E., additional, and Günster, C., additional
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- 2020
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8. Risk profile analysis and complications after surgery for autoimmune thyroid disease
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Thomusch, Oliver, Sekulla, C., Billmann, F., Seifert, G., Dralle, H., Lorenz, K., Vorländer, C., Freitag, M., Jähne, J., Steinmüller, T., Trupka, A., Steinert, F., Schabram, J., Heinzmann, B., Lang, H., Cotte, J., Hoffmann, T.F., Dette, K., Gellert, K., Henne-Bruns, D., Boese-Landgraf, J., Simon Evangelisches, D., Kube, R., Lorenz, E.P.M., Pross, M., Hartel, M., Thomschke, D., Pistorius, G., Hopt, U.T., Franke, C., Rose, U., Steuer, W., Schwenk, W., Ebert, K.-H., Kelm, C., Witzigmann, H., Rampf, W., Ridwelski, K., Knoefel, W.T., Bechstein, W.O., Grothe, D., Anthuber, M., Mirow, L., Probst, W., Thews, A., Fleck, U., Kärgel, W., Schimmelpenning, H., Fielitz, J., Schöffauer, T., Asperger, W., Zaage, J., Dorn, H.-U., Weitz, J., Neubauer, M., Klar, E., Lautermann, J., Senkal, M., Lippert, H., Lück, R., Ziesche, M., Kröll, K.-P., Skrobisz, J., Lorenc, Z., Dudešek, Bohumil, Smutny, S., Brauckhoff, M., Längle, F., Wenzl, E., the Prospective Evaluation Study of Thyroid Surgery (PETS 2) Study Group, Thomusch, Oliver, Sekulla, C., Billmann, F., Seifert, G., Dralle, H., Lorenz, K., Vorländer, C., Freitag, M., Jähne, J., Steinmüller, T., Trupka, A., Steinert, F., Schabram, J., Heinzmann, B., Lang, H., Cotte, J., Hoffmann, T.F., Dette, K., Gellert, K., Henne-Bruns, D., Boese-Landgraf, J., Simon Evangelisches, D., Kube, R., Lorenz, E.P.M., Pross, M., Hartel, M., Thomschke, D., Pistorius, G., Hopt, U.T., Franke, C., Rose, U., Steuer, W., Schwenk, W., Ebert, K.-H., Kelm, C., Witzigmann, H., Rampf, W., Ridwelski, K., Knoefel, W.T., Bechstein, W.O., Grothe, D., Anthuber, M., Mirow, L., Probst, W., Thews, A., Fleck, U., Kärgel, W., Schimmelpenning, H., Fielitz, J., Schöffauer, T., Asperger, W., Zaage, J., Dorn, H.-U., Weitz, J., Neubauer, M., Klar, E., Lautermann, J., Senkal, M., Lippert, H., Lück, R., Ziesche, M., Kröll, K.-P., Skrobisz, J., Lorenc, Z., Dudešek, Bohumil, Smutny, S., Brauckhoff, M., Längle, F., Wenzl, E., and the Prospective Evaluation Study of Thyroid Surgery (PETS 2) Study Group
- Abstract
Background: Surgical approaches to autoimmune thyroid disease are currently hampered by concerns over postoperative complications. Risk profiles and incidences of postoperative complications have not been investigated systematically, and studies with sufficient power to show valid data have not been performed. Methods: A prospective multicentre European study was conducted between July 2010 and December 2012. Questionnaires were used to collect data prospectively on patients who had surgery for autoimmune thyroid disease and the findings were compared with those of patients undergoing surgery for multinodular goitre. Logistic regression analysis was used to evaluate risk factors for thyroid surgery-specific complications, transient and permanent recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism. Results: Data were available for 22 011 patients, of whom 18 955 were eligible for analysis (2488 who had surgery for autoimmune thyroid disease and 16 467 for multinodular goitre). Surgery for multinodular goitre and that for autoimmune thyroid disease did not differ significantly with regard to general complications. With regard to thyroid surgery-specific complications, the rate of temporary and permanent vocal cord palsy ranged from 2·7 to 6·7 per cent (P = 0·623) and from 0·0 to 1·4 per cent (P = 0·600) respectively, whereas the range for temporary and permanent hypoparathyroidism was 12·9 to 20·0 per cent (P < 0·001) and 0·0 to 7·0 per cent (P < 0·001) respectively. In logistic regression analysis of transient and permanent vocal cord palsy, autoimmune thyroid disease was not an independent risk factor. Autoimmune thyroid disease, extent of thyroid resection, number of identified parathyroid glands and no autotransplantation were identified as independent risk factors for both transient and permanent hypoparathyroidism. Conclusion: Surgery for autoimmune thyroid disease is safe in comparison with surgery for multinodular goitre in terms of general complicati
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- 2018
9. Logopädie nach Schilddrüsenoperationen in Deutschland: eine Routinedatenanalyse von 50.676 AOK-Patienten
- Author
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Maneck, M., primary, Dotzenrath, C., additional, Dralle, H., additional, Fahlenbrach, C., additional, Paschke, R., additional, Steinmüller, T., additional, Tusch, E., additional, Jeschke, E., additional, and Günster, C., additional
- Published
- 2018
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10. Risk profile analysis and complications after surgery for autoimmune thyroid disease
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Thomusch, O, primary, Sekulla, C, additional, Billmann, F, additional, Seifert, G, additional, Dralle, H, additional, Lorenz, K, additional, Vorländer, C, additional, Freitag, M, additional, Jähne, J, additional, Steinmüller, T, additional, Trupka, A, additional, Steinert, F, additional, Schabram, J, additional, Heinzmann, B, additional, Lang, H, additional, Cotte, J, additional, Hoffmann, T F, additional, Dette, K, additional, Gellert, K, additional, Henne-Bruns, D, additional, Boese-Landgraf, J, additional, Simon Evangelisches, D, additional, Kube, R, additional, Lorenz, E P M, additional, Pross, M, additional, Hartel, M, additional, Thomschke, D, additional, Pistorius, G, additional, Hopt, U T, additional, Franke, C, additional, Rose, U, additional, Steuer, W, additional, Schwenk, W, additional, Ebert, K-H, additional, Kelm, C, additional, Witzigmann, H, additional, Rampf, W, additional, Ridwelski, K, additional, Knoefel, W T, additional, Bechstein, W O, additional, Grothe, D, additional, Anthuber, M, additional, Mirow, L, additional, Probst, W, additional, Thews, A, additional, Fleck, U, additional, Kärgel, W, additional, Schimmelpenning, H, additional, Fielitz, J, additional, Schöffauer, T, additional, Asperger, W, additional, Zaage, J, additional, Dorn, H-U, additional, Weitz, J, additional, Neubauer, M, additional, Klar, E, additional, Lautermann, J, additional, Senkal, M, additional, Lippert, H, additional, Lück, R, additional, Ziesche, M, additional, Kröll, K-P, additional, Skrobisz, J, additional, Lorenc, Z, additional, Dudesek, B, additional, Smutny, S, additional, Brauckhoff, M, additional, Längle, F, additional, and Wenzl, E, additional
- Published
- 2018
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11. Komplikationen nach Schilddrüsenoperationen in Deutschland
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Maneck, M., primary, Dotzenrath, C., additional, Dralle, H., additional, Fahlenbrach, C., additional, Paschke, R., additional, Steinmüller, T., additional, Tusch, E., additional, Jeschke, E., additional, and Günster, C., additional
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- 2016
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12. Abrupt onset of suture granuloma 27 years after hemithyroidectomy.
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Alghanemi R and Steinmüller T
- Abstract
Suture granuloma is a rare complication after thyroidectomy and usually manifests as a chronic inflammation mimicking cancer or even tuberculous lymphadenitis and can be expected within the first 2 postoperative years. We report the case of a 53-year-old woman who presented, 27 years after her first hemithyroidectomy, with a sudden onset of a growing lump on the same site. Neck magnetic resonance imaging revealed a fast-growing tumor suggestive of a cancerous lesion. An excisional biopsy revealed only acute inflammation with pus formation. During surgery, we excised 20 thickly ligated sutures from the neck. These sutures were suggested to have caused the suture granulomas., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.)
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- 2023
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13. Clinical Presentation, Treatment, and Outcome of Parathyroid Carcinoma: Results of the NEKAR Retrospective International Multicenter Study.
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Lenschow C, Schrägle S, Kircher S, Lorenz K, Machens A, Dralle H, Riss P, Scheuba C, Pfestroff A, Spitzweg C, Zielke A, Nießen A, Dotzenrath C, Riemann B, Quinkler M, Vorländer C, Zahn A, Raue F, Chiapponi C, Iwen KA, Steinmüller T, Kroiss M, and Schlegel N
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Internationality, Male, Middle Aged, Parathyroid Neoplasms mortality, Prognosis, Retrospective Studies, Survival Rate, Treatment Outcome, Young Adult, Parathyroid Neoplasms diagnosis, Parathyroid Neoplasms therapy
- Abstract
Objective: In this retrospective cohort study, we describe the clinical presentation and workup of parathyroid carcinoma (PC) and determine its clinical prognostic parameters. Primary outcome was recurrence free survival., Summary Background Data: PC is an orphan malignancy for which diagnostic workup and treatment is not established., Methods: Eighty-three patients were diagnosed with PC between 1986 and 2018. Disease-specific and recurrence-free survivals were estimated with the Kaplan-Meier method. Risk factors for recurrence were identified by binary logistic regression with adjustment for age and sex. Thirty-nine tumors underwent central histopathological review., Results: Renal (39.8%), gastrointestinal (24.1%), bone (22.9%), and psychiatric (19.3%) symptoms were the most common symptoms. Surgical treatment was heterogeneous [parathyroidectomy [PTx)] alone: 22.9%; PTx and hemithyroidectomy: 24.1%; en bloc resection 15.7%; others 37.3%] and complications of surgery were frequent (recurrent laryngeal nerve palsy 25.3%; hypoparathyroidism 6%). Recurrence of PC was observed in 32 of 83 cases. In univariate analysis, rate of recurrence was reduced when extended initial surgery had been performed (P = 0.04). In multivariate analysis low T status [odds ratio (OR) = 2.65, 95% confidence interval (CI) 1.02-6.88, P = 0.045], N0 stage at initial diagnosis (OR = 6.32, 95% CI 1.33-30.01, P = 0.02), Ki-67 <10% (OR = 14.07, 95% CI 2.09-94.9, P = 0.007), and postoperative biochemical remission (OR = 0.023, 95% CI 0.001-0.52, P = 0.018) were beneficial prognostic parameters for recurrence-free survival., Conclusion: Despite a favorable overall prognosis, PC shows high rates of recurrence leading to repeated surgery and postoperative recurrent laryngeal nerve palsy and hypoparathyroidism. In view of the reduced recurrence rate in cases of extended surgery, ipsilateral completion surgery may be considered when PC is confirmed., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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14. 9p24.1 alterations and programmed cell death 1 ligand 1 expression in early stage unfavourable classical Hodgkin lymphoma: an analysis from the German Hodgkin Study Group NIVAHL trial.
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Gerhard-Hartmann E, Goergen H, Bröckelmann PJ, Mottok A, Steinmüller T, Grund J, Zamò A, Ben-Neriah S, Sasse S, Borchmann S, Fuchs M, Borchmann P, Reinke S, Engert A, Veldman J, Diepstra A, Klapper W, and Rosenwald A
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- Antineoplastic Combined Chemotherapy Protocols adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biomarkers, Tumor, Combined Modality Therapy, DNA Copy Number Variations, Disease Management, Genetic Association Studies, Genetic Predisposition to Disease, Germany, Hodgkin Disease mortality, Hodgkin Disease therapy, Humans, Immunohistochemistry, In Situ Hybridization, Fluorescence, Prognosis, Treatment Outcome, B7-H1 Antigen genetics, Chromosomes, Human, Pair 9, Hodgkin Disease diagnosis, Hodgkin Disease etiology, Translocation, Genetic
- Abstract
High programmed cell death 1 ligand 1 (PD-L1) protein expression and copy number alterations (CNAs) of the corresponding genomic locus 9p24.1 in Hodgkin- and Reed-Sternberg cells (HRSC) have been shown to be associated with favourable response to anti-PD-1 checkpoint inhibition in relapsed/refractory (r/r) classical Hodgkin lymphoma (cHL). In the present study, we investigated baseline 9p24.1 status as well as PD-L1 and major histocompatibility complex (MHC) class I and II protein expression in 82 biopsies from patients with early stage unfavourable cHL treated with anti-PD-1-based first-line treatment in the German Hodgkin Study Group (GHSG) NIVAHL trial (ClinicalTrials.gov Identifier: NCT03004833). All evaluated specimens showed 9p24.1 CNA in HRSC to some extent, but with high intratumoral heterogeneity and an overall smaller range of alterations than reported in advanced-stage or r/r cHL. All but two cases (97%) showed PD-L1 expression by the tumour cells in variable amounts. While MHC-I was rarely expressed in >50% of HRSC, MHC-II expression in >50% of HRSC was found more frequently. No obvious impact of 9p24.1 CNA or PD-L1 and MHC-I/II expression on early response to the highly effective anti-PD-1-based NIVAHL first-line treatment was observed. Further studies evaluating an expanded panel of potential biomarkers are needed to optimally stratify anti-PD-1 first-line cHL treatment., (© 2021 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)
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- 2022
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15. The histological and molecular spectrum of lipoblastoma: A case series with identification of three novel gene fusions by targeted RNA-sequencing.
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Gerhard-Hartmann E, Vokuhl C, Roth S, Steinmüller T, Rosenfeldt M, Zamò A, Rosenwald A, Appenzeller S, Ernestus K, and Maurus K
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- Child, Child, Preschool, Female, Humans, Infant, Male, Oncogene Fusion genetics, DNA-Binding Proteins genetics, HMGA2 Protein genetics, Lipoblastoma genetics, Lipoblastoma pathology
- Abstract
Lipoblastoma is a rare benign mesenchymal neoplasm that typically occurs in infancy but may also occur in older age groups and various locations. Thus, there are often numerous clinical differential diagnoses. Moreover, lipoblastomas can show a broad histologic spectrum, which can hamper the correct diagnosis, particularly in small biopsies. At the genomic level, lipoblastomas are characterized by chromosomal fusions involving the PLAG1 gene. We investigated 11 lipoblastoma samples from 10 pediatric patients (age range five months to 12 years), including one patient with local recurrence, in view of their histopathological features, and performed targeted RNA sequencing. We found a broad histological spectrum with some tumors with prominent myxoid changes, but also tumors composed mainly of mature adipocytic cells, and classified the cases according to the literature as classic (mixed), maturing, or myxoid subtype. By targeted RNA sequencing analysis, we identified characteristic PLAG1 rearrangements in 70% of the investigated cases. Moreover, these analyses revealed three novel gene fusions, two affecting the PLAG1 gene and one involving HMGA2. Besides, we performed PLAG1 immunohistochemistry and identified positive cells, typically immature adipocytic cells and spindle cells, at various numbers in all cases. However, in the maturing areas, only very sparsely positive cells were found, limiting the value of the PLAG1 immunohistochemistry as an adjunct in the diagnosis of lipoblastoma, particularly for the maturing subtype and small biopsies. The presented case series confirms the broad morphological spectrum of lipoblastoma described in the literature and underlines the value of modern molecular diagnostic approaches as a supportive diagnostic tool in challenging cases and for gaining further insights into the molecular basis of this rare mesenchymal tumor., (Copyright © 2021 Elsevier GmbH. All rights reserved.)
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- 2021
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16. Elotuzumab for the treatment of extramedullary myeloma: a retrospective analysis of clinical efficacy and SLAMF7 expression patterns.
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Danhof S, Rasche L, Mottok A, Steinmüller T, Zhou X, Schreder M, Kilian T, Strifler S, Rosenwald A, Hudecek M, Einsele H, and Gerhard-Hartmann E
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- Adult, Aged, Aged, 80 and over, Female, Humans, Immunohistochemistry, Male, Middle Aged, Multiple Myeloma pathology, Retrospective Studies, Treatment Outcome, Antibodies, Monoclonal, Humanized therapeutic use, Antineoplastic Agents, Immunological therapeutic use, Multiple Myeloma drug therapy, Signaling Lymphocytic Activation Molecule Family analysis
- Abstract
Extramedullary disease (EMD) represents a high-risk state of multiple myeloma (MM) associated with poor prognosis. While most anti-myeloma therapeutics demonstrate limited efficacy in this setting, some studies exploring the utility of chimeric antigen receptor (CAR)-modified T cells reported promising results. We have recently designed SLAMF7-directed CAR T cells for the treatment of MM. SLAMF7 is a transmembrane receptor expressed on myeloma cells that plays a role in myeloma cell homing to the bone marrow. Currently, the only approved anti-SLAMF7 therapeutic is the monoclonal antibody elotuzumab, but its efficacy in EMD has not been investigated thoroughly. Thus, we retrospectively analyzed the efficacy of elotuzumab-based combination therapy in a cohort of 15 patients with EMD. Moreover, since the presence of the target antigen is an indispensable prerequisite for effective targeted therapy, we investigated the SLAMF7 expression on extramedullary located tumor cells before and after treatment. We observed limited efficacy of elotuzumab-based combination therapies, with an overall response rate of 40% and a progression-free and overall survival of 3.8 and 12.9 months, respectively. Before treatment initiation, all available EMD tissue specimens (n = 3) demonstrated a strong and consistent SLAMF7 surface expression by immunohistochemistry. Furthermore, to investigate a potential antigen reduction under therapeutic selection pressure, we analyzed samples of de novo EMD (n = 3) outgrown during elotuzumab treatment. Again, immunohistochemistry documented strong and consistent SLAMF7 expression in all samples. In aggregate, our data point towards a retained expression of SLAMF7 in EMD and encourage the development of more potent SLAMF7-directed immunotherapies, such as CAR T cells.
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- 2021
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17. Giant bilateral adrenal lipoma in a patient with congenital adrenal hyperplasia.
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Kienitz T, Schwander J, Bogner U, Schwabe M, Steinmüller T, and Quinkler M
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Summary: Apart from adrenal myelolipomas, adrenal lipomatous tumors are rare and only seldom described in the literature. We present the case of a 50-year-old man, with a classical form of congenital adrenal hyperplasia (CAH), which was well treated with prednisolone and fludrocortisone. The patient presented with pollakisuria and shortness of breath while bending over. On MRI, fat-equivalent masses were found in the abdomen (14 × 19 × 11 cm on the right side and 10 × 11 × 6 cm on the left side). The right adrenal mass was resected during open laparotomy and the pathohistological examination revealed the diagnosis of an adrenal lipoma. Symptoms were subdued totally postoperatively. This is the first report of a bilateral adrenal lipoma in a patient with CAH that we are aware of., Learning Points: Macronodular hyperplasia is common in patients with congenital adrenal hyperplasia (CAH). Solitary adrenal tumors appear in approximately 10% of adult CAH patients and are often benign myelolipomas. The Endocrine Society Clinical Practice Guideline does not recommend routine adrenal imaging in adult CAH patients. Adrenal imaging should be performed in CAH patients with clinical signs for an adrenal or abdominal mass. Adrenal lipoma is rare and histopathological examinations should rule out a differentiated liposarcoma.
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- 2021
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18. [Case volume and complications after thyroid gland surgery in Germany: an analysis of routine data from 48,387 AOK patients].
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Maneck M, Dotzenrath C, Dralle H, Fahlenbrach C, Steinmüller T, Simon D, Tusch E, Jeschke E, and Günster C
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- Germany, Humans, Postoperative Complications epidemiology, Postoperative Complications etiology, Thyroidectomy, Thyroid Gland surgery, Vocal Cord Paralysis epidemiology, Vocal Cord Paralysis etiology
- Abstract
Background: Many studies showed that hospital and surgeon volume have a significant influence on the complication rates of thyroid surgery. The present study investigates whether this relationship applies in subtotal as well as total lobe resections. Furthermore, it is still unclear which threshold for the hospital-related case volume can be determined, above which the risk of complications lies below the current national average., Material and Methods: The study was based on nationwide routine data for persons insured with the Local General Sickness Fund (AOK) who had undergone thyroid surgery in 2014-2016. Permanent vocal cord palsy, bleeding and wound infection needing revision were recorded using indicators. The effect of the case volume on the indicators and the case number threshold was determined using logistic regression., Results: Permanent vocal cord palsy was observed in 1.3% and bleeding or wound infections needing revision in 1.6% and 0.3% of the cases. Compared to hospitals with >450 surgeries per year, the risk of permanent vocal cord palsy in hospitals with fewer than 201, 101 and 51 surgeries was significantly increased (OR [95% CI]: 1.5 [1.1-2.1]; 1.5 [1.1-2.1]; 1.8 [1.3-2.5]). The threshold needed to achieve a risk for permanent vocal cord palsy below the national average (1.3%) was 265 thyroid surgeries per year (95% CI: 110-420). For bleeding or wound infection in need of revision, no association between volume and outcome was found., Conclusion: The present study showed that the risk of postoperative permanent vocal cord palsy decreased with increasing case volume. The broad confidence interval of the threshold makes clear case volume recommendation difficult. In order that the risk for a postoperative permanent vocal cord palsy is not likely above the national average, the annual case volume should reach 110 thyroid interventions.
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- 2021
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19. Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow-up.
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Sedlmaier A, Steinmüller T, Hermanns M, Nawka T, Weikert S, Sedlmaier B, and Caffier PP
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- Female, Follow-Up Studies, Germany, Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, Thyroidectomy, Vocal Cord Paralysis etiology, Monitoring, Intraoperative methods, Thyroid Diseases surgery, Vocal Cord Paralysis prevention & control
- Abstract
Objectives: To compare continuous (C-IONM) vs intermittent intraoperative neuromonitoring (I-IONM) in complex benign thyroid surgery, and to follow up patients with loss of signal (LOS) or unilateral vocal fold paralysis (UVFP)., Design: Retrospective clinical study, prospective case series., Setting: University hospital and academic teaching hospital of Charité-University Medicine Berlin, Germany., Participants: C-IONM- and I-IONM-assisted thyroid surgery was conducted in 357 patients diagnosed with recurrent goitre, Graves' disease, complex hyperparathyroidism, cervical preoperation (anterior access) and LOS in primary operation (2-stage thyroidectomy)., Main Outcome Measures: To evaluate the incidence of early postoperative and permanent UVFP, and to report the results of phonosurgical therapy in patients suffering from persisting dysphonia., Results: In 346 patients enrolled (81.8% female, 18.2% male) with 613 nerves at risk (NAR) being monitored (409 I-IONM vs 204 C-IONM), early postoperative UVFP was observed in 10.5% of I-IONM vs 4.9% of C-IONM group (P < .05), permanent paralysis in 1.5% of I-IONM vs 1.0% of C-IONM group (P = .619). In total, 72 patients (21%) experienced pathological events (19 LOS < 100 μV, 53 transient or permanent UVFP). Three patients with permanent UVFP and persisting dysphonia received phonosurgery with stable improvements of all acoustic-aerodynamic parameters., Conclusion: Compared to I-IONM, C-IONM-application in complex benign thyroid surgery shows a significant reduction of transient UVFP and a non-significant trend in preventing permanent UVFP. In persistent UVFP with dysphonia, endolaryngeal phonomicrosurgery and transcervical laryngeal framework surgery are long-term effective treatment approaches to improve vocal function., (© 2019 John Wiley & Sons Ltd.)
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- 2019
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20. Total Versus Near-total Thyroidectomy in Graves Disease: Results of the Randomized Controlled Multicenter TONIG-trial.
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Maurer E, Maschuw K, Reuss A, Zieren HU, Zielke A, Goretzki P, Simon D, Dotzenrath C, Steinmüller T, Jähne J, Kemen M, Coerper S, Leister I, Nies C, Hartel M, Türler A, Holzer K, Agha A, Knoop M, Musholt T, Aminossadati B, and Bartsch DK
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- Adult, Female, Follow-Up Studies, Humans, Hypoparathyroidism etiology, Male, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications surgery, Prospective Studies, Risk Assessment, Severity of Illness Index, Thyroidectomy adverse effects, Time Factors, Transplantation, Autologous methods, Treatment Outcome, Young Adult, Graves Disease diagnosis, Graves Disease surgery, Hypoparathyroidism surgery, Parathyroid Glands transplantation, Thyroidectomy methods
- Abstract
Background: Previous data suggest that the incidence of hypoparathyroidism after surgery for Graves disease (GD) is lower after subtotal thyroidectomy compared to total thyroidectomy (TT). The present study evaluated the incidence of postoperative hypoparathyroidism after near-total (NTT) versus TT in GD., Methods/design: In a multicenter prospective randomized controlled clinical trial, patients with GD were randomized intraoperatively to NTT or TT. Primary endpoint was the incidence of transient postoperative hypoparathyroidism. Secondary endpoints were permanent hypoparathyroidism, transient recurrent laryngeal nerve palsy (RLNP), reoperations for bleeding, inadvertently removed parathyroid glands, and recurrent hyperthyroidism after 12 months., Results: Eighteen centers randomized 205 patients to either TT (n = 102) or NTT (n = 103) within 16 months. According to intention-to-treat postoperative transient hypoparathyroidism occurred in 19% (20/103) patients after NTT and in 21% (21 of 102) patients after TT (P = 0.84), which persisted >6 months in 2% and 5% of the NTT and TT groups (P = 0.34). The rates of parathyroid autotransplantation (NTT 24% vs TT 28%, P = 0.50) and transient RLNP (NTT 3% vs TT 4%, P = 0.35) was similar in both groups. The rate of reoperations for bleeding tended to be higher in the NTT group (3% vs 0%, P = 0.07) and the rate of inadvertently removed parathyroid glands was significantly higher after NTT (13% vs 3%, P = 0.01). An existing endocrine orbitopathy improved in 35% and 24% after NTT and TT (P = 0.61). Recurrent disease occurred in only 1 patient after TT (P = 0.34)., Conclusion: NTT for GD is not superior to TT regarding transient postoperative hypoparathyroidism.
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- 2019
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21. Surgical therapy of adrenal tumors: guidelines from the German Association of Endocrine Surgeons (CAEK).
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Lorenz K, Langer P, Niederle B, Alesina P, Holzer K, Nies C, Musholt T, Goretzki PE, Rayes N, Quinkler M, Waldmann J, Simon D, Trupka A, Ladurner R, Hallfeldt K, Zielke A, Saeger D, Pöppel T, Kukuk G, Hötker A, Schabram P, Schopf S, Dotzenrath C, Riss P, Steinmüller T, Kopp I, Vorländer C, Walz MK, and Bartsch DK
- Subjects
- Delphi Technique, Evidence-Based Medicine, Germany, Humans, Adrenal Gland Neoplasms surgery, Endocrine Surgical Procedures methods
- Abstract
Background and Aims: Previous guidelines addressing surgery of adrenal tumors required actualization in adaption of developments in the area. The present guideline aims to provide practical and qualified recommendations on an evidence-based level reviewing the prevalent literature for the surgical therapy of adrenal tumors referring to patients of all age groups in operative medicine who require adrenal surgery. It primarily addresses general and visceral surgeons but offers information for all medical doctors related to conservative, ambulatory or inpatient care, rehabilitation, and general practice as well as pediatrics. It extends to interested patients to improve the knowledge and participation in the decision-making process regarding indications and methods of management of adrenal tumors. Furthermore, it provides effective medical options for the surgical treatment of adrenal lesions and balances positive and negative effects. Specific clinical questions addressed refer to indication, diagnostic procedures, effective therapeutic alternatives to surgery, type and extent of surgery, and postoperative management and follow-up regime., Methods: A PubMed research using specific key words identified literature to be considered and was evaluated for evidence previous to a formal Delphi decision process that finalized consented recommendations in a multidisciplinary setting., Results: Overall, 12 general and 52 specific recommendations regarding surgery for adrenal tumors were generated and complementary comments provided., Conclusion: Effective and balanced medical options for the surgical treatment of adrenal tumors are provided on evidence-base. Specific clinical questions regarding indication, diagnostic procedures, alternatives to and type as well as extent of surgery for adrenal tumors including postoperative management are addressed.
- Published
- 2019
- Full Text
- View/download PDF
22. [Speech therapy after thyroid gland operations in Germany: analysis of routine data from 50,676 AOK patients].
- Author
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Maneck M, Dotzenrath C, Dralle H, Fahlenbrach C, Paschke R, Steinmüller T, Tusch E, Jeschke E, and Günster C
- Subjects
- Germany, Humans, Postoperative Complications, Thyroidectomy, Speech Therapy, Thyroid Diseases surgery, Vocal Cord Paralysis
- Abstract
Background: This study investigated the frequency of postoperative speech therapy in the context of vocal cord palsy after thyroid surgery based on nationwide routine data. Additionally, volume-outcome relationships were examined., Material and Methods: Nationwide routine data from insured patients of the Local Health Insurance Fund (AOK) who underwent thyroid surgery for a benign thyroid disease between 2013 and 2015 were analyzed. Postoperative speech therapy was determined based on prescription data. Transient and permanent vocal cord palsy were determined using indicators. The effect of hospital volumes (volume quintiles) on prescription of postoperative speech therapy was determined by multivariate logistic regression., Results: A total of 50,676 thyroid gland operations were identified. The overall frequency of postoperative speech therapy prescription was 6.5%. In AOK patients with transient or permanent vocal cord palsy, the frequencies of postoperative speech therapy prescription were 56.1% and 75.2%, respectively. The prescription volume of the normal case (≥21 units of speech therapy) was exceeded in 0.7% of the AOK patients. In the two lowest case volume categories the risk of postoperative speech therapy exceeding the prescription volume of the normal case was significantly higher compared to the highest case volume hospitals (odds ratios: 1.2 and 1.8, respectively)., Conclusion: This study presents the reality of healthcare with respect to the frequency of speech therapy prescription after thyroid gland surgery in Germany. In addition, it was determined that the risk of postoperative speech therapy prescription exceeding the volume of the normal case after thyroid gland operations decreases with increasing case volumes of hospitals.
- Published
- 2019
- Full Text
- View/download PDF
23. Frühes MIBI-SPECT/CT zur Detektion eines 6 mm großen Nebenschilddrüsenadenoms im Thymus.
- Author
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Grünwald L, Derwahl KM, Steinmüller T, and Kuwert T
- Subjects
- Humans, Male, Radiopharmaceuticals, Technetium Tc 99m Sestamibi, Young Adult, Adenoma diagnostic imaging, Parathyroid Neoplasms diagnostic imaging, Single Photon Emission Computed Tomography Computed Tomography, Thymus Gland diagnostic imaging
- Abstract
Competing Interests: Professor Kuwert hält für die Firma Siemens gelegentlich Vorträge gegen Honorar. Die Nuklearmedizinische Universitätsklinik in Erlangen hat eine Forschungsförderung durch Siemens auf dem Gebiet der SPECT/CT-Entwicklung. Die anderen Autoren erklären, dass kein Interessenskonflikt besteht.
- Published
- 2018
- Full Text
- View/download PDF
24. [Update of the S2k guidelines : Surgical treatment of benign thyroid diseases].
- Author
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Musholt TJ, Bockisch A, Clerici T, Dotzenrath C, Dralle H, Goretzki PE, Hermann M, Holzer K, Karges W, Krude H, Kussmann J, Lorenz K, Luster M, Niederle B, Nies C, Riss P, Schabram J, Schabram P, Schmid KW, Simon D, Spitzweg C, Steinmüller T, Trupka A, Vorländer C, Weber T, and Bartsch DK
- Subjects
- Germany, Humans, Postoperative Complications, Retrospective Studies, Vocal Cord Paralysis etiology, Thyroid Diseases surgery, Thyroidectomy
- Abstract
Thyroid resections represent one of the most common operations with 76,140 interventions in the year 2016 in Germany (source Destatis). These are predominantly benign thyroid gland diseases. Recommendations for the operative treatment of benign thyroid diseases were last published by the CAEK in 2010 as S2k guidelines (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. [AWMF] 003/002) against the background of increasingly more radical resection procedures. Hemithyroidectomy and thyroidectomy are routinely performed for benign thyroid disease in practice. The operation-specific risks show a clear increase with the extent of the resection. Therefore, weighing-up of the risk-indications ratio between unilateral lobectomy or thyroidectomy necessitates an independent evaluation of the indications for both sides. This principle in particular has been used to update the guidelines. In addition, the previously published recommendations of the CAEK for correct execution and consequences of intraoperative neuromonitoring were included into the guidelines, which in particular serve the aim to avoid bilateral recurrent laryngeal nerve paralysis. Moreover, the recommendations for the treatment of postoperative complications, such as hypoparathyroidism and postoperative infections were revised. The updated guidelines therefore represent the current state of the science as well as the resulting surgical practice.
- Published
- 2018
- Full Text
- View/download PDF
25. [Complications after thyroid gland operations in Germany : Further information and routine data analysis].
- Author
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Maneck M, Dotzenrath C, Dralle H, Fahlenbrach C, Paschke R, Steinmüller T, Tusch E, Jeschke E, and Günster C
- Subjects
- Germany, Humans, Parathyroid Glands, Thyroidectomy, Data Analysis, Thyroid Gland
- Published
- 2017
- Full Text
- View/download PDF
26. Functional Implications of LH/hCG Receptors in Pregnancy-Induced Cushing Syndrome.
- Author
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Plöckinger U, Chrusciel M, Doroszko M, Saeger W, Blankenstein O, Weizsäcker K, Kroiss M, Hauptmann K, Radke C, Pöllinger A, Tiling N, Steinmüller T, Huhtaniemi I, Quinkler M, Bertherat J, Lacroix A, and Rahman N
- Abstract
Context: Elevated human choriogonadotropin (hCG) may stimulate aberrantly expressed luteinizing hormone (LH)/hCG receptor (LHCGR) in adrenal glands, resulting in pregnancy-induced bilateral macronodular adrenal hyperplasia and transient Cushing syndrome (CS)., Objective: To determine the role of LHCGR in transient, pregnancy-induced CS., Design Setting Patient and Intervention: We investigated the functional implications of LHCGRs in a patient presenting, at a tertiary referral center, with repeated pregnancy-induced CS with bilateral adrenal hyperplasia, resolving after parturition., Main Outcome Measures and Results: Acute testing for aberrant hormone receptors was negative except for arginine vasopressin (AVP)-increased cortisol secretion. Long-term hCG stimulation induced hypercortisolism, which was unsuppressed by dexamethasone. Postadrenalectomy histopathology demonstrated steroidogenically active adrenocortical hyperplasia and ectopic cortical cell clusters in the medulla. Quantitative polymerase chain reaction showed upregulated expression of LHCGR , transcription factors GATA4 , ZFPM2 , and proopiomelanocortin ( POMC ), AVP receptors (AVPRs) AVPR1A and AVPR2 , and downregulated melanocortin 2 receptor ( MC2R ) vs control adrenals. LHCGR was localized in subcapsular, zona glomerulosa, and hyperplastic cells. Single adrenocorticotropic hormone-positive medullary cells were demonstrated in the zona reticularis. The role of adrenal adrenocorticotropic hormone was considered negligible due to downregulated MC2R . Coexpression of CYP11B1/CYP11B2 and AVPR1A/AVPR2 was observed in ectopic cortical cells in the medulla. hCG stimulation of the patient's adrenal cell cultures significantly increased cyclic adenosine monophosphate, corticosterone, 11-deoxycortisol, cortisol, and androstenedione production. CTNNB1 , PRKAR1A , ARMC5 , and PRKACA gene mutational analyses were negative., Conclusion: Nongenetic, transient, somatic mutation-independent, pregnancy-induced CS was due to hCG-stimulated transformation of LHCGR-positive undifferentiated subcapsular cells (presumably adrenocortical progenitors) into LHCGR-positive hyperplastic cortical cells. These cells respond to hCG stimulation with cortisol secretion. Without the ligand, they persist with aberrant LHCGR expression and the ability to respond to the same stimulus.
- Published
- 2017
- Full Text
- View/download PDF
27. [Complications after thyroid gland operations in Germany : A routine data analysis of 66,902 AOK patients].
- Author
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Maneck M, Dotzenrath C, Dralle H, Fahlenbrach C, Paschke R, Steinmüller T, Tusch E, Jeschke E, and Günster C
- Subjects
- Adult, Aged, Female, Germany, Humans, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Postoperative Hemorrhage epidemiology, Postoperative Hemorrhage etiology, Postoperative Hemorrhage surgery, Reoperation statistics & numerical data, Surgical Wound Infection epidemiology, Surgical Wound Infection etiology, Surgical Wound Infection surgery, Vocal Cord Paralysis epidemiology, Vocal Cord Paralysis etiology, Vocal Cord Paralysis surgery, Data Interpretation, Statistical, Hospitals, High-Volume statistics & numerical data, Hospitals, Low-Volume statistics & numerical data, Postoperative Complications epidemiology, Postoperative Complications etiology, Thyroid Diseases epidemiology, Thyroid Diseases surgery, Thyroidectomy adverse effects, Thyroidectomy statistics & numerical data
- Abstract
Background: Routine data from hospitals in the public healthcare system allow the analysis of large patient datasets without generating additional documentation efforts for hospitals. This study reports the frequencies of postoperative complications after thyroid surgery based on routine nationwide data. Moreover, volume-outcome relationships were investigated., Material and Methods: Nationwide routine data from insured patients of the Local Health Insurance Fund (AOK) who underwent thyroid surgery between 2008 and 2010 were analyzed. Complications were determined based on indicators for permanent vocal cord palsy, re-bleeding with re-operations and wound infections with specific treatment. The effect of hospital volumes (volume quintiles) on the indicators was determined by multivariate logistic regression., Results: A total of 66,902 thyroid gland operations were identified. The overall frequency of permanent vocal cord palsy was 1.5 %, re-bleeding 1.8 % and wound infections 0.4 %. In the four lowest case volume categories the risk of permanent vocal cord palsy was significantly higher compared to the highest case volume hospitals (odds ratio 1.5, 1.7, 1.7 and 2.2, respectively)., Conclusion: This study represents the reality of healthcare for thyroid surgery in Germany. Additionally, it was determined that the risk for permanent vocal cord palsy after thyroid gland operations decreased with increasing case volumes of hospitals.
- Published
- 2017
- Full Text
- View/download PDF
28. Local recurrence in the neck and survival after thyroidectomy for metastatic renal cell carcinoma.
- Author
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Iesalnieks I, Machens A, Bures C, Krenz D, Winter H, Vorländer C, Bareck E, Alesina PF, Musholt T, Steinmüller T, Anthuber M, Goretzki P, Trupka A, Mayr M, Weber T, Schlitt HJ, Dralle H, Hermann M, and Agha A
- Subjects
- Aged, Aged, 80 and over, Carcinoma, Renal Cell mortality, Carcinoma, Renal Cell pathology, Female, Follow-Up Studies, Humans, Kidney Neoplasms mortality, Kidney Neoplasms pathology, Lymphatic Metastasis, Male, Middle Aged, Neck surgery, Neoplasm Recurrence, Local etiology, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prognosis, Survival Rate, Thyroid Neoplasms mortality, Thyroid Neoplasms pathology, Carcinoma, Renal Cell surgery, Kidney Neoplasms surgery, Neck pathology, Neoplasm Recurrence, Local mortality, Thyroid Neoplasms surgery, Thyroidectomy adverse effects
- Abstract
Background: Most investigations of thyroidectomy for metastatic renal cell carcinoma (RCC) are case studies or small series. This study was conducted to determine the contribution of clinical and histopathologic variables to local recurrence in the neck and overall survival after thyroidectomy for RCC metastases., Methods: The medical records of 140 patients with thyroidectomy for metastatic RCC performed between 1979 and 2012 at 25 institutions in Germany and Austria were analyzed., Results: The median interval between nephrectomy and thyroidectomy was 120 months. Concurrence of thyroid and pancreatic metastases was present in 23 % of the patients and concurrence of thyroid and adrenal metastases in 13 % of the patients. Clinical outcome data were available for 130 patients with a median follow-up period of 34 months. The 5-year overall survival rate was 46 %, and 28 % of patients developed a local neck recurrence at a median of 12 months after thyroidectomy. Multivariate analysis showed that invasion of adjacent cervical structures (hazard ratio [HR] 3.2; p = 0.001), patient age exceeding 70 years (HR 2.5; p = 0.004), and current or past evidence of metastases to nonendocrine organs (HR 2.4; p = 0.003) were independent determinants of inferior overall survival. Conversely, invasion of adjacent cervical structures (HR 12.1; p < 0.0001) and year of thyroidectomy (HR 5.7 before 2000; p < 0.0001) were shown to be independently associated with local recurrence in the neck by multivariate analysis., Conclusions: Although significant improvement of local disease control in patients with thyroid metastases of RCC has been achieved during the last decade, overall outcome continues to be poor for patients with locally invasive thyroid metastases.
- Published
- 2015
- Full Text
- View/download PDF
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