Outpatient hemithyroidectomies; Experience in NHS Scotland

S2 Results: Of 207 FNA’s, 5 were Thy 5, 19 Thy 4, 36 Thy 3f, 13 Thy 3a, 84 Thy 2 & 50 Thy 1. 29 Thy 3f, Thy 4, or Thy 5 FNA’s were tested for BRAF V600 mutation and 7 of 29 (24 %) showed evidence of mutation. Four patients with BRAF V600 mutation underwent surgery to remove all thyroid tissue, one patient received a right lobectomy for technical reasons and two patients are awaiting total thyroidectomy. All patients with BRAF V600 mutation were found to have malignancy on final histology, with a diagnostic sensitivity for malignancy excluding co-incidental microcarcinoma of 100% and specificity of 42%. BRAF V600 mutation is 100% specific for thyroid carcinoma, if a lesion is a primary thyroid tumour. Conclusion: BRAF V600 mutational analysis enables single stage total thyroidectomy for carcinoma if gene mutation is present in pre-operative FNA. BRAF V600 testing potentially reduces the need for completion thyroidectomy with significant cost savings and lowers patient morbidity associated with completion thyroidectomy in cases where the cytology does not show definite features of malignancy but where BRAF V600 mutation is identified in pre-operative thyroid FNA. http://dx.doi.org/10.1016/j.ejso.2014.07.004 BJS Prize 4. Outpatient hemithyroidectomies; Experience in NHS Scotland Louis de Boisanger, Lead Author1, Nicky Blackwell2, Tiarnan Magos3, Richard Adamson3, Omar Hilmi4 1 University of Glasgow, Scotland 2 NHS Scotland 3 NHS Lothian, Scotland 4 Consultant ENT Surgeon, Greater Glasgow and Clyde, Scotland Background: Performing hemithyroidectomy as a daycase has the potential to improve patient satisfaction (Kasbekar 2013) and reduce healthcare costs. Current literature suggests that the major complications of hemithyroidectomy postoperatively are of symptomatic hypocalcaemia, compressive haematoma requiring re-intervention or laryngeal nerve palsy (Almeida 2010, Torfs 2012). This study aimed to analyse the feasability of daycase hemithyroidectomy. Methods: This retrospective study looked at all hemithyroidectomy procedures led by two surgeons across two sites between 2010 and the end of 2013. Patients were divided into ‘planned as inpatient’ or ‘planned as outpatient’. In order to assess outcomes: day of discharge; conversion to inpatient procedure; intraoperative and postoperative complications; postoperative presentations or readmission to hospital were analysed. Age, BMI, gender, ASA Score and indication for surgery were also recorded. Completion thyroid surgery was excluded from this study. Results: 181 hemithyroidectomy cases were analysed, 27(14.9%) were planned as inpatient procedures. Of the remaining 154(85.1%) planned outpatients: 106(68.8%) were successfully discharged on the same day and 48(31.2%) were not; 8(5.2%) were converted to inpatient procedures perioperatively; 7(4.5%) had additional procedures; 6(3.9%) had wound infections; 7(4.5%) presented to ER; 1(0.65%) of which required readmission to hospital. The reasons for representation to hospital included 1(0.65%) deliberate overdose of paracetamol (readmitted); 2(1.3%) wound breakdown; 2(1.3%) wound infections; 1(0.65%) neck pain; and 1(0.65%) for cardiac arrest for an unrelated pathology). No planned outpatients developed hypocalcaemia, compressive haematomata or laryngeal nerve palsy postoperatively. Conclusion: This study showed that hemithyroidectomy by experienced surgeons can be performed safely in a day surgery setting. None of the planned outpatients in this study developed laryngeal nerve palsy, compressive haematoma or symptomatic hypocalcaemia. We recommend that hemithyroidectomy be classified as a 23 hour procedure rather than as a day case procedure, due to the large number of patients (31.2%) requiring an overnight admission. http://dx.doi.org/10.1016/j.ejso.2014.07.005

ABSTRACTS BJS Prize 5. Stimulated thyroglobulin levels after thyroidectomy could guide the need for radioactive iodine ablation in patients with well differentiated thyroid cancer T. Cvasciuc1,2, D. Maccora1,2, G. Sadler1,2, B. Shine1, A. Weaver2, R. Mihai1,2 1 Dept Endocrine Surgery, Biochemistry, Churchill Cancer Centre, Oxford University Hospitals NHS Trust, UK 2 Dept Oncology, Churchill Cancer Centre, Oxford University Hospitals NHS Trust, UK Background: The routine use of radioactive iodine ablation (RIA) in all patients with papillary/follicular thyroid cancer >10 mm is increasingly controversial. The hypothesis explored in this study is that radical thyroid surgery can lead to unmeasurable stimulated thyroglobulin (sTG) levels in a significant proportion of patients who could therefore avoid RIA. Methods: A prospective database recorded details of patients treated for thyroid cancer in a tertiary referral centre. Results: Between April2008-December2013, 192 patients had RIA after liothyronine withdrawal at 4-18 weeks following thyroid surgery. sTG levels before RAI were available in 175 patients (52M:123F, age 52
18 yrs) with papillary (n¼104) or follicular (n¼26) thyroid cancer who underwent total thyroidectomy only (n¼134) or with central compartment lymph node dissection (n¼58) or with lateral radical neck dissection (n¼31). In the presence of raised TSH (53.6
32.5, range 11-150 mU/L) sTG was unmeasurable (i.e. <5ng/ml until Jan2012 and <0.2 ng/ml in more recent years) in 81 patients and very low (0.2-5 ng/ml) in 10 patients. In the absence of metastatic disease, median post-RIA cervical uptake correlated with pre-ablation sTG: 0.7% for TG<5ng/ml vs. 2.8% for TG 5-50 ng/ml. The likelihood of having unmeasurable sTG levels appeared higher if operated in the tertiary centre (52/81 vs. 39/71, p¼ns) but was not influenced by having two-stage thyroidectomy vs. total-thyroidectomy (27/40 vs 40/73). Conclusion: At least 50% of patients operated for well-differentiated thyroid carcinoma have unmeasurable stimulated-TG hence they could be spared RAI and offered long term monitoring. Selection for RIA relying on risk stratification based on postoperative sTG should be the basis of a randomized trial. http://dx.doi.org/10.1016/j.ejso.2014.07.006

BJS Prize 6. Does minimally invasive parathyroidectomy improve cosmetic outcome? P. Truran, E. Thompson, H. Nightingale, R.D. Bliss, S.R. Aspinall, T.W.J. Lennard Royal Victoria Infirmary, Newcastle Upon Tyne, England, UK Introduction: Minimally invasive parathyroidectomy (MIP) is performed for dual localised parathyroid disease. Smaller scars are presumed to result in a better cosmetic outcome. We hypothesize that MIP provides better cosmesis and examine other factors that may influence this outcome. Methods: 240 patients who underwent conventional cervicotomy or MIP were contacted and asked to complete a validated Patient Scar Assessment Questionnaire (PSAQ). Scars were assessed at a minimum of 12 months after surgery. Patients completed the 100 point PSAQ evaluating appearance, satisfaction with appearance, scar consciousness, and an overall satisfaction score and selected a preference between MIP or cervicotomy scar from pictures. Power calculations showed that 114 cases would be required to detect a difference of 2 in any subscale. Binary logistic regression analysis was performed to determine which factors were associated with a poorer scar. Results: 152/240 (63%) responded. 102 patients underwent cervicotomy and 50 MIP (median age 68, male n¼27, female n¼125). Overall patients were very happy with their scars and 90% thought their scar