Nathalie Chereau

Objectives: Oncocytic thyroid carcinoma (OTC) is recognized as a distinct entity of follicular thyroid carcinoma (FTC), and its prognosis has traditionally been considered poor. However, the available data on this topic remain limited and highly heterogeneous. The objective of this study was to investigate the clinicopathological features and prognosis of patients with OTC and compare them with those of patients with FTC. Methods: A retrospective comparative study of all patients who underwent total thyroidectomy for OTC or FTC in a high‐volume endocrine surgery center between January 2005 and December 2021. Demographic and clinicopathological characteristics, complications, and recurrence rates were compared using univariate and multivariate regression analyses. Results: In total, 347 patients, 72% female, median age 48 years (35–61 years) were enrolled, including 123 with OTC and 224 with FTC. Patients were significantly older in the OTC group than in the FTC group (54.7 vs. 44.5 years, respectively, p = 0.001). With respect to other demographic, clinical, and pathological characteristics, no statistically significant differences were observed between the two groups. The median follow‐up duration was 5.6 years (3.2–10.5 years). Eighteen patients (5.2%) experienced recurrence, including 7 (5.7%) in the OTC group and 11 (4.9%) in the FTC group. No difference in recurrence‐free survival was observed between the OTC and FTC groups ( p = 0.47). In multivariate analysis, histological type was not associated with the risk of recurrence. Conclusion: Patients withOTC have the same recurrence rate as do patients with FTC . It does not appear justified to propose a different therapeutic management for this histological type, and a stepdown management could be proposed.

The ATA guidelines suggest lobectomy as an option for select patients with thyroid cancer (TC), but some may need completion thyroidectomy because of unfav

The current dogma is a life-long follow-up for patients treated for follicular-derived differentiated thyroid cancers (DTC). Our primary objective was to determine the time to recurrence in a series of DTC patients with an excellent response to therapy 6 months after total thyroidectomy and radioiodine therapy. The secondary objectives were to determine the time to suspicion of recurrence and to identify factors associated with recurrence. This retrospective cohort study included patients treated for DTC between 2008 and 2012 and in remission 6 months after total thyroidectomy and radioiodine treatment. The criteria for remission were negative imaging and suppressed thyroglobulin (Tg) < 0.2 ng/mL or rh-TSH-(recombinant human TSH) stimulated Tg < 1 ng/mL according to the 2015 ATA (American Thyroid Association) guidelines. Recurrence was defined by cytologically and/or histologically proven cervical lymph node metastasis or the administration of a second radioiodine treatment. Among 721 patients treated for DTC, 158 were excluded because of persistent disease at 6 months and 71 because of missing follow-up data and 492 were included. The mean and median follow-up time were 7.0 and 7.9 years [IQR 2.1-11.3]. Recurrence occurred for 7 patients (1.4%), 1 initially classified as high recurrence risk, 3 as intermediate and 3 as low risk according to the 2015 ATA guidelines. All relapses occurred within 10 years after initial management (4 within the first 5 years). For patients with recurrence, rise in Tg and/or suspicious lymph node were detected in 6 out of 7 cases in the first 8 years, and for the last case 10 years after initial surgery. Low and intermediate recurrence risk DTC patients with excellent response 6 months after total thyroidectomy and radioiodine and in remission 10 years later have an extremely low recurrence risk. Follow-up might be undertaken by primary care providers from this time point. These discharge recommendations should be confirmed by further prospective studies.

Background: Prophylactic central neck dissection (pCND) remains controversial during the initial surgery for preoperative and intraoperative node‐negative (cN0) papillary thyroid carcinoma (PTC).Methods: Patients undergoing thyroidectomy with or without pCND (Nx) for PTC in nine French surgical departments, registered in the EUROCRINE® national data in France between January 2015 and June 2021, were included in a cohort study. Demographic and clinicopathological characteristics, complications, and recurrence rates were compared using multivariate regression analysis.Results: A total of 1905 patients with cN0 PTC were enrolled, including 1534 who had undergone pCND and 371 who hadn't (Nx). Of these, 1546 (81.2%) were female, and the median age was 49 years (range: 15–89 years). Patients who had undergone pCND were more likely to have multifocal tumors (n = 524 [34.2%] vs. n = 68 [18.3%], p < .001) and larger tumors (15.3 vs. 10.2 mm, p = .01) than patients with Nx. Of the patients with pCND, 553 (36%) had positive central LN (N1a), with a median of 1 N1 (IQR 0–5). pCND was associated with a higher temporary hypocalcemia rate (n = 25 [8%] vs. n = 15 [4%], p < .001). The rates of permanent hypocalcemia and temporary and permanent recurrent laryngeal nerve (RLN) palsy were not significantly different between the two groups (p > .2). After adjusting for covariates (age, sex, multifocality, and pathological T stage) in a multivariable Cox PH model, the performance of lymph node dissection (pCND vs. no‐pCND) was not associated with PTC recurrence (p = .2).Conclusion: pCND in PTC does not reduce recurrence and is associated with a two‐fold increase in the incidence of transient hypoparathyroidism. These data should be considered while issuing further guidelines regarding the treatment of patients with cN0 PTC.

Background: The impact of lymph node characteristics on mortality and recurrence remains controversial. This study evaluated the prognostic impact of lymph node characteristics in a large, homogenous cohort of patients with therapeutic neck dissection for clinically N1 classic papillary thyroid cancer (PTC). Methods: All consecutive adult patients with therapeutic central and lateral neck dissection for PTC at a French referral centre were prospectively enrolled from January 2000 until June 2021. The primary outcome was the impact of lymph node characteristics in predicting a disease event (persistence or recurrence), using univariable and multivariable logistic regression modelling. Results: A total of 462 patients were included. Lymph node capsular rupture was seen in 260 patients (56.3 per cent). Median maximum lymph node size was 15 (i.q.r. 9–23) mm. The median central, lateral, and total lymph node ratio (LNR) was 0.50 (i.q.r. 0.22–0.75), 0.15 (i.q.r. 0.07–0.29), and 0.26 (i.q.r. 0.14–0.41), respectively. After a median follow-up of 93 (i.q.r. 50–149) months, 182 (39.4 per cent) patients had a disease event. After multivariable analysis, the number of harvested lymph node >35 (OR 2.33 (95 per cent c.i. 1.10–4.95)), presence of lymph node capsular rupture (OR 1.92 (1.17–3.14)), and total LNR >0.20 (OR 2.37 (1.08–5.19)) and >0.40 (OR 4.92 (1.61–15.03)) predicted a disease event. An LNR of 0.20 predicted a disease event with a sensitivity of 80.8 per cent and a specificity of 50.4 per cent. Conclusion: Disease persistence or recurrence after thyroidectomy with therapeutic neck dissection for classic PTC with preoperative nodal disease appears to depend on number of harvested lymph node, presence of lymph node capsular rupture, and total LNR.

Background: Postoperative adhesive small bowel obstruction (SBO) is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive SBO can be managed nonoperatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive SBO. Treatment recommendations are still controversial. Methods: We conducted an observational retrospective monocentric study to test our protocol of management of SBO using Gastrografin^®, enrolling 661 patients from January 2008 to December 2021. An emergency surgery was performed in patients with abdominal tenderness, peritonitis, hemodynamic instability, major acute abdominal pain despite gastric decompression, or CT scan findings of small bowel ischemia. Nonoperative management was proposed to patients who did not need emergency surgery. A gastric decompression with a nasogastric tube was immediately performed in the emergency room for four hours, then the nasogastric tube was clamped and 100 ml of nondiluted oral Gastrografin^® was administered. The nasogastric tube remained clamped for eight hours and an abdominal plain radiograph was taken after that period. Emergency surgery was then performed in patients who had persistent abdominal pain, onset of abdominal tenderness or vomiting during the clamping test, or if the abdominal plain radiograph did not show contrast product in the colon or the rectum. In other cases, the nasogastric tube was removed and a progressive refeeding was introduced, starting with liquid diet. Results: Seventy-eight percent of patients with SBO were managed nonoperatively, including 183 (36.0%) who finally required surgery. Delayed surgery showed a complete small bowel obstruction in all patients who failed the conservative treatment, and a small bowel resection was necessary in 19 patients (10.0%): among them, only 5 had intestinal ischemia. Conclusions: Our protocol is safe, and it is a valuable strategy in order to accelerate the decision-making process for management of adhesive SBO, with a percentage of risk of late small bowel resection for ischemia esteemed at 0.9%.