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Objectives We used population-based data to identify incident cancer cases and correlates of cancer among women living with HIV/ AIDS in British Columbia ( BC), Canada between 1994 and 2008. Methods Data were obtained from a retrospective population-based cohort created from linkage of two province-wide databases: (1) the database of the BC Cancer Agency, a province-wide population-based cancer registry, and (2) a database managed by the BC Centre for Excellence in HIV/ AIDS, which contains data on all persons treated with antiretroviral therapy in BC. This analysis included women (≥ 19 years old) living with HIV in BC, Canada. Incident cancer diagnoses that occurred after highly active antiretroviral therapy ( HAART) initiation were included. We obtained a general population comparison of cancer incidence among women from the BC Cancer Agency. Bivariate analysis ( Pearson χ2, Fisher's exact or Wilcoxon rank-sum test) compared women with and without incident cancer across relevant clinical and sociodemographic variables. Standardized incidence ratios ( SIRs) were calculated for selected cancers compared with the general population sample. Results We identified 2211 women with 12 529 person-years ( PY) of follow-up who were at risk of developing cancer after HAART initiation. A total of 77 incident cancers (615/100 000 PY) were identified between 1994 and 2008. HIV-positive women with cancer, in comparison to the general population sample, were more likely to be diagnosed with invasive cervical cancer, Hodgkin's lymphoma, non- Hodgkin's lymphoma and Kaposi's sarcoma and less likely to be diagnosed with cancers of the digestive system. Conclusions This study observed elevated rates of cancer among HIV-positive women compared to a general population sample. HIV-positive women may have an increased risk for cancers of viral-related pathogenesis. [ABSTRACT FROM AUTHOR]

Background: Fine needle aspiration biopsy represents the critical initial diagnostic test used for evaluation of thyroid nodules. Our objectives were to determine the cytological distribution, the utility of clinicopathologic characteristics for predicting malignancy and the true proportion of cancer among individuals who presented with indeterminate cytology and had undergone thyroid surgery for suspicion of cancer.Methods: We retrospectively reviewed 1040 consecutive primary thyroid operations carried out over an 8-year period at a tertiary care endocrine referral centre. Follicular neoplasm (FN), Hürthle cell neoplasm (HN), neoplasms suspicious for but not diagnostic of papillary carcinoma (IP) and neoplasms with cellular atypia (IA) were reviewed.Results: In all, 380 individuals presented with cytologically indeterminate thyroid nodules. Of these, 252 (66%) patients had FN, 47 (12%) HN, 44 (12%) IP, 26 (7%) IA and 11 (4%) had mixed diagnoses. Biopsied lesions were found to be malignant on pathological evaluation in 102 (27%) patients: 49 (19%) with FN, 11 (23%) HN, 28 (64%) IP and 9 (35%) with IA. Hemithyroidectomy was adequate definitive treatment in 196 of 225 (87%) patients with FN and 39 of 42 (93%) with HN. Significant associations with a cancer diagnosis were identified for smaller tumour size in patients with FN (p = 0.004) and right thyroid lobe location in patients with IP (p = 0.012), although these factors were nonsignificant in the corrected analyses for multiple comparisons.Conclusion: In a review of the experience at a Canadian centre, 4 operations were carried out to identify each cancer, and hemithyroidectomy was the optimal initial and definitive surgical approach for most patients. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study were to determine the frequency and prognostic significance of beta-catenin expression in a cohort of non-small cell lung cancer (NSCLC) patients.Methods: Tissue microarrays were constructed using clinically annotated formalin-fixed paraffin-embedded tumor samples from individuals diagnosed with NSCLC who underwent surgical resection with curative intent and had beta-catenin expression status determined by immunohistochemistry.Results: Negative beta-catenin expression was seen in 28% (103/370) of NSCLC cases and was prognostic of a reduced overall patient survival (P = .008) and also was significantly correlated with the presence of lymphatic invasion (P = .015). In multivariate analysis, the loss of beta-catenin expression retained independent prognostic significance and showed an adjusted hazard ratio of 3.18 (confidence interval, 1.46-6.91, P = .004) for reduced patient survival when adjusting for the presence of lymphatic invasion, tumor grade, nodal status, and tumor stage.Conclusions: Beta-catenin represents an important prognostic marker in individuals diagnosed with surgically resectable NSCLC. [ABSTRACT FROM AUTHOR]

Background: We performed a bibliometric study to identify the most-cited publications in MTC research and demonstrate how they highlight the most important historical developments in this area., Methods: Bibliometric data from papers published on the topic of MTC until December 31, 2022 was extracted from the Web of Science database. Analysis was performed utilizing Bibliometrix and VOSViewer software., Results: There has been a gradual increase in the number of publications on the topic of MTC over the years. The most cited publications focused on the underlying genetic basis for MTC, the use of targetted therapy, and guidelines. Recent research frontiers have focused on management, guidelines, and tyrosine kinase inhibitors., Conclusion: Bibliometric study of the topic of MTC has allowed for identification, characterization and appreciation of many of the key historical developments in this field. Bibliometric analysis can also be helpful in identifying research frontiers., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This is the first study of Canadian thyroid and parathyroid surgery legal decisions, and the first study of surgical malpractice using the Canadian Legal Information Institute (CanLII) database. The objective was to identify quality improvement opportunities in surgical practice, to increase patient safety and satisfaction., Methods: Legal decisions relating to thyroid and parathyroid surgery in the CanLII database were screened. Cases were included if a surgeon was listed as applicant or respondent; they related to pre-, intra-, or post-operative management of thyroid or parathyroid disease; and malpractice was alleged. Cases were excluded if surgery was mentioned incidentally or for non-surgical focus., Results: Of the 347 unique legal decisions screened, 14 met inclusion and exclusion criteria. Surgeries occurred between 1976 and 2012, with 13 thyroid surgeries, 1 parathyroidectomy, and 4 mortalities., Conclusions: Quality improvement lessons include communication, pre-operative patient education and documentation of risks discussed, and in-person assessment of complications., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This study aimed to review the varied 1-4 gastrointestinal (GI) system surgical outcomes among people living with Human Immunodeficiency Virus (PLWH) in the HAART-era., Methods: MEDLINE and EMBASE were searched for primary publications on GI surgery outcomes exclusively in HAART-treated HIV patients. NSQIP-reported complications (NRCs), all-cause complications (ACC) and HIV disease parameters were extracted., Results: 12 studies met study inclusion criteria, examining bowel (4), bariatric (5), cholecystectomy (1), appendectomy (1), and other general abdominal operations (1). The NRC rate was 0%, ≥44.4% and 13.3% in bariatric, bowel and appendix surgeries, respectively. Over half of NRCs were infectious. HAART-treated patients had lower ACC, LOS, and sepsis versus untreated-HIV, and higher ACC, LOS and reoperation rates versus HIV-negative patients., Conclusion: HAART use is associated with markedly improved NRC outcomes post GI surgery among PLWH; however, these remained inferior to those documented among HIV uninfected individuals., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Studies in the United States demonstrate a low proportion of cisgender women in medical leadership. No research exists about the prevalence of transgender people in medical leadership. The objective of this study was to evaluate gender representation within Canadian surgical training leadership., Design: This study represents a survey based exploratory analysis and literature review. Associations between gender and leadership position, surgical subspecialty, years in practice and leadership role, province of work, and age were calculated using Chi squared goodness of fit and independence tests., Setting: The study was based out of the University of British Columbia in Vancouver and included all Canadian surgical training programs., Participants: Participants were identified using the Canadian Resident Matching Service and program websites. All prospective respondents (359) were emailed an encrypted survey link., Results: The survey response rate was 65/359 responses (18%). The overall gender distribution was cis men (n = 36, 56.5%), cis women (n = 26, 40%), nonbinary (n = 1, 1.5%), agender (n = 1, 1.5%) and nonresponse (n = 1, 1.5%). Sixty-three percent of program directors were cis men, 33% were cis women and 4% were agender. Sixty-seven percent of associate program directors were cis women and 33% were cis men. Sixty-five percent of division leads were cis men, 29% were cis women, and 6% were nonbinary. There were more cis women in general surgery leadership than expected (df = 1, N = 20, x 2  = 11.05, p ≤ 0.001). No statistically significant associations between gender identity/modality, leadership role, province, or age were found using chi squared tests., Conclusions: Cis men continue to outnumber all others in surgical training leadership. More cis women than expected work in general surgery training leadership. However, these findings must be interpreted with caution considering the low survey response rate and the greater proportion of cis women respondents compared to cis women surgeons. There is a marked absence of binary-identified trans people in surgical training leadership in Canada, however a small number of nonbinary and agender people are present., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: Guidelines recommend that health-related information for patients should be written at or below the sixth-grade level. We sought to evaluate the readability level and quality of online patient education materials regarding epidural and spinal anesthesia., Methods: We evaluated webpages with content written specifically regarding either spinal or epidural anesthesia, identified using 11 relevant search terms, with seven commonly used readability formulas: Flesh-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed the quality of the reading materials using the Brief DISCERN tool., Results: We analyzed 261 webpages. The mean (standard deviation) readability scores were: FKGL = 8.8 (1.9), GFI = 11.2 (2.2), CLI = 10.3 (1.9), ARI = 8.1 (2.2), SMOG = 11.6 (1.6), FRE = 55.7 (10.8), and NDC = 5.4 (1.0). The mean grade level was higher than the recommended sixth-grade level when calculated with six of the seven readability formulas. The average Brief DISCERN score was 16.0., Conclusion: Readability levels of online patient education materials pertaining to epidural and spinal anesthesia are higher than recommended. When we evaluated the quality of the information using a validated tool, the materials were found to be just below the threshold of what is considered good quality. Authors of educational materials should provide not only readable but also good-quality information to enhance patient understanding., (© 2024. Canadian Anesthesiologists' Society.)

Introduction: Improving transition to the operating room (OR) can enhance healthcare efficiency. Our aim was to determine whether adopting a communication board (CB) for first case surgical patients reduced delays to OR., Methods: A retrospective observational study was conducted from April to October 2021. We calculated differences in surgical daycare (SDC) departure time before and after implementation of the CB, differences in departure whether the CB was used or not, delay in variability between surgical specialties, and overall adoption of the CB., Results: After CB adoption, 13% of first cases left SDC by predefined target times. The mean delay in transfer was 18:51 minutes. When the CB was used, cases were on average 10:43 late, compared with 26:00 when it was not used. Otolaryngology had the shortest delays while plastic surgery had the longest. Reasons for delays included staffing delays, holds, and pending laboratory results., Conclusions: Introducing a CB significantly reduced delays in transferring first case surgical patients from SDC to the OR., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 National Association for Healthcare Quality.)

Background: We aimed to investigate the prevalence, characteristics, and management of nephrolithiasis in primary hyperparathyroidism (PHPT) patients., Methods: Medical records of patients who underwent parathyroidectomy at a tertiary care hospital in British Columbia from January 2016 to April 2023 were retrospectively reviewed. Demographic data, laboratory results, imaging reports, and urologic consultations were examined. Descriptive statistics and relevant statistical tests, including logistic regressions, were utilized for data analysis., Result: Of the 413 PHPT patients included in the study population, 41.9% harbored renal stones, and nearly half (48.6%) required urological interventions. Male sex, elevated preoperative serum ionized calcium (iCa) and 24-h urinary calcium (24 ​h urine Ca) levels were independent risk factors for stone formation. Additionally, male sex, younger age, and lower preoperative serum 25-hydroxyvitamin D (25(OH)D) level were associated with higher odds of requiring urological intervention for stones., Conclusions: This study identified significant prevalence of asymptomatic renal calcifications in PHPT patients, with a substantial proportion necessitating urological intervention. These findings emphasize the importance of incorporating screening and treatment of renal stones into the management of PHPT patients., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This review aimed to consolidate the existing literature on intraoperative teaching strategies and highlight areas for future research., Objective: The objective is to review the research conducted regarding the implementation of various teaching frameworks for surgical learners and to present their feasibility, benefits, and limitations within surgical residencies, as well as areas for future research., Methods: Two independent investigators searched MEDLINE, EMBASE, and ERIC and reviewed articles on intraoperative teaching strategies for surgical resident education., Results: 3050 abstracts were reviewed, and 66 studies (2.2%) were included. The most common study type was single cohort studies (33%), followed by survey studies (17%). The majority of articles were carried out in General Surgery (50%), or a combination of surgical specialties (17%)., Conclusions: The BID model encompasses perioperative teaching time points and suggests a universal organizational approach to intraoperative teaching that would likely be compatible with documented competency assessments for residents., Competing Interests: Declaration of Competing interest The authors do not report any conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest.

Objectives: The objective of this study was to evaluate the psychological impact of the COVID-19 pandemic on surgical residents., Design: An online survey was distributed evaluating multiple domains: demographics, health and socioeconomic factors, clinical experience, educational experience, and psychological outcomes. The Mayo Clinic Resident Well-Being Index (RWBI) was used as a validated measure of resident mental health., Setting and Participants: Surgical residents from University of British Columbia's surgical residency programs., Results: A total of 31/86 surgical residents responded to the survey. Of which, 57% and 46% reported feeling burned out or depressed, respectively. Residents who were concerned about personal protective equipment supply and who lived with family members with comorbidities had a higher risk of depression (p = 0.03, p = 0.04). The median Mayo Clinic Resident Well-Being Index was 2.5, higher than the median of 2 observed in the United States national survey of residents., Conclusions: The pandemic had a considerable negative impact on the psychological well-being of surgical residents., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: This study aims to estimate the prevalence of and determine physician approaches to the screening and management of lithium-associated thyroid and parathyroid disorders in British Columbia, Canada., Methods: Serum lithium and thyroid/parathyroid laboratory data were collected retrospectively for patients with lithium levels measured at seven BC hospitals between 2012 and 2021. A mail-out survey about screening and management of thyroid/parathyroid disorders in patients on lithium was sent to the ordering physicians of patients with abnormal results. Three months after, a follow-up questionnaire was sent to respondents, and the original survey was re-sent to non-responders., Results: Of 4917 patients, 1.9 % had PTH (mean 22.33 ± 23.00 pmol/L) and 77.1 % had TSH (mean 3.61 ± 6.69 pmol/L) measured. Of 222 hypercalcemic patients (defined as any serum calcium or ionized calcium above the laboratory reference), 17.6 % had a PTH level measured. From 294 surveys sent to 214 physicians, the overall response rate was 31.6 % (n = 93) with twelve fully completed surveys. All twelve respondents monitored TSH levels every 6-12 months, and eight physicians monitored PTH and/or calcium at variable intervals. Two physicians routinely ordered both thyroid and parathyroid screening laboratory tests. Of the 80 non-respondents, limited patient contact was the most common reason for opting out (n = 27)., Conclusions: Our results suggest biochemical screening for lithium-associated parathyroid disorders is less common than for thyroid disorders. There is insufficient data to determine the true prevalence of lithium-associated thyroid and parathyroid disorders. This highlights the need for updated clinical guidelines for management of lithium-associated thyroid and parathyroid disorders., Competing Interests: Declaration of competing interest The authors do not declare any conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The backlog of cases on surgical wait lists is a substantial problem for surgical patients, their families, surgeons, health care systems and governments. There are several approaches governments can take to improve the health, well-being and surgical outcomes of waiting patients. First, provinces should consider patient-centred approaches to triaging that reflect pain, symptoms or functional gain, and approaches using multidisciplinary teams or centralized triage. Second, governments could provide prehabilitation and mental health supports aligned with patients' and families' preferences during unavoidable waits. Wait times are not going to shorten any time soon; provinces should not only find innovative approaches to reducing waits, but also organize services to improve the health and well-being of waiting patients. Such changes will allow for optimization of patients' surgical outcomes and reduce the complexity of managing the wait list for their surgeons., Competing Interests: Competing interests: J.M. Sutherland declares reimbursement from the federal governments of Australia, Iceland, Ireland and Canada and the provincial governments of Ontario, Alberta and British Columbia for travel costs to attend meetings. He is the chair of the Data Safety Monitoring Board at Purdue University and sits on the board of directors of the Canadian Association of Health Services and Policy Research; he receives no remuneration for these roles. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)

Objective: We aim to evaluate the body of evidence reporting on normohormonal primary hyperparathyroidism (NHpHPT) patients to help guide their diagnosis, characterization and treatment., Background: Normohormonal primary hyperparathyroidism is a term used to describe patients with a normal PTH and elevated calcium levels. There is limited understanding regarding the presentation and appropriate management of these patients., Methods: A systematic review was conducted: abstract and full-text screening were independently conducted by 2 investigators. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals were calculated., Results: Twenty-two studies were identified. Patients with NHpHPT were more likely to present with lower PTH (p < 0.00001) and calcium (p < 0.00001) levels. Intraoperatively, the NHpHPT group was 1.8 times more likely to undergo bilateral neck exploration (BNE) and harbor multigland disease. The rates of surgical cure were 93% in the NHpHPT and 96% in the pHPT groups (p = 0.0003)., Conclusion: Symptomatic patients with NHpHPT benefit from parathyroidectomy with prolonged intraoperative PTH monitoring, and a low threshold for conversion to BNE., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: This review aims to summarize the findings from recent literature (2010-2022) reporting on complications that resulted from the surgical use of SURGICEL for intraoperative hemostasis., Methods: A literature search was conducted using the MEDLINE (OVID), Embase, and Cochrane Central Register of Controlled Trials - CENTRAL (OVID) databases. The studies were sorted into case reports and other study types for data extraction. Covidence was used for data extraction and statistics were descriptive., Results: Of the total 560 articles screened, 73 papers were selected for a full-text review and 70 studies were included in this review. A total of 7,242 participants were included in the studies (case studies n  = 93, others n  = 7149). 67/70 of the included studies reported complications when SURGICEL was used intraoperatively. Reported complications included: SURGICEL induced masses (granulomas, abscesses, hematomas, cysts) ( n  = 25), hemorrhagic complications ( n  = 12), masses misdiagnosed as tumors, cardiovascular, nervous system, and hepatobiliary complications, pain, and infections. Other complications included: fistulas, erectile dysfunction, chorioamnionitis, swelling, urinary leak, renal failure, and anaphylaxis., Conclusions: Publications reporting on complications associated with the use of SURGICEL intraoperatively have continued to emerge. Future studies should compare how the types and rates of complications compare between SURGICEL and alternative hemostatic agents.

Background: We performed a bibliometric analysis of the American Journal of Surgery (AJS) to identify, characterize and place within a historical context, its published classic cited papers (CCPs)., Methods: Bibliometric data from papers published in the AJS between January 1, 1945, and December 31, 2021 was extracted from the Web of Science database. Analysis was performed utilizing Bibliometrix and VOSViewer software., Results: 27,070 papers were published in the AJS over the study period. There were 16 CCPs, including 5 Top CCPs, identified. Review of the Top CCPs reveals that they are based on careful clinical observations, innovation and generally build on prior published work. Top CCPs usually are specific to a particular diagnosis or a commonly performed procedure, as such papers frequently present a scoring or classification system, or important details related to new operative approaches or techniques., Conclusions: Bibliometric study of the AJS has allowed for identification, characterization and appreciation of many of the key changes that have occurred in the discipline throughout the history of modern surgery., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The objective of this study was to the assess the risk of malignancy in thyroid lesions that were diagnosed as AUS/FLUS when using a novel cytology subclassification system that is based on the presence or absence of papillary features., Methods: AUS/FLUS case cytology was re-reviewed and subclassified into minor or major concern groups based upon the absence or presence of papillary features, respectively. The risk of malignancy (ROM) was calculated and compared between the two groups. Inter-pathologist agreement in case subclassification was also measured., Results: The minor concern group had a 12.6% associated ROM, while the major concern group had a significantly higher ROM (58.4%), (P < 0.001). Based on 108 cases, the inter-pathologist agreement in case subclassification was 79%, and the κ value was 0.47., Conclusions: The identification of papillary features significantly increases the ROM in thyroid lesions with an AUS/FLUS diagnosis., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: We aimed to investigate the association of preoperative calcium and parathyroid hormone (PTH) levels with sensitivity and accuracy of dual energy computed tomography (DECT), single-photon emission CT with 99m Tc-sestamibi (CT-MIBI), and ultrasound (US) for pre-operative localization primary hyperparathyroid (PHP) patients., Methods: Patients undergoing parathyroidectomy for PHP at a tertiary care facility who underwent DECT, CT-MIBI and US between 2012 and 2021 were stratified by preoperative calcium and PTH levels., Results: Of 278 patients, those with high calcium and PTH levels had a higher sensitivity and accuracy with DECT (87.7%, 85.2%) compared to CT-MIBI (82.3%, 79.0%), and US (61.7%, 53.1%). DECT was more sensitive and accurate than other preoperative localization techniques in subgroups with normal PTH (DECT sensitivity 60.9%, accuracy 52.1%) and normal calcium levels (41.7%, 33.3%)., Conclusion: Preoperative calcium and PTH were associated with sensitivity and accuracy of pre-operative localization in PHP. DECT was sensitive and accurate for preoperative localization compared to other first-line imaging techniques., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

Background: Narrative operative reports (NOR) are important for cancer management but often lack key information. This review investigated the efficacy of synoptic operative reports (SORs) for cancer operations compared to NORs., Methods: A database search included published studies up to October 31, 2021. Overall report completeness and reporting frequencies of cancer elements were descriptively compared between NORs and SORs., Results: Among 4353 studies, 32 were included. 47% of studies compared NORs to SORs. Overall completeness favored SORs (80 ± 19%) over NORs (47 ± 18%, p < 0.001). Essential cancer operative report elements including tumor location (NOR: 51 ± 28%, SOR: 89 ± 11%, p < 0.001), presence of metastases (NOR: 36 ± 33%, SOR: 96 ± 5%, p < 0.001), and final resection margins (NOR: 39 ± 30%, SOR: 87 ± 17%, p < 0.001) demonstrated higher mean reporting frequencies in SORs., Conclusion: Overall completeness and reporting of cancer elements were superior in SORs. Although standardization of SORs requires further research, transition from NORs to SORs may improve the quality of postoperative cancer care., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: It remains unclear how thyroid surgical oncologic quality indicators (TSOQIs) are related to each other, and how to best interpret and apply these measures within the context of surgical quality assurance. We aimed to examine the relation between 3 TSOQIs: postoperative serum thyroglobulin level, 24-hour radioactive iodine uptake (RAIU) and metastatic lymph node ratio (MLNR)., Methods: We conducted a retrospective review of patients who underwent total thyroidectomy for treatment of papillary thyroid cancer (PTC) performed by a single high-volume thyroid surgeon at a tertiary referral centre between 2012 and 2017. To establish the strength of correlation between pairs of quality indicators and the MACIS (metastasis, age, completeness of resection, invasion and size) prognostic score, we performed tests of normality and used the Spearman correlation coefficient to determine the correlation of nonnormal data containing outliers., Results: A total of 139 patients with PTC were included in the study. Their mean MACIS score was 5.0 (standard deviation 1.5). Fifteen patients had high-risk thyroid cancer (MACIS score > 6.99). A weak correlation was found between serum thyroglobulin level and RAIU ( r s = 0.27, p = 0.006) and a moderate correlation was found between serum thyroglobulin level and MLNR ( r s = 0.40 p = 0.002). A weak correlation between serum thyroglobulin level and MACIS score was also observed ( r s = 0.20, p = 0.05)., Conclusion: Based on our findings, we propose that the postoperative serum thyroglobulin level represents the quality metric that has the most clinical utility because it is measurable in all patients and also correlates with both RAIU and MLNR. With further research, surgeons seeking to evaluate the oncologic quality of thyroidectomy performed for PTC may consider applying a quality indicator to their future practice., Competing Interests: Competing interests: None declared., (© 2022 CMA Impact Inc. or its licensors.)

Introduction: Dedicated anatomy educational time in medical schools has decreased significantly, disproportionately affecting surgical residents. In this scoping review, we aim to consolidate existing evidence, describe ongoing research, and highlight future directions for surgical anatomy education., Methods: Two independent investigators searched MEDLINE, EMBASE, and the Cochrane library, for educational interventions targeting anatomy knowledge in surgical residents. English articles until October 28, 2021, were reviewed., Results: 1135 abstracts were considered, and 59 (5.2%) included. Agreement on inclusion was excellent (k = 0.90). The majority were single-cohort studies (53%) and prospective cohort studies (17%). The most common disciplines were General Surgery (17%) and Obstetrics and Gynecology (17%)., Discussion: Cadavers consistently produce positive knowledge gains and are heavily favored by residents. They remain the educational method to which new educational models are compared. New technologies do not yet match cadaver fidelity. Research showing knowledge translation from cadaver labs to patient outcomes remains limited., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Many patients with Medullary Thyroid Cancer (MTC) will have persistent or recurrent disease after surgery requiring lifelong surveillance with imaging and tumor markers. The objective of this study is to evaluate the efficacy of 68 Ga-DOTATATE-PET (or 68 Ga labelled equivalent radiopharmaceutical) versus 18 F-FDG-PET for detecting persistent and/or metastatic recurrent MTC., Methods: Relevant studies were identified by conducting searches in Embase and PubMed and five studies were included in the final review., Results: Five studies investigated per-patient sensitivity of 18 F-FDG-PET and 68 Ga-DOTATATE-PET in MTC patients. Four studies investigated the correlation between calcitonin and number of lesions detected by 18 F-FDG-PET and 68 Ga-DOTATATE-PET, and three investigated the correlation between CEA and number of lesions detected by 18 F-FDG-PET and 68 Ga-DOTATATE-PET. There was no significant difference in number of lesions detected by 18 F-FDG -PET compared with 68 Ga-DOTATATE-PET., Conclusions: When compared directly to 18 F-FDG-PET, there is a general trend towards favoring 68 Ga-DOTATATE-PET in per-patient sensitivities, and incidence of lesion detection., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Sporadic or hereditary medullary thyroid carcinoma (MTC) is an uncommon thyroid malignancy arising from calcitonin secreting parafollicular C cells. Interestingly, MTC and calcitonin were distinct entities that were discovered independently yet concurrently, and their association was unknown., Areas Covered: This review aims to present a historical review of the evolution of our understanding of MTC and its tumor marker calcitonin to highlight the prominent individuals that influenced and shaped our knowledge of this uncommon thyroid cancer type up to the dawn of the 21 st century. An overview of all published reports of novel research and work summarizing important findings for MTC and calcitonin was carried out., Expert Opinion: Surgery remains the cornerstone of treatment for localized MTC. However, several new treatment options are either available or in development for advanced or metastatic MTC, including several novel small molecules targeting oncogenic RET and peptide receptor radionuclide therapy, immunotherapy, radioimmunotherapy, and radiofrequency ablation. In the near future, these novel treatments hold promise for therapy of this very distinct thyroid cancer type.

Background: We sought to determine if using the ACR TI-RADS ultrasound score combined with the Bethesda diagnosis can help augment thyroid cancer risk estimation., Methods: TI-RADS scores and Bethesda diagnoses were collected for patients treated in our center who had undergone thyroidectomy. Data from 186 patients with both TI-RADS scores and Bethesda diagnosis, and Bethesda diagnosis alone, were analyzed by multivariable regression analysis and observed for whether the pathology was benign or malignant., Results: The regression analysis model showed that as the TI-RADS score increases, the odds of malignancy increases as well. The predictive value of the odds of malignancy in a thyroid nodule using both Bethesda diagnosis and TI-RADS score together was more powerful than the odds given using the Bethesda diagnosis alone., Conclusions: Our model shows that the ACR TI-RADS score may assist with preoperative decision-making for patients with cytologically indeterminate thyroid nodules when combined with Bethesda diagnosis., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: This meta-analysis aimed to evaluate the body of evidence investigating the post-operative use of non-opioid analgesic drugs and techniques in endocrine neck surgeries. Adequate pain control is crucial for successful recovery after thyroid and parathyroid surgery. Effective postoperative pain control can shorten hospital stay, improve postoperative outcomes, decrease morbidity and improve the overall patient experience. Traditionally, opioids have been the mainstay of postoperative analgesia after thyroid and parathyroid surgeries. However, the use of opioids has been linked to an increased incidence of postoperative complications., Methods: A comprehensive systematic literature review via Medline, Embase, Web of Science and Cochrane Central Register for Controlled Trials from inception until December 26th, 2020 was conducted, followed by meta-analysis. Abstract and full-text screening, data extraction and quality assessment were independently conducted by 2 investigators. Odds ratios (OR), mean differences (MD) and 95% confidence intervals were calculated using RevMan 5.3., Results: Sixty-five randomized control trials were identified from 486 unique publications. Pooled MD and 95% confidence interval for pain scores were higher for the control group at 24 h postoperatively both at rest (-0.65 [-0.92, -0.37]) and with swallowing (-0.77 [-1.37, -0.16]). These differences were statistically significant. The pooled MD and confidence interval for postoperative analgesic requirements was lower in the intervention group (-1.38 [-1.86, -0.90]). The incidence of PONV had a pooled OR of 0.67 [0.48, 0.94]., Conclusion: Non-opioid analgesia was superior to the control group for pain control in patients undergoing thyroid and parathyroid operations with no significant difference in complications., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

This study aimed to investigate the survival and efficacy indicators of human thyroid tissue transplantation into a retrievable, prevascularized implanted Sernova Corp Cell Pouch™ (CP) device. Thyroid tissue from human donors was transplanted subcutaneously into the pre-implanted CP device or into the subcutaneous (SC) space alone as a control in a nude Mus musculus model. Transplanted M. musculus were monitored for human serum thyroglobulin (TG) levels for 3 months until the transplants were removed for histological assessment. Human thyroid tissue survived and continued to produce TG in transplanted nude M. musculus in the CP, with no adverse events. CP transplants exhibited more persistent and robust production of human TG than tissue placed in the SC space alone from 3 to 13 weeks post transplantation. Fresh thyroid transplants had better survival and function compared to cryopreserved transplants. Thyroid transplant viability correlated with TG levels at 3 months post-transplant (p = 0.03). Immunofluorescence staining of transplants for TG and TPO localized in thyroid follicles. Human thyroid tissue transplanted into the subcutaneously implanted pre-vascularized CP in nude M. musculus survived and continued to produce robust and persistent human TG and warrants further investigation as a treatment for postoperative hypothyroidism., Competing Interests: I have read the journal’s policy and the following authors of this manuscript have the following competing interests. Some of the authors of this study have a commercial affiliation with Sernova Corp as described here: SMW serves on the scientific advisory board of Sernova Corp and received an honorarium from Sernova Corp for drafting and delivery of a KOL online lecture. AM is employed as a Research Scientist at Sernova Corp and receives salary & benefits. DMM was employed as the Senior Director of R&D and Clinical Programs of Sernova Corp and received salary & benefits when this work was carried out. PMT is the President and CEO of Sernova Corp and receives salary & benefits. All other co-authors listed have declared that no competing interests exist.

Radioactive iodine-resistant differentiated thyroid cancer (RAIRTC) is an aggressive form of thyroid cancer that is uncommon and heterogeneous in its clinical behavior. With the emergence of more effective systemic therapy, the need for guidance in decision-making was recognized and a consensus committee of national experts was assembled. The consensus committee consisted of 13 clinicians involved in treating RAIRTC from across Canada and included endocrinologists, nuclear medicine physicians, surgeons, and radiation and medical oncologists. Domains of interest were identified by consensus, and evidence gathered using systematic reviews. Consensus recommendations for the diagnosis and management of RAIRTC were developed. It was recognized that the rarity of RAIRTC in practice and heterogeneous patterns of thyroid cancer care could limit access to effective therapy for some RAIRTC patients. This document offers guidance to manage RAIRTC patients in a multidisciplinary manner., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The study aim was to systematically review literature evaluating surgeon volume-outcome relationships for thyroid and parathyroid operations in order to inform surgical quality improvement initiatives. Current literature suggests surgeons who perform a high volume of thyroid and/or parathyroid operations have better outcomes than low volume surgeons, though specific volume definition are not standardized., Methods: Eligible studies were selected through a literature search focused on the effect of surgeon volume on thyroid and parathyroid surgery patient outcomes. The literature search was conducted in accordance with the PRISMA guidelines. Publication dates extended from January 1998 to February 2021, and were limited to articles published in English., Results: A total of 33 studies were included: 25 studies evaluating thyroid surgery outcomes, 4 studies evaluating parathyroid surgery outcomes, and 4 studies evaluating both thyroid and parathyroid (mixed) surgery outcomes. Higher volume thyroid and parathyroid surgeons were found to be associated with fewer surgical and medical complications, shorter length of hospital stay, and reduced total cost when compared to lower volume surgeons. This volume-outcome relationship was also found to specifically affect the complication and recurrence rates for thyroid cancer patients undergoing surgery, especially for individuals with advanced stage disease., Conclusion: The heterogeneity in cut-offs used for characterizing surgeons as high versus low volume, and also in subsequent patient outcome measures, limited direct study comparisons. The trend of improved patient outcomes with higher surgeon volume for both thyroid and parathyroid surgeries was consistently present in all studies reviewed., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Post-thyroidectomy haemorrhage occurs in 1-2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation., Methods: The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018., Results: Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality., Conclusion: The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Guidelines recommend patient health-related information be written at or below the sixth-grade level. This study evaluates the readability level and quality of online appendectomy patient education materials., Methods: Webpages were evaluated using seven readability formulae: Flesh-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed quality using the Brief DISCERN tool., Results: Thirty seven webpages were analyzed. The mean readability scores were: FKGL = 9.11, GFI = 11.82, CLI = 10.84, ARI = 7.99, SMOG = 11.88, FRE = 51.17, and NDC = 5.48. 6 of the 7 readability formulae indicate that the materials were written at too high a level. The average Brief DISCERN score was 17.81, indicating good quality., Conclusions: Readability levels for online appendectomy patient education materials are higher than recommended but are of good quality. Authors of such materials should not only provide good quality information but also ensure readability., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to develop a low-cost prototype near-infrared fluorescence device that enables contrast-free, real time, high-resolution intraoperative visualization of normal and pathological parathyroid glands (PGs) by imaging their autofluorescence (AF)., Methods: A novel near-infrared parathyroid AF (NIR-PAF) imaging device with visible laser PG targeting was developed. The device was evaluated during parathyroid and thyroid operations in a pilot clinical study., Results: Overall, of the 6 parathyroidectomies carried out in the study population a parathyroid adenoma was found to exhibit AF ex vivo in 6/6 (100%) of cases, and in vivo in 3/3 (100%) of these cases. Two of 4 thyroidectomies were evaluated in vivo and all PGs (6 PGs total) were identified by the NIR-PAF device. The NIRPAF device cost less than $1200 Canadian to build., Conclusion: The inexpensive NIR-PAF device that we developed can successfully intraoperatively identify both normal and pathological PGs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction : Surgical treatment of thyroid cancer has become less aggressive but for many patients, the threshold for performing total thyroidectomy (TT), as opposed to thyroid lobectomy (TL), has remained unclear. Current American Thyroid Association (ATA) guidelines encourage more individualization of treatment options, which necessitates explicit review of the pros and cons of the different options with patients. Areas covered : This review focuses on the extent of surgery for treatment of intermediate-risk differentiated thyroid cancer, restricted to relevant literature available after publication of the 2015 ATA guidelines. Expert opinion : Dynamic risk-stratification facilitates a tailored approach when deciding on the extent of surgery for thyroid cancer. Treatment with TT allows for a lower recurrence risk, a simpler follow-up regimen, and treatment with adjuvant post-operative radioactive iodine. Treatment with TL has a lower associated risk of complications and avoidance of lifelong thyroid hormone replacement but has a significant risk of requiring a completion thyroid lobectomy (CT). Overall, treatment with TL and TT have comparable survival outcomes, but TL is the more cost-effective option. Larger cancer size is correlated with worse clinical outcomes, and numerous subgroup analyses have shown poorer outcomes for cancers with a diameter that is 2-4 cm compared to 1-2 cm.

Introduction: The parathyroid glands (PGs) are critical for calcium regulation and homeostasis. The preservation of PGs during neck surgery is crucial to avoid postoperative hypoparathyroidism. There are no existing guidelines for intraoperative PG identification, and the current approach relies heavily on the experience of the operating surgeon. A technique that accurately and rapidly identifies PGs would represent a useful intraoperative adjunct., Areas Covered: This review aims to assess common dye and fluorescence-based PG imaging techniques and examine their utility for intraoperative PG identification. A literature search of published data on methylene blue (MB), indocyanine green (ICG) angiography, near-infrared autofluorescence (NIRAF), and the PGs between 1971 and 2020 was conducted on PubMed., Expert Opinion: NIRAF and near-infrared (NIR) parathyroid angiography have emerged as promising and reliable techniques for intraoperative PG identification. NIRAF may aid with real-time identification of both normal and diseased PGs and reduce the risk of postoperative complications such as hypocalcemia. Further large prospective multicenter studies should be conducted in thyroid and parathyroid surgical patient populations to confirm the clinical efficacy of these intraoperative NIR-based PG detection techniques.

Summary: The impact of waiting for surgery on the mental health of patients usually receives little attention. Because of the coronavirus disease 2019 (COVID-19) pandemic, the waits for elective surgery have been lengthening, potentially inducing or exacerbating mental health burdens. Provinces' health systems need to provide better support to assess not only patients' physical health, but also their mental health, and provide them with timely access to care based on need. A stepped care approach is needed to mitigate negative mental health effects associated with prolonged waits for elective operations. To provide the best care possible, we need to recognize and address both the physical and mental health problems of our waiting patients.