Thyroid Cancer in the U.S.: Are All Detected Cancers Important?

Scientific Session—Monday

morbidity, excellent cosmesis it is useful adjunct to the general head and neck surgeon. 9:46

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Thyroid Cancer in the U.S.: Are All Detected Cancers Important? Louise Davies, MD (presenter); H.G. Welch, MD MPH Seattle WA; White River Junction VT

Objectives: Describe the current rates of thyroid cancer detection and survival in the United States, and explore the meaning of the epidemiologic shift occurring in those rates. Methods: Thyroid cancer incidence and histology (in adults over age 18) was obtained from the nine cancer registries of the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program for the period 19752001. Thyroid cancer mortality was obtained from National Death Index for the same period. Results: Thyroid cancer incidence has increased 52% (1975-77 vs 1999-2001). The diagnosis of papillary cancer has increased from 35/million to 63/million (up 83%). Thyroid cancer is being classified as follicular less often: down from 8/million to 5/million, and more often as hurthle cell: up from 1/million to 3/million. The numbers of medullary and anaplastic carcinoma cases continue to be very small and combined are stable at 2/million. The death rate from thyroid cancer has been stable since 1975: 0.5 deaths/million people. Conclusion: The apparent increase in thyroid cancer incidence is largely the result of increased diagnosis of papillary cancer. The finding that thyroid cancer mortality is stable suggests that these newly diagnosed cases may not represent clinically significant disease. More studies on the natural history of incidentally detected thyroid cancer would help distinguish which tumors require aggressive intervention. 9:58

(preoperative to POD1) was noted within each group (mean change(mg/dl)⫽1.1 neck, 1.1 total, and 0.95 completion; all p ⬍ 0.001), with no significant difference noted between group (p⫽0.60). No significant difference was noted for incidence of POD1 hypocalcemia (corrected calcium ⬍ 7.5) between groups (5% neck, 12% total, 9% completion; p⫽0.38). However, a significant drop in postoperative calcium (PACU to POD1) occurred after completion and total thyroidectomy (mean change (mg/dl) ⫽ 0.46 total, 0.47 completion; both p ⬍ 0.001) but not neck dissection (mean change (mg/dl) ⫽ 0.06; p⫽0.38); and this difference was significant (p ⬍ 0.01). Symptomatic POD1 hypocalcemia (circumoral parasthesia) occurred in 2% of thyroidectomies. No patients experienced long-term hypocalcemia. Conclusion: A significant reduction in perioperative serum calcium of 1 mg/dl occurred within each group. The results suggest that change from preoperative to PACU levels likely results from hemodilution, whereas changes from PACU to POD1 reflect transient parathyroid dysfunction. PACU calcium is a better reference baseline than preoperative calcium for assessment of post-thyroidectomy hypocalcemia resulting from parathyroid dysfunction. Preoperative calcium may be useful to identify subjects in need of longterm increased dietary calcium and vitamin D intake.

10:06

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Laparoscopic Gastric Pull-up: Analysis of a Consecutive Series of 120 Esophageal Cancers Aureo L. De Paula, MD; Antonio L.V. Macedo, MD; Claudio R Cernea, MD (presenter); Vladimir Schraibman, MD; Jose R. Milanez, MD; Jose E. Succi, MD; Flavio C. Hojaij, MD; Dorvial De Carlucci, Jr, MD Goiania Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil

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Comparison of Serum Calcium Change Following Thyroid and Non-Thyroid Neck Surgery Nicholas Y Mehta, MD (presenter); Nelson Watts; David L Steward, MD Cincinnati OH; Cincinnati OH; Cincinnati OH

Objectives: To compare perioperative change in serum calcium following thyroid and non-thyroid/parathyroid neck surgery, and to estimate difference between effects of hemodilution and parathyroid dysfunction. Methods: Historic cohort study of 166 patients undergoing thyroidectomy (79 total, 23 completion) or lateral neck dissection (64) from 2002-2004. Endpoints included change in serum calcium and incidence of hypocalcemia measuring preoperative, PACU, POD1, and long-term follow-up serum calcium values plus hypocalcemic symptoms. Results: A significant drop in perioperative serum calcium

Objectives: To analyze the experience of a multidisciplinary team with a laparoscopic gastric pull-up (LGPU) method, with or without thoracoscopic mediastinal dissection, in a consecutive series of 120 patients with esophageal cancer (EC). Methods: From 1992 to 2004, 120 patients with EC underwent reconstruction with a LGPU (76% males/24% females; median age: 59.4 yrs). Locations of lesions were: cervical or cervicothoracic (3%), middle third (15%) or inferior third (82%). Most prevalent histologies were SCC (47%) and adenocarcinomas (34%). Nearly 1/3 of patients received preoperative chemo and/or radiotherapy. All patients had their stomach dissected and mobilized exclusively by laparoscopy. In some cases, laparoscopic approach was extended cranially, through mediastinum, connecting with cervical dissection, done simultaneously by a H&N surgical team. In these instances, thoracic esophagus was dissected by this

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Otolaryngology– Head and Neck Surgery August 2005