- Email: [email protected]
Endocrine Surgery
Endocrine Surgery
Preface E n d o c r i n e Su r g e r y
Peter J. Mazzaglia, MD, FACS Editor
The field of endocrine surgery continues to witness scientific and technical advances that are reshaping the ways that we take care of patients with thyroid, parathyroid, adrenal, and pancreatic neoplasms. Endocrine surgeons and their colleagues in endocrinology and radiology are actively studying better ways to diagnose and manage many disease processes. This issue of the Surgical Clinics of North America aims to cover areas within endocrine surgery that are actively being transformed by our research efforts. It also addresses the necessity of dealing with increased recognition of disease at a time of shrinking health care dollars. The growing number of incidentally detected thyroid neoplasms has led to more investigation of their prognostic significance, and a need to determine what should be the impact on nationally recognized guidelines. Evolving concepts and understandings of thyroid cancer biology are influencing recommendations about when to perform lymph node dissections, and which patients benefit from radioiodine ablation. Exciting research into genetic markers is changing the way we approach some thyroid nodules and malignancies. Despite everything that’s been written about hyperparathyroidism, debate over its management continues. Controversy exists over the best localizing studies, and which preoperative strategy is most cost-effective. There is still lively debate about the best operative approach, and the door is far from closed on four-gland exploration. Due to the current high volume of cross-sectional imaging studies of the chest and abdomen, adrenal incidentalomas are increasingly recognized. While determining which are functional is relatively straightforward, there are complex management decisions required for patients with subclinical Cushing syndrome and hyperaldosteronism. For the nonfunctioning adrenal neoplasms, determining malignant potential is paramount to proper management. Radiographic characterization is playing a larger role in this process. Once adrenocortical cancer is recognized, judicious, timely treatment administered by a team of surgeons, endocrinologists, and oncologists is necessary.
Surg Clin N Am 94 (2014) xv–xvi http://dx.doi.org/10.1016/j.suc.2014.04.001 surgical.theclinics.com 0039-6109/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
xvi
Preface
Finally, just as with adrenal neoplasms, more and more frequently we are faced with the incidental pancreatic neuroendocrine tumor. Understanding its differential diagnosis and possible manifestations is essential to the management of these multiple diseases. The authors who contributed to this issue represent present and future leaders in the fields of endocrine surgery, endocrinology, radiology, and oncology. Their comprehensive reviews on these timely topics will be helpful references for surgeons, endocrinologists, and all other practitioners providing care for patients with endocrine neoplasms. Peter J. Mazzaglia, MD, FACS Department of General Surgery The Warren Alpert School of Medicine Brown University 593 Eddy Street, APC 4 Providence, RI 02905, USA E-mail address: [email protected]
Preface E n d o c r i n e Su r g e r y
Peter J. Mazzaglia, MD, FACS Editor
The field of endocrine surgery continues to witness scientific and technical advances that are reshaping the ways that we take care of patients with thyroid, parathyroid, adrenal, and pancreatic neoplasms. Endocrine surgeons and their colleagues in endocrinology and radiology are actively studying better ways to diagnose and manage many disease processes. This issue of the Surgical Clinics of North America aims to cover areas within endocrine surgery that are actively being transformed by our research efforts. It also addresses the necessity of dealing with increased recognition of disease at a time of shrinking health care dollars. The growing number of incidentally detected thyroid neoplasms has led to more investigation of their prognostic significance, and a need to determine what should be the impact on nationally recognized guidelines. Evolving concepts and understandings of thyroid cancer biology are influencing recommendations about when to perform lymph node dissections, and which patients benefit from radioiodine ablation. Exciting research into genetic markers is changing the way we approach some thyroid nodules and malignancies. Despite everything that’s been written about hyperparathyroidism, debate over its management continues. Controversy exists over the best localizing studies, and which preoperative strategy is most cost-effective. There is still lively debate about the best operative approach, and the door is far from closed on four-gland exploration. Due to the current high volume of cross-sectional imaging studies of the chest and abdomen, adrenal incidentalomas are increasingly recognized. While determining which are functional is relatively straightforward, there are complex management decisions required for patients with subclinical Cushing syndrome and hyperaldosteronism. For the nonfunctioning adrenal neoplasms, determining malignant potential is paramount to proper management. Radiographic characterization is playing a larger role in this process. Once adrenocortical cancer is recognized, judicious, timely treatment administered by a team of surgeons, endocrinologists, and oncologists is necessary.
Surg Clin N Am 94 (2014) xv–xvi http://dx.doi.org/10.1016/j.suc.2014.04.001 surgical.theclinics.com 0039-6109/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
xvi
Preface
Finally, just as with adrenal neoplasms, more and more frequently we are faced with the incidental pancreatic neuroendocrine tumor. Understanding its differential diagnosis and possible manifestations is essential to the management of these multiple diseases. The authors who contributed to this issue represent present and future leaders in the fields of endocrine surgery, endocrinology, radiology, and oncology. Their comprehensive reviews on these timely topics will be helpful references for surgeons, endocrinologists, and all other practitioners providing care for patients with endocrine neoplasms. Peter J. Mazzaglia, MD, FACS Department of General Surgery The Warren Alpert School of Medicine Brown University 593 Eddy Street, APC 4 Providence, RI 02905, USA E-mail address: [email protected]