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1. Impact of the COVID-19 pandemic on surgery for thyroid cancer in Italy: nationwide retrospective study

Author

Medas, F., Ansaldo, G. L., Avenia, N., Basili, G., Bononi, M., Bove, A., Carcoforo, P., Casaril, A., Cavallaro, G., Conzo, G., De Pasquale, L., Del Rio, P., Dionigi, G., Dobrinja, C., Docimo, G., Graceffa, G., Iacobone, M., Innaro, N., Lombardi, C. P., Novelli, G., Palestini, N., Pedicini, F., Perigli, G., Pezzolla, A., Pezzullo, L., Scerrino, G., Spiezia, S., Testini, M., Calo, P. G., Anedda, G., Antonelli, G., Arrigoni, G., Badii, B., Bonati, E., Boniardi, M., Bulfamante, A. M., Candalise, V., Cangiano, A., Canu, G. L., Cappellacci, F., Caracciolo, A., Caruso, E., Casal Ide, E., Chiappini, A., Chiofalo, M. G., Cipolla, C., Costigliola, L., Cozzani, F., Crocco, A., Crocetti, D., De Manzini, N., DI Gioia, A., DI Resta, V., Eramo, R., Erdas, E., Ferriolo, S., Filardo, M., Filograna Pignatelli, M., Gervasi, R., Giudici, F., Gordini, L., Gurrado, A., Impellizzeri, H., Inama, M., Koleva Radica, M., Laforgia, R., Lattarulo, S., Loderer, T., Lucchini, R., Mascioli, F., Marcellinaro, R., Menditto, R., Melfa, G., Minuto, M., Misso, C., Offi, C., Orlando, G., Ossola, P., Pagetta, C., Pasculli, A., Patrone, R., Pauna, I., Pennetti Pennella, F., Pietrasanta, D., Pino, A., Pinto, V. L., Piras, S., Polistena, A., Portinari, M., Reina, S., Rotolo, G., Russo, G., Scalise, E., Sgaramella, L. I., Sibilla, M. G., Spinelli, S., Spoletini, D., Curto, L. S., Tascone, M., Torresan, F., Varaldo, E., Viviani, E., Zucca, A., Medas, F, Ansaldo, G L, Avenia, N, Basili, G, Bononi, M, Bove, A, Carcoforo, P, Casaril, A, Cavallaro, G, Conzo, G, De Pasquale, L, Del Rio, P, Dionigi, G, Dobrinja, C, Docimo, G, Graceffa, G, Iacobone, M, Innaro, N, Lombardi, C P, Novelli, G, Palestini, N, Pedicini, F, Perigli, G, Pezzolla, A, Pezzullo, L, Scerrino, G, Spiezia, S, Testini, M, Calò, P G, Cipolla C, Medas, F., Ansaldo, G. L., Avenia, N., Basili, G., Bononi, M., Bove, A., Carcoforo, P., Casaril, A., Cavallaro, G., Conzo, G., De Pasquale, L., Del Rio, P., Dionigi, G., Dobrinja, C., Docimo, G., Graceffa, G., Iacobone, M., Innaro, N., Lombardi, C. P., Novelli, G., Palestini, N., Pedicini, F., Perigli, G., Pezzolla, A., Pezzullo, L., Scerrino, G., Spiezia, S., Testini, M., Calo, P. G., Anedda, G., Antonelli, G., Arrigoni, G., Badii, B., Bonati, E., Boniardi, M., Bulfamante, A. M., Candalise, V., Cangiano, A., Canu, G. L., Cappellacci, F., Caracciolo, A., Caruso, E., Casal Ide, E., Chiappini, A., Chiofalo, M. G., Cipolla, C., Costigliola, L., Cozzani, F., Crocco, A., Crocetti, D., De Manzini, N., DI Gioia, A., DI Resta, V., Eramo, R., Erdas, E., Ferriolo, S., Filardo, M., Filograna Pignatelli, M., Gervasi, R., Giudici, F., Gordini, L., Gurrado, A., Impellizzeri, H., Inama, M., Koleva Radica, M., Laforgia, R., Lattarulo, S., Loderer, T., Lucchini, R., Mascioli, F., Marcellinaro, R., Menditto, R., Melfa, G., Minuto, M., Misso, C., Offi, C., Orlando, G., Ossola, P., Pagetta, C., Pasculli, A., Patrone, R., Pauna, I., Pennetti Pennella, F., Pietrasanta, D., Pino, A., Pinto, V. L., Piras, S., Polistena, A., Portinari, M., Reina, S., Rotolo, G., Russo, G., Scalise, E., Sgaramella, L. I., Sibilla, M. G., Spinelli, S., Spoletini, D., Curto, L. S., Tascone, M., Torresan, F., Varaldo, E., Viviani, E., and Zucca, A.

Subjects
2019-20 coronavirus outbreak, medicine.medical_specialty, AcademicSubjects/MED00910, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pandemics, NO, Pandemic, Research Letter, medicine, humans, Thyroid cancer, Thyroid Neoplasm, LS7_4, Thyroid Neoplasms, Thyroidectomy, SARS-CoV-2, COVID-19, Pandemics, Italy, business.industry, thyroid neoplasms, Retrospective cohort study, medicine.disease, Comorbidity, comorbidity, retrospective studies, thyroidectomy, Settore MED/18 - Chirurgia Generale, Emergency medicine, Surgery, AcademicSubjects/MED00010, business
Abstract

N/A

Published
2021

2. The THYCOVIT (Thyroid Surgery during COVID-19 pandemic in Italy) study: results from a nationwide, multicentric, case-controlled study

Author

Medas, F., Ansaldo, G. L., Avenia, N., Basili, G., Boniardi, M., Bononi, M., Bove, A., Carcoforo, P., Casaril, A., Cavallaro, G., Chiofalo, M. G., Conzo, G., De Pasquale, L., Del Rio, P., Dionigi, G., Dobrinja, C., Docimo, G., Graceffa, G., Iacobone, M., Innaro, N., Lombardi, C. P., Palestini, N., Pedicini, F., Perigli, G., Pezzolla, A., Scerrino, G., Spiezia, S., Testini, M., Calo, P. G., Anedda, G., Antonelli, G., Arrigoni, G., Badii, B., Bonati, E., Bulfamante, A. M., Candalise, V., Cangiano, A., Canu, G. L., Cappellacci, F., Caracciolo, A., Caruso, E., Annamaria, D. A., Ide, E. C., Chiappini, A., Cipolla, C., Costigliola, L., Cozzani, F., Crocco, A., Crocetti, D., Demanzini, N., Digioia, A., Diresta, V., Eramo, R., Erdas, E., Ferriolo, S., Filardo, M., Filograna Pignatelli, M., Gervasi, R., Giudici, F., Gordini, L., Gurrado, A., Impellizzeri, H., Inama, M., Koleva Radica, M., Laforgia, R., Lattarulo, S., Loderer, T., Lucchini, R., Mascioli, F., Marcellinaro, R., Menditto, R., Melfa, G., Minuto, M., Misso, C., Offi, C., Orlando, G., Ossola, P., Pagetta, C., Pasculli, A., Patrone, R., Pauna, I., Pennetti Pennella, F., Pietrasanta, D., Pino, A., Pinto, V. L., Piras, S., Polistena, A., Portinari, M., Reina, S., Rotolo, G., Russo, G., Scalise, E., Sgaramella, L. I., Sibilla, M. G., Spinelli, S., Spoletini, D., Curto, L. S., Tascone, M., Torresan, F., Varaldo, E., Viviani, E., Zucca, A., Medas, Fabio, Ansaldo, Gian Luca, Avenia, Nicola, Basili, Giancarlo, Boniardi, Marco, Bononi, Marco, Bove, Aldo, Carcoforo, Paolo, Casaril, Andrea, Cavallaro, Giuseppe, Chiofalo, Maria Grazia, Conzo, Giovanni, De Pasquale, Loredana, Del Rio, Paolo, Dionigi, Gianlorenzo, Dobrinja, Chiara, Docimo, Giovanni, Graceffa, Giuseppa, Iacobone, Maurizio, Innaro, Nadia, Lombardi, Celestino Pio, Palestini, Nicola, Pedicini, Francesco, Perigli, Giuliano, Pezzolla, Angela, Scerrino, Gregorio, Spiezia, Stefano, Testini, Mario, Calò, Pietro Giorgio, Calogero, Cipolla, Medas, F., Ansaldo, G. L., Avenia, N., Basili, G., Boniardi, M., Bononi, M., Bove, A., Carcoforo, P., Casaril, A., Cavallaro, G., Chiofalo, M. G., Conzo, G., De Pasquale, L., Del Rio, P., Dionigi, G., Dobrinja, C., Docimo, G., Graceffa, G., Iacobone, M., Innaro, N., Lombardi, C. P., Palestini, N., Pedicini, F., Perigli, G., Pezzolla, A., Scerrino, G., Spiezia, S., Testini, M., Calo, P. G., Anedda, G., Antonelli, G., Arrigoni, G., Badii, B., Bonati, E., Bulfamante, A. M., Candalise, V., Cangiano, A., Canu, G. L., Cappellacci, F., Caracciolo, A., Caruso, E., Annamaria, D. A., Ide, E. C., Chiappini, A., Cipolla, C., Costigliola, L., Cozzani, F., Crocco, A., Crocetti, D., Demanzini, N., Digioia, A., Diresta, V., Eramo, R., Erdas, E., Ferriolo, S., Filardo, M., Filograna Pignatelli, M., Gervasi, R., Giudici, F., Gordini, L., Gurrado, A., Impellizzeri, H., Inama, M., Koleva Radica, M., Laforgia, R., Lattarulo, S., Loderer, T., Lucchini, R., Mascioli, F., Marcellinaro, R., Menditto, R., Melfa, G., Minuto, M., Misso, C., Offi, C., Orlando, G., Ossola, P., Pagetta, C., Pasculli, A., Patrone, R., Pauna, I., Pennetti Pennella, F., Pietrasanta, D., Pino, A., Pinto, V. L., Piras, S., Polistena, A., Portinari, M., Reina, S., Rotolo, G., Russo, G., Scalise, E., Sgaramella, L. I., Sibilla, M. G., Spinelli, S., Spoletini, D., Curto, L. S., Tascone, M., Torresan, F., Varaldo, E., Viviani, E., and Zucca, A.

Subjects
COVID-19, Endocrine surgery, SARS-CoV-2, Thyroid carcinoma, Thyroidectomy, medicine.medical_specialty, medicine.medical_treatment, Thyroid Gland, Humans, Italy, Retrospective Studies, Pandemics, NO, Retrospective Studie, Pandemic, Epidemiology, medicine, Thyroid cancer, LS7_4, business.industry, Thyroid disease, Case-control study, Retrospective cohort study, medicine.disease, Surgery, Original Article, business, Human
Abstract

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.

Published
2021

3. Cervico-Mediastinal Extension of Thyroid Cancer

Author

Torre, G. C., Ansaldo, G. L., GIACOMO BORGONOVO, Varaldo, E., Meola, C., Bottaro, P., Minuto, M., and Mattioli, F. P.

Subjects
Adult, Aged, 80 and over, Male, General Medicine, Middle Aged, Prognosis, Mediastinal Neoplasms, Head and Neck Neoplasms, Humans, Female, Neoplasm Invasiveness, Thyroid Neoplasms, Aged, Retrospective Studies
Abstract

A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospectively reviewed. Results were compared with those obtained in patients operated on for benign cervico-mediastinal goiter and thyroid cancer confined to cervical region. Of 4688 thyroidectomies performed, 30 patients were operated on for thyroid carcinoma with cervico-mediastinal extension. There were 15 males and 15 females. The mean age was 67 years (range, 21–86 years). Patients with cervico-mediastinal cancer were significantly older than patients with benign cervico-mediastinal goiter ( P < 0.0001). Time between onset of first symptoms and surgery was significantly longer in patients with cervico-mediastinal cancer than in those with benign cervico-mediastinal goiter ( P < 0.0001) and cervical thyroid cancer. Signs and symptoms at the time of surgery were cervical mass in 28 patients (93%), cervical lymphadenopathy in 20 patients (66%), dyspnea in 21 (70%), dysphagia in 9 (30%), dysphonia in 2 (7%), and venous stasis in 1 (3%). None of the patients was asymptomatic. Total thyroidectomy with functional lymphectomy was performed in 16 cases. Seven of these patients were operated on in 2 stages. In 8 cases the operation was a debulking procedure, and in 6 it was a near-total thyroidectomy. Sternotomy was performed in two cases. A differentiated thyroid cancer was found in 21 patients (70%), medullary in 5 (17%) and undifferentiated in 4 (13%). The incidence of medullary carcinoma was significantly higher compared with cervical cancer ( P < 0.008). Postoperative complications were higher than those occurring in benign cervico-mediastinal goiter and similar to those occurring in cervical cancer. The actuarial survival was similar to that of cervical cancer matched for age and sex. This analysis shows that the longer clinical history of goiter is related to its endothoracic development and its neoplastic transformation. This finding should further encourage surgeons to treat any cervico-mediastinal goiter as promptly as possible.

Published
2000

4. Parathyroid cyst, a case report and review of the literature

Author

Varaldo, E., Michele Minuto, and Torre, G.

Subjects
Adult, Cysts, Parathyroid Diseases, Humans, Female
Abstract

Parathyroid cysts are rare, representing 1% of all neck swellings. A correct preoperative diagnosis is rarely formulated, especially because of the non-specific clinical and ultrasonographic findings; for this reason, patients are often submitted to surgery for thyroid nodules. In the present report we describe a case where the preoperative diagnosis was correctly formulated following the aspiration and PTH assay of clear, colorless, watery fluid from the cyst. While cyst aspiration is considered the elective treatment for these lesions, recurrences being uncommon, surgery was indicated in the present case because of two recurrences after aspiration and the onset of compressive symptoms. Cystic masses of the neck should be accurately diagnosed to recognize their true nature and to allow their correct and non-invasive treatment: surgery is indicated only when recurrences and symptoms are present. Indications for aspiration of all solitary cysts of the neck should be considered to correctly identify their nature.

Published
2002

5. Pheochromocytoma during pregnancy treated by surgery. A case report and the review of the literature

Author

Varaldo, E., Ansaldo, G., Assalino, M., Massobrio, A., Minuto, M., Torre, G., and GIACOMO BORGONOVO

Subjects
Adult, Pregnancy Trimester, First, Early Diagnosis, Treatment Outcome, Pregnancy, Prenatal Diagnosis, Hypertension, Adrenal Gland Neoplasms, Humans, Adrenalectomy, Female, Pheochromocytoma, Pregnancy Complications, Neoplastic
Abstract

Prenatal diagnosis of pheocromocytoma, although rare, is important as it allows a reduction in both maternal mortality and foetal loss. Pheocromocytoma operated on in the first trimester of pregnancy with survival of both patient and foetus is rare in literature. Our case was operated on with success after a correct and early diagnosis was obtained despite a chronic hypertension which existed long before pregnancy. Our case study well illustrates that a correct multidisciplinary approach involving endocrinologists, anesthesiologists, surgeons and gynecologists is fundamental for a positive outcome.The case of a white caucasian pregnant woman at 13th weeks of gestation with pheocromocytoma and severe and unstable hypertension that could not be pharmacologically controlled is described. Morphological diagnosis was safely obtained by Magnetic Resonance Imaging (MRI) without intravenous medium contrast agent. Pre-operative treatment consisted of therapy with alpha-blockers and rehydration. Adrenalectomy was performed through a laparotomy. Postoperative treatment consisted of rehydration and ephedrine continued until the fourth post-operative day. The post-operative period was uneventful and a new ultrasound (US) scan confirmed foetal vitality. The patient was discharged seven days after surgery. A live newborn was physiologically delivered after a nine-month pregnancy.A correct diagnosis in all pregnant women with severe hypertension particularly those not screened for secondary hypertension and a multidisciplinary management are mandatory to obtain optimal results and avoid deleterious effects at delivery.

6. Hemithyroidectomy versus total thyroidectomy in the intermediate-risk differentiated thyroid cancer: the Italian Societies of Endocrine Surgeons and Surgical Oncology Multicentric Study

Author

E. Varaldo, Giuseppa Graceffa, Angela Gurrado, Chiara Dobrinja, Fabiola Giudici, Michele Minuto, Gian Luca Ansaldo, Roberto Ruggiero, Nadia Innaro, C. De Crea, Natasa Samardzic, Celestino Pio Lombardi, Domenico Parmeggiani, L. De Pasquale, I. Pauna, Luca Sessa, Alessandro Pasculli, Marco Raffaelli, Giovanni Docimo, Gianlorenzo Dionigi, Stefano Spiezia, Mario Testini, M. Boniardi, Pier Giorgio Calò, Maurizio Iacobone, A. Massara, Ludovico Docimo, N. de Manzini, S. Lattarulo, Angela Pezzolla, Dobrinja, C., Samardzic, N., Giudici, F., Raffaelli, M., De Crea, C., Sessa, L., Docimo, G., Ansaldo, G. L., Minuto, M., Varaldo, E., Dionigi, G., Spiezia, S., Boniardi, M., Pauna, I., De Pasquale, L., Testini, M., Gurrado, A., Pasculli, A., Pezzolla, A., Lattarulo, S., Calo, P. G., Graceffa, G., Massara, A., Docimo, L., Ruggiero, R., Parmeggiani, D., Iacobone, M., Innaro, N., Lombardi, C. P., de Manzini, N., Dobrinja C., Samardzic N., Giudici F., Raffaelli M., De Crea C., Sessa L., Docimo G., Ansaldo G.L., Minuto M., Varaldo E., Dionigi G., Spiezia S., Boniardi M., Pauna I., De Pasquale L., Testini M., Gurrado A., Pasculli A., Pezzolla A., Lattarulo S., Calo P.G., Graceffa G., Massara A., Docimo L., Ruggiero R., Parmeggiani D., Iacobone M., Innaro N., Lombardi C.P., de Manzini N., Dobrinja, C. a., Spiezia, S. Boniardi M., and Calò, P. G.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Papillary, Differentiated thyroid carcinoma, Hemithyroidectomy, Intermediate-risk differentiated thyroid cancer, Risk stratification, Surgery, Thyroid, Humans, Italy, Neoplasm Recurrence, Local, Retrospective Studies, Thyroidectomy, Carcinoma, Papillary, Surgeons, Surgical Oncology, Thyroid Neoplasms, Surgeon, Surgical oncology, Retrospective Studie, medicine, Risk factor, Thyroid cancer, Completion thyroidectomy, business.industry, Carcinoma, Neck dissection, Retrospective cohort study, medicine.disease, medicine.anatomical_structure, Neoplasm Recurrence, Local, business, Human
Abstract

The surgical treatment of the intermediate-risk DTC (1–4 cm) remains still controversial. We analyzed the current practice in Italy regarding the surgical management of intermediate-risk unilateral DTC to evaluate risk factors for recurrence and to identify a group of patients to whom propose a total thyroidectomy (TT) vs. hemithyroidectomy (HT). Among 1896 patients operated for thyroid cancer between January 2017 and December 2019, we evaluated 564 (29.7%) patients with unilateral intermediate-risk DTC (1–4 cm) without contralateral nodular lesions on the preoperative exams, chronic autoimmune thyroiditis, familiarity or radiance exposure. Data were collected retrospectively from the clinical register from 16 referral centers. The patients were followed for at least 14 months (median time 29.21 months). In our cohort 499 patients (88.4%) underwent total thyroidectomy whereas 65 patients (11.6%) underwent hemithyroidectomy. 151 (26.8%) patients had a multifocal DTC of whom 57 (10.1%) were bilateral. 21/66 (32.3%) patients were reoperated within 2 months from the first intervention (completion thyroidectomy). Three patients (3/564) developed regional lymph node recurrence 2 years after surgery and required a lymph nodal neck dissection. The single factor related to the risk of reoperation was the histological diameter (HR = 1.05 (1.00–1-09), p = 0.026). Risk stratification is the key to differentiating treatment options and achieving better outcomes. According to the present study, tumor diameter is a strong predictive risk factor to proper choose initial surgical management for intermediate‐risk DTC. © 2021, Italian Society of Surgery (SIC).

Published
2021

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