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8. Preoperative Evaluation of Thyroid Cancer: A Review of Current Best Practices

Author

Russell, Marika D., Shonka, David C., Jr., Noel, Julia, Karcioglu, Amanda Silver, Ahmed, Amr H., Angelos, Peter, Atkins, Kristen, Bischoff, Lindsay, Buczek, Erin, Caulley, Lisa, Freeman, Jeremy, Kroeker, Teresa, Liddy, Whitney, McIver, Bryan, McMullen, Caitlin, Nikiforov, Yuri, Orloff, Lisa, Scharpf, Joseph, Shah, Jatin, Shaha, Ashok, Singer, Michael, Tolley, Neil, Tuttle, Robert Michael, Witterick, Ian, and Randolph, Gregory W.

Published
2023
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11. Surgical informed consent: new challenges

Author

Hoppenot, Claire, Bryan, Ava Ferguson, Wightman, Sean C., Yin, Victoria, Ferguson, Benjamin D., Bidadi, Sanam, Mitchell, Margaret B., Langerman, Alexander J., Angelos, Peter, and Singh, Puneet

Published
2023
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15. Medullary Thyroid Cancer: Single Institute Experience Over 3 Decades and Risk Factors for Recurrence.

Author

Azar, Sara Abou, Tobias, Joseph, Applewhite, Megan, Angelos, Peter, and Keutgen, Xavier M

Subjects
MEDULLARY thyroid carcinoma, LYMPHATIC metastasis, CANCER relapse, THYROID cancer, REGRESSION analysis
Abstract

Context Medullary thyroid cancer (MTC) has a historic recurrence rate up to 50%, and surgery remains the only cure. Objective This study aims to assess factors related to recurrence and metastatic spread in MTC. Methods Retrospective chart review was performed from 1990 to 2023 at a single specialized tertiary care referral center. Descriptive analysis and regression models were used for analysis. Sixty-eight patients with MTC, who underwent surgery, were included and the main outcome measure was recurrence. Results Mean age at diagnosis was 54.9 years (42.2-64.1), 65% (n = 44) females. Lymph node and distant metastases were found in 24% (n = 16) and 4% (n = 3), respectively. RET mutations were present in 52% (n = 35): MTC risk levels were highest 6%, high 7%, and moderate 39%. Mean tumor size was 1.9 cm (1.2-3.2) and mean preoperative calcitonin was 504.4 pg/mL (133.2-1833.8). Total thyroidectomy (TT) was performed in 10 patients, TT + central neck dissection (CND) in 28, and TT + CND + lateral neck dissection (LND) in 25. On final pathology, 40% had positive central nodes and 25% had positive lateral nodes. Recurrence was 22%, median follow-up 4.7 years (1.2-28.0). Male gender (hazard ratio [HR] 5.81, P =.021), positive lateral neck nodes (HR 8.10, P =.011), and high/highest MTC risk level RET mutations (HR 8.66, P =.004) were significantly associated with recurrence. Preoperative calcitonin >2175 pg/mL was a strong predictor for distant metastasis (area under the curve [AUC] 0.893) and a good predictor for lateral neck disease (AUC 0.706). Extent of surgery was not significantly associated with recurrence (P =.634). Conclusion One of 4 patients undergoing surgery for MTC will recur. Risk factors associated with recurrence are male gender, lateral lymph node metastasis, and high/highest MTC risk level mutations, but not necessarily surgery type. Preoperative calcitonin >2175 pg/mL is suggestive of advanced disease and should prompt further evaluation. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Consensus Statement by the American Association of Clinical Endocrinology (AACE) and the American Head and Neck Society Endocrine Surgery Section (AHNS) on Pediatric Benign and Malignant Thyroid Surgery

Author

Stack, Brendan C., Jr., Twining, Christine, Rastatter, Jeff, Angelos, Peter, Baloch, Zubair, Diercks, Gillian, Faquin, William, Kazahaya, Ken, Rivkees, Scott, Sheyn, Tony, Shin, Jennifer J., Smith, Jessica, Thompson, Geoffrey, Viswanathan, Pushpa, Wassner, Ari, Brooks, Jennifer, and Randolph, Gregory W.

Published
2021
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22. Review Paper on Penetrating Brain Injury: Ethical Quandaries in the Trauma Bay and Beyond

Author

Zakrison, Tanya L., Essig, Rachael, Polcari, Ann, McKinley, William, Arnold, Damon, Beyene, Robel, Wilson, Kenneth, Rogers, Selwyn, Jr, Matthews, Jeffrey B., Millis, J. Michael, Angelos, Peter, O’Connor, Michael, Mansour, Ali, Goldenberg, Fernando, Spiegel, Thomas, Horowitz, Peleg, Das, Paramita, Slidell, Mark, Chokshi, Nikunj, Okeke, Iheoma, Barth, Rolf, Wilkins, Harry E., III, Kass-Hout, Tareq, and Lazaridis, Christos

Published
2023
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25. What Do We Owe Our Patients? Surgeon Obligations When Patients Are Too Sick for Surgery.

Author

Lazenby, Kevin A. and Angelos, Peter

Subjects
*PATIENT autonomy, *SURGERY, *PATIENTS, *PROFESSIONAL ethics, *RESPECT, *PATIENTS' rights, *PHYSICIANS' attitudes, *PHYSICIAN-patient relations
Abstract

As the principle of respect for patient autonomy has gained salience over the past 75 years, surgeons now struggle to resolve conflicts between autonomy and beneficence in certain clinical scenarios. One such conflict occurs when a patient desires a surgical intervention, but the surgeon concludes that the patient is "too sick for surgery" and hence would not benefit from the operation. We provide historical context for the principle of respect for patient autonomy and review recent qualitative data that demonstrate surgeons experience significant moral distress when asked to perform nonbeneficial surgery. Therefore, we sought to empower surgeons with the appropriate ethical justifications to decline to perform surgery when they believe it would be nonbeneficial or harmful to patients. We outline 4 concepts that can help surgeons engage with patients, families, and colleagues in these scenarios. First, we describe the term "futility" and explain the difficulty in precisely defining and using the term in practice. Second, we contrast patients' positive and negative rights, drawing on historical context to argue that patients have robust negative rights but limited positive rights to request nonbeneficial interventions. Third, we use the centuries-old notion of medicine as a profession to show that surgeons have a fiduciary responsibility to act in the best interests of their patients, including and especially when patients request interventions that are not beneficial. Finally, we draw on virtue ethics to give surgeons character-based resources for fulfilling their professional obligations to patients. We contend that surgeons owe their patients the ability to trust that they will always use their knowledge and skills for patients' benefit, even if surgeons must limit patients' autonomy in certain ways to do so. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Injection of bulking agents for laryngoplasty

Author

Snyder, Samuel K., Angelos, Peter, Carty, Sally E., Doherty, Gerard M., Howe, James R., Lee, James A., Libutti, Steven K., Miller, Barbra S., Parangi, Sareh, Patel, Kepal N., Sippel, Rebecca C., Sturgeon, Cord, Wang, Tracy S., Yip, Linwah, and Zeiger, Martha A.

Published
2018
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49. COVID-19, Ethics and Equity—What Is Our Role as Surgeons?

Author

Zakrison, Tanya L., Martin, Matthew, Seamon, Mark, Matthews, Jeffrey, Joseph, Bellal, Rattan, Rishi, Mendoza, April, Bernard, Andrew, Gelbard, Rondi, Crandall, Marie, Punch, Laurie, Joseph, D’Andrea, Bonne, Stephanie, Mubang, Ronnie, McCunn, Maureen, Rogers, Selwyn, Turner, Patricia, Claridge, Jeffrey, Henry, Sharon, de Moya, Marc, Tseng, Esther, Goulet, Nicole, Tung, Lily, Kiselak, Elizabeth, Duncan, Thomas, Kaafarani, Haytham, Ferrada, Paula, Foster, Shannon, Ding, Linda, Santos, Ariel, Winfield, Robert D., Weaver, Jessica, and Angelos, Peter

Published
2020
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