Difficult decisions in endocrine surgery : an evidence-based approach

✍ Scribed by Raymon H. Grogan; Peter Angelos

• Publisher: Springer
• Year: 2018
• Tongue: English
• Leaves: 490
• Series: Difficult decisions in surgery
• Edition: 1
• Category: Library

✦ Table of Contents

Acknowledgements
Introduction
What Is a Difficult Decision?
What Is This Book About Anyway?
What Is Evidence-Based Medicine Really?
Contents
Contributors
Abbreviations
1: Evidence-Based Medicine and the GRADE Approach
Introduction
Asking the Clinical Question
Finding the Evidence
Appraising the Studies
The Grade System
Features Increasing Quality of Observational Studies
References
Recommended Reading
2: Clinical Decision Analysis
Introduction
What Is Decision Analysis?
Why Know About This?
Anatomy of Clinical Decision Analysis
Constructing the Decision Analytical Framework
Determining Probabilities and Utility Values
Calculating the Utility of Each Decision
Management of an Incidentaloma
Cost Effectiveness
References
3: Decision-Making from the Surgeon’s Perspective
Introduction
The Clinical Recommendation
Factors Influencing Surgeon Recommendations
Application of Evidence
Quality of Recommendations
Shared Decision-Making
Informed Consent
Disclosure
Understanding
Process of Deciding
Patient Factors Affecting Shared Decision-Making
Surgeon Factors Affecting Shared Decision-Making
Model for Ethical Decision-Making
Special Situations in Decision-Making
Genomic Issues
Pediatric Patients
Surrogate Decision-Making
Unexpected Intraoperative Findings
End-of-Life Issues
Allocation of Resources
References
4: Involving Patients in Difficult Decisions About Having Surgery
What Is Shared Decision Making?
Call for Shared Decision Making
Meeting the Requirement of Informed Patients in SDM
Impact of SDM on Clinical Outcomes
The Need for SDM in Surgical Care
Problems with SDM and Surgery
Patient Clinical Complexity
Difficulties in Patient Comprehension
Surgical Practice
The Way Forward
Summary
References
5: Surgery vs Active Surveillance for Low-Risk Papillary Thyroid Carcinoma
Background
The Evidence Base: Survival, Recurrence, and Progression of Disease
The Evidence Base: PROs Including Quality of Life (QOL)
The Evidence Base: Cost and Harm
Discussion
Recommendations
References
6: Prospective Screening Protocol for FNMTC Family Members: Ultrasound Versus Physical Examination
Overview of Familial Non-medullary Thyroid Cancer (FNMTC)
Genetics of FNMTC
Prognostic Differences in FNMTC Patients
Screening for FNMTC
Detection of the Abnormal Thyroid
Defining the Population Most Likely to Benefit from Screening
Understanding Risks with Numbers: Hypothetical Scenario of Patient Without Known Thyroid Disease
Fine Needle Aspiration of Thyroid Nodules
References
7: Operative Management Versus Observation for Thyroid Nodules Larger than 4 cm with Benign Cytology
Introduction
Methodology
Results of Literature Review and Data Analysis
Nodules Larger Than 4 cm
Nodules Larger Than 3 cm
Summary and Limitations
Recommendations
Personal View
Abstracted Recommendation for Box
References
8: Lobectomy Versus Total Thyroidectomy for Follicular Microcarcinomas
Incidental Diagnosis of FTC
Synchronous Distant Metastasis
Surgical Treatment for FTC <1 cm
References
9: Initial Total Thyroidectomy Versus Lobectomy with Intraoperative Frozen Section for Thyroid Nodules That Are “Suspicious for PTC”
Introduction
Current Status of Thyroid Cancer Diagnosis
Optimal Surgical Management of Thyroid Nodules That Are ‘Suspicious for PTC’
Evaluation of Surgical Management Options
Search Strategy
Diagnostic Accuracy
Accuracy of FNA in Thyroid Nodules That Are ‘Suspicious for PTC’
Accuracy of Frozen Section in Thyroid Nodules That Are ‘Suspicious for PTC’
Use of Molecular Markers in Thyroid Nodules That Are ‘Suspicious for PTC’
Recommendation
Quality of Life
Recurrent Laryngeal Nerve Injury
Hypoparathyroidism
Hypothyroidism
Recommendation
Cost/Time Benefits
Costs for the Treatment of Thyroid Nodules That Are ‘Suspicious for PTC’
Total Thyroidectomy Versus Lobectomy with Intraoperative Frozen Section
Recommendation
Summary of Recommendations
References
10: Primary Repair Versus No Repair for Transected Recurrent Laryngeal Nerve
Introduction
The Recurrent Laryngeal Nerve and Management Options for Nerve Transection
Types of Primary Repair
Methods
Measurement of Clinical Outcomes
Immediate Management of Transected RLN
Recommendations
Selection of Re-innervation Technique
Recommendations
Summary of Recommendations
Immediate Management of Transected RLN
Selection of Re-innervation Technique
References
11: Surgery Versus Observation for Papillary Thyroid Microcarcinoma
Introduction
Background and Details of These Active Observation Trials
Results of These Observation Trials for Low-Risk PTMC
Implications from These Trials
Downsides with Active Observation as Opposed to Immediate Surgery for PTMC
Conclusions
Recommendation
References
12: First-Line Therapy for Anaplastic Thyroid Cancer: Operation Versus Medical Management
Introduction
Early Multidisciplinary Assessment
Prognostic Factors
Determine Resectability
Operative Resection as First Line Therapy
Airway Management
Medical Management as First-Line Therapy
Radiotherapy
Dose Benefit
Hyperfractionation
Combined Treatment Modalities
Systemic Therapy
Neoadjuvant Therapy
Cytotoxic Agents
Targeted Therapies
Combination Therapy
Conclusion
Recommendations
References
13: Same-Day Versus Overnight Inpatient Surgery for Total Thyroidectomy
Introduction
Search Strategy
Complications to Be Considered
Recurrent Laryngeal Nerve Injury
Hypocalcemia
Hemorrhage
Review of the Available Literature
Recommendations
References
14: Prophylactic Versus Selective Central Neck Dissection in Pediatric Papillary Thyroid Cancer
Introduction
Search Strategy
Results
Personal View of the Literature
References
15: Subtotal Parathyroidectomy Versus Total Parathyroidectomy with Autotransplantation for Patients with Multiple Endocrine Neoplasia 1 and Primary Hyperparathyroidism
Background
Preoperative Localization Tests
Four Gland Exploration
Subtotal Parathyroidectomy Versus Total Parathyroidectomy with Autotransplantation
Recommendations
References
16: Four-Gland Exploration Versus Four-Dimensional Computed Tomography in Patients with Nonlocalized Primary Hyperparathyroidism
Introduction
Search Strategy
Preoperative Localization of Abnormal Parathyroid Glands in Primary Hyperparathyroidism
Recommendations
Recommendations
Unilateral Versus Bilateral Neck Exploration for Primary Hyperparathyroidism
Recommendations
Four-Gland Exploration Versus 4D CT in Patients with Non-localized Primary Hyperparathyroidism
Summary of Recommendations
Preoperative Localization of Abnormal Parathyroid Glands in Primary Hyperparathyroidism
Unilateral Versus Bilateral Neck Exploration for Primary Hyperparathyroidism
Four-Gland Exploration Versus 4D CT in Patients with Non-localized Primary Hyperparathyroidism
Conclusion
A Personal View of the Data
References
17: Lymph Node Dissection Versus No Lymph Node Dissection for Parathyroid Cancer
Introduction
Current Recommendations
Difficulty in Diagnosis
Current Practice
Overall Outcomes
Outcomes with and Without Central Lymph Node Dissection
Recurrence
Survival
Complications
Summary
Recommendations
References
18: Early Versus Late Parathyroidectomy for Tertiary (Posttransplant) Hyperparathyroidism
Introduction
Indications for Parathyroidectomy in Tertiary Hyperparathyroidism
Techniques of Parathyroidectomy in Tertiary Hyperparathyroidism
References
19: Observation Versus Surgery for Pregnant Patients with Primary Hyperparathyroidism
Evidence Summary
Quality of Evidence
Best Estimates
Judgment of Benefits Versus Risks, Burden, and Cost
Grade of Recommendation
Introduction
Methods
Calcium Homeostasis During Pregnancy
Diagnosis of Primary Hyperparathyroidism During Pregnancy
Fetal Complications
Maternal Complications
Management of Primary Hyperparathyroidism in the Pregnant Patient
References
20: Four-Gland Exploration Versus Focused Parathyroidectomy for Hyperparathyroidism Jaw Tumor Syndrome
Introduction
Search Strategy
Intervention
Comparator
Outcome
Recommendations
References
21: Long-Term Success of Surgery for Primary Hyperparathyroidism: Focused Exploration using Intraoperative Parathyroid Hormone Monitoring Versus Four-Gland Exploration
Population: Patients with Primary Hyperparathyroidism Undergoing Surgery
Epidemiology
Pathophysiology
Diagnosis
Clinical Manifestations
Initial Investigations
Natural History of Asymptomatic Primary Hyperparathyroidism Without Surgery
Surgical Management of Primary Hyperparathyroidism
Intervention: Four-Gland Exploration
Technique of Four-Gland Exploration
Outcomes Following Four-Gland Exploration
Cure Rates
Complications
Comparator: Focused Exploration Using Intraoperative Parathyroid Hormone Monitoring
Historical Perspective of Unilateral Exploration
Preoperative Localization Tests
Ultrasound
Sestamibi Scintigraphy
Computed Tomography
Invasive Localization
Intraoperative Localization Tests
Intraoperative Gamma Probe
Intraoperative Parathyroid Hormone Monitoring
Outcome: Comparison of Cure Rates and Complications Following Focused Versus Four-Gland Exploration
Cure Rates
Complications
Other Advantages of a Focused Exploration
Recommendations
References
22: The Evidence for and Against Parathyroid Cryopreservation: Should We Continue to Promote Parathyroid Cryopreservation?
Introduction
Cryopreservation of Parathyroid Tissue
Parathyroid Graft Function and Cellular Viability
Does Cryopreservation Affect Cellular Viability and Graft Function?
Financial Cost
Does the Cost of Parathyroid Cryopreservation Support Its Use?
Conclusion
Recommendations
Routine Use of Cryopreservation
Selective Use of Cryopreservation
Delayed Autograft Transplantation
References
23: Should Antibiotic Prophylaxis Be  Given Prior to Thyroidectomy or Parathyroidectomy?
Prevalence and Predictors of Wound Infections Following Thyroid or Parathyroid Surgery
Reasons (and Supportive Data) to Consider Administering Preoperative Antibiotics Routinely Prior to Thyroid or Parathyroid Surgery
Reasons (and Supportive Data) to Consider NOT Administering Preoperative Antibiotics Routinely Prior to Thyroid or Parathyroid Surgery
Conclusions
Recommendations
References
24: The Value of Intraoperative Parathyroid Hormone Monitoring in Primary Hyperparathyroidism Cases That Are Localized with Two Imaging Studies
Study Design
Discussion
Introduction
Concordant Preoperative Imaging
Intraoperative Parathyroid Hormone Monitoring
Search Strategy
Discussion
Surgeon-Performed Ultrasound
Cost-Effectiveness of Iopth Use in Primary Hyperparathyroidism
Recommendation
References
25: Transperitoneal Versus Retroperitoneal Laparoscopic Adrenalectomy
Introduction
Search Strategy
Posterior Retroperitoneal Adrenalectomy
Lateral Transperitoneal Adrenalectomy
Posterior Approach vs. Lateral Approach–The Evidence
Complications
Operative Time
Conversion
Tumor Size
Length of Stay
A Personal View of Laparoscopic Adrenalectomy
References
26: Bilateral Adrenalectomy Versus Medical Management for Cushing’s Syndrome with Bilateral Adrenal Hyperplasia
Introduction
Surgical Management
Medical Management
Discussion
References
27: Routine Screening for Primary Hyperaldosteronism in Hypertensive Patients: Yes or No?
What Is the Public Health Impact of Hypertension?
Why Should We Screen for Primary Hyperaldosteronism?
Are Clinical Signs and Symptoms of Primary Hyperaldosteronism Helpful?
Who Should We Screen for Primary Hyperaldosteronism and How?
How Do We Identify Appropriate Patients for Adrenalectomy?
Routine Screening for Primary Hyperaldosteronism in Hypertensive Patients?
References
28: Routine Glucose Monitoring in Postoperative Pheochromocytoma Patients: Yes or No?
Background
Preoperative Hemodynamic Changes and Management
Preoperative Hyperglycemia
Postoperative Hypoglycemia
Preoperative Factors Associated with or Predictive of Postoperative Hypoglycemia
Recommendations
References
29: Surgical Versus Nonsurgical Management of Malignant Pheochromocytoma
Introduction
Surgical Therapy
Non-operative Therapy
Recommendations
References
30: Alpha Blocker Versus Calcium Channel Blocker for Pheochromocytoma
Introduction
Search Strategy
No Preoperative Medical Blockade Versus Preoperative Medical Blockade
Recommendation
Preoperative Non-selective Alpha Blockade Versus Preoperative Selective Alpha1 Blockade
Recommendation
Preoperative Alpha Blockade Versus Preoperative Calcium Channel Blockade
Recommendation
Summary of Recommendations
No Preoperative Medical Blockade Versus Preoperative Medical Blockade
Preoperative Non-selective Alpha Blockade Versus Preoperative Selective Alpha1 Blockade
Preoperative Alpha Blockade Versus Preoperative Calcium Channel Blockade
References
31: Surgery Versus Nonsurgical Therapy for Recurrent Adrenocortical Carcinoma
Introduction
Search Strategy
Surgical Management
Recommendation
Non-surgical Management
Chemotherapy
Recommendation
Radiotherapy
Recommendation
Tumor Ablation
Recommendation
Novel Therapies
Recommendation
Recommendations Summary
Surgery
Chemotherapy
Radiotherapy
Tumor Ablation
Targeted Therapies
References
32: Resection Versus Observation for Adrenal Gland Metastasis
Introduction
Methods
Search Strategy
Characterization of Adrenal Gland Metastasis
Incidence
Prevalence
Etiology
Defining the Extent of the Disease in the Context of Adrenal Metastasis
Solitary Metastases
Oligometastases
Diffuse Metastatic Disease
Adrenal Metastases and the “Seed and Soil” Theory
Radiological Imaging Characterization
CT Scan
MRI
PET-CT Scan
Biopsy of an Adrenal Mass
Synchronous vs. Metachronous Metastases
Surgical and Ablative Therapies in the Treatment of Adrenal Gland Metastases
Surgical Resection
Who Are the Candidates?
Solitary vs. Oligometastases vs. Diffuse Metastatic Disease
Synchronous vs. Metachronous Adrenal Metastases
Outcomes: Morbidity of Surgery, Local Control, Overall Survival
Non Invasive Options: Curative vs Palliative
Stereotactic Ablative Body Radiotherapy and Percutaneous Catheter Ablation
Outcomes: Local Control Versus Overall Survival from Surgical and Ablative Treatments
Outcomes: Morbidity from Surgery Compared with SABR and Percutaneous Ablation
Summary Recommendations
References
33: Routine Versus Selective Adrenal Vein Sampling for Primary Aldosteronism
Introduction
Search Strategy
Diagnosing Primary Aldosteronism
Confirmatory Testing
Lateralization
Cross-Sectional Imaging
Technique of Adrenal Vein Sampling
Safety of AVS
References
34: Surgery Versus Observation for Asymptomatic Nonfunctioning Pancreatic Neuroendocrine Tumors
Introduction
Clinical Presentation
Diagnosis
Treatment
Surgery for Hepatic Metastasis
Chemotherapy
References
35: Routine Lymph Node Dissection Versus Duodenal Inspection Alone for the Treatment of Multiple Endocrine Neoplasia Type 1 Patients with Hypergastrinemia
Background
Surgical Series Evaluating Outcomes for MEN-1 Patients with Hypergastrinemia
Rationale for Duodenal Inspection and Routine Lymphadenectomy in MEN1 Patients with Hypergastrinemia
References
36: Resection Versus Chemotherapy for Metastatic Neuroendocrine Tumors of the Pancreas
Introduction
Search Strategy
Surgical Resection of PNET
Minimal Resection for Early Disease
Lymph Node Resection
High Risk/Malignant Disease
Liver Metastases
Extended Resections of the Primary
Liver Transplantation
High Grade Pancreatic Neuroendocrine Carcinomas
Summary of Recommendations
Medical Management of Metastatic PNET
Chemotherapy for PNETs
Biotherapy for Advanced/Metastatic PNETs
Somatostatin Analogues
Targeted Therapy
mTOR Inhibitors (Everolimus)
Tyrosine Kinase Inhibitors (Sunitinib)
Summary of Targeted Therapy
Peptide Receptor Radionuclide Therapy with Radiolabeled Somatostatin (PRRT)
Treatment of Metastatic Poorly Differentiated PNETs
Summary of Recommendations for Medical Management
Personal View of the Data/How We Do It
Initial Evaluation
Single Small Pancreatic PNET
Larger Volume Tumors with Vascular Involvement and/or Metastatic Disease
References
37: Observation Versus Surgery for Nonlocalized Insulinoma
Introduction
Pathophysiology of Insulinoma
Clinical Features of Insulinoma
Localization of Insulinomas
Intraoperative Localization of Insulinoma
Surgery for Insulinoma
Observation and Conservative Management of Insulinoma
Management of Non-localized Insulinoma
Recommendations
Summary
References
Index