Publications by authors named "Jean-Christophe Lifante"

73 Publications

[Adenomatoid tumor of the adrenal gland: Clinicopathologic characteristics and differential diagnosis on two tumors of exceptional adrenal location].

Ann Pathol 2021 Jul 10;41(4):410-416. Epub 2021 Jun 10.

Service d'anatomie et cytologie pathologiques, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Cancer Research Center of Lyon, INSERM1052 CNRS5286, Lyon 1 University, France.

Adenomatoid tumors are benign tumors from mesothelial origin, usually occurring in the genital tract. Extragenital locations, especially in the adrenal gland are extremely rare. Here we are reporting two cases of a 28-year-old and 50-year-old men with an adenomatoid tumor of the right adrenal gland. Usual morphological aspects join scattered and microcystic pattern with epithelioid or signet-ring cells. According to the morphological features, main differential diagnoses are adenocarcinoma metastasis, vascular tumors or mesotheliomas. Immunohistochemistry provides precious help to confirm the mesothelial origin thanks to positivity of epithelial markers (CK7, AE1-AE3, CK5/6) coupled to mesothelial markers (D2-40, Calretinin, WT1). On the other hand, there is no loss of BAP1 by immunohistochemistry and usually a surexpression of P16. Adrenal gland adenomatoid tumor is a benign tumor, which can be promoted by iatrogenous or constitutive immunodepression.
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http://dx.doi.org/10.1016/j.annpat.2021.03.011DOI Listing
July 2021

Controversy: For or against thyroid lobectomy in>1cm differentiated thyroid cancer?

Ann Endocrinol (Paris) 2021 Apr 20;82(2):78-82. Epub 2021 Mar 20.

Department of endocrine surgery, Hôpital Lyon Sud, 165, rue du grand Revoyet, 69495 Pierre-Bénite, France; Inserm U1290, Research on Healthcare Performance Lab (RESHAPE), Université Claude-Bernard Lyon 1, domaine Rockefeller, 8, avenue Rockefeller, 69003 Lyon, France. Electronic address:

In this controversy article, the respective advantages of lobectomy vs. total thyroidectomy in differentiated thyroid cancers are argued. The authors conclude that lobectomy has the same oncological prognosis as thyroidectomy in terms of specific survival or recurrence, in case of low risk of recurrence (T1-2N0). However, as a precaution, and taking into account current data, thyroidectomy is recommended in N0 thyroid papillary cancers with aggressive subtype, with even minimal infiltration of perithyroid tissue and/or vascular invasion, and in N1 cancers with more than 5 lymphadenopathies or lymphadenopathies with a major axis greater than or equal to 0.2cm. Other forms of papillary cancer should be treated with lobectomy, as risk of morbidity is low and hospital stay is short. Lobectomy allows reliable monitoring, especially by ultrasound. On the other hand, total thyroidectomy, despite a higher rate of surgical complications due to the risk of recurrent paralysis and permanent hypoparathyroidism, is nevertheless preferable to lobectomy. Indeed lobectomy is not always avoiding hormone replacement therapy, for more precise monitoring by thyroglobulin assay, which is an uninterpretable tool after lobectomy but allows early diagnosis of local or metastatic recurrence with reducing mortality. Thus, in situations where the diagnostic criteria for high-risk cancer are not rigorously determined or taken into account, thyroidectomy is recommended. In addition, it will remain preferable as long as the recommendations for administration of radioactive iodine do not change in favor of use reserved for high-risk cancers as in US guidelines.
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http://dx.doi.org/10.1016/j.ando.2021.03.004DOI Listing
April 2021

Comparison of Morbidity After Total Thyroidectomy Among Adult Patients With and Without Preoperative Hyperthyroidism.

JAMA Otolaryngol Head Neck Surg 2021 Jun;147(6):573-575

Chirurgie Cancérologique, Digestive et Endocrinienne, Hôtel Dieu, Centre Hospitalier Universitaire Nantes, Nantes, France.

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http://dx.doi.org/10.1001/jamaoto.2021.0080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7974829PMC
June 2021

Pancreatoduodenectomy for Neuroendocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1: An AFCE (Association Francophone de Chirurgie Endocrinienne) and GTE (Groupe d'étude des Tumeurs Endocrines) Study.

World J Surg 2021 06 1;45(6):1794-1802. Epub 2021 Mar 1.

Department of Digestive and Endocrine Surgery, Dijon University Hospital, University of Burgundy, Dijon, France.

Aim: To assess postoperative complications and control of hormone secretions following pancreatoduodenectomy (PD) performed on multiple endocrine neoplasia type 1 (MEN1) patients with duodenopancreatic neuroendocrine tumors (DP-NETs).

Background: The use of PD to treat MEN1 remains controversial, and evaluating the right place of PD in MEN1 disease makes sense.

Methods: Thirty-one MEN1 patients from the Groupe d'étude des Tumeurs Endocrines MEN1 cohort who underwent PD for DP-NETs between 1971 and 2013 were included. Early and late postoperative complications, secretory control and overall survival were analyzed.

Results: Indication for surgery was: Zollinger-Ellison syndrome (n = 18; 58%), nonfunctioning tumor (n = 9; 29%), insulinoma (n = 2; 7%), VIPoma (n = 1; 3%) and glucagonoma (n = 1; 3%). Mean follow-up was 141 months (range 0-433). Pancreatic fistulas occurred in 5 patients (16.1%), distant metastases in 6 (mean onset of 43 months; range 13-110 months), postoperative diabetes mellitus in 7 (22%), and pancreatic exocrine insufficiency in 6 (19%). Five-year overall survival was 93.3% [CI 75.8-98.3] and ten-year overall survival was 89.1% [CI 69.6-96.4]. After a mean follow-up of 151 months (range 0-433), the biochemical cure rate for MEN-1 related gastrinomas was 61%.

Conclusion: In MEN1 patients, pancreatoduodenectomy can be used to control hormone secretions (gastrin, glucagon, VIP) and to remove large NETs. PD was found to control gastrin secretions in about 60% of cases.
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http://dx.doi.org/10.1007/s00268-021-06005-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093175PMC
June 2021

[Myxoid variant of adrenocortical carcinoma].

Ann Pathol 2021 Apr 3;41(2):186-191. Epub 2021 Feb 3.

Service d'anatomie et cytologie pathologiques, hôpital Lyon Sud, hospices civils de Lyon, Pierre-Bénite, France; Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud, hospices civils de Lyon, Pierre-Bénite, France; Service d'endocrinologie, groupement hospitalier Est, hospices civils de Lyon, Bron, France; Service d'oncologie médicale, hôpital Lyon Sud, hospices civils de Lyon, Pierre-Bénite, France; Cancer Research Center of Lyon, INSERM1052 CNRS5286, Lyon 1 University, Lyon, France. Electronic address:

We report two cases of patients presenting myxoid variant of adrenocortical carcinoma (ACC). This very rare variant is characterized by a tumoral proliferation organized in trabeculae, cords or even pseudo-glands within an acellular myxoid materiel stained by Alcian Blue and negative for PAS. Tumor cells have a small to medium size and have little atypia. Their immunohistochemical profil (positivity of Synaptophysin, SF1, Melan A, Vimentin and Inhibin, with a weak or negative pancytokeratin expression) eliminate the main differential diagnoses (metastasis of a myxoid adenocarcinoma and soft tissue myxoid tumor). Many scoring systems have been proposed in order to evaluate the risk of malignancy of these lesions: the Weiss score seems less efficient to evaluate malignancy in this variant than the reticulinic algorithm or the Helsinki score. Prognosis of myxoid variant of ACC seems worse than classical ACC.
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http://dx.doi.org/10.1016/j.annpat.2020.12.010DOI Listing
April 2021

[Hobnail variant of papillary thyroid carcinoma].

Ann Pathol 2021 Apr 4;41(2):201-206. Epub 2020 Dec 4.

Service d'anatomie et cytologie pathologiques, CHU de Lyon-Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Inserm1052 CNRS5286, Cancer Research Center of Lyon, Lyon 1 University, Lyon, France.

We report the case of a hobnail variant of papillary thyroid carcinoma revealed by a cervical mass in a 67 years-old patient. This new entity in the 2017 WHO classification is rare. Histopathological diagnosis is based on four main criteria, present in≥30% of tumor cells: a discohesive tumor, micropapillary structures and loss of cell polarity and hobnail cells. This tumor expresses markers of thyroid differentiation. The most widely described molecular alteration is BRAF V600E mutation associated with other alterations, especially p53 mutations. This reflects the agressivness of this variant. It is important to recognize the hobnail variant of papillary thyroid carcinoma and to specify it in the pathological report because of its more pejorative prognosis, with local invasion, lymph node and distant metastasis, and deacreased survival. No specific management is recommended, but a close follow up seems necessary.
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http://dx.doi.org/10.1016/j.annpat.2020.10.004DOI Listing
April 2021

Effect of monitoring surgical outcomes using control charts to reduce major adverse events in patients: cluster randomised trial.

BMJ 2020 11 4;371:m3840. Epub 2020 Nov 4.

Health Services and Performance Research lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, France.

Objective: To determine the effect of introducing prospective monitoring of outcomes using control charts and regular feedback on indicators to surgical teams on major adverse events in patients.

Design: National, parallel, cluster randomised trial embedding a difference-in-differences analysis.

Setting: 40 surgical departments of hospitals across France.

Participants: 155 362 adults who underwent digestive tract surgery. 20 of the surgical departments were randomised to prospective monitoring of outcomes using control charts with regular feedback on indicators (intervention group) and 20 to usual care only (control group).

Interventions: Prospective monitoring of outcomes using control charts, provided in sets quarterly, with regular feedback on indicators (intervention hospitals). To facilitate implementation of the programme, study champion partnerships were established at each site, comprising a surgeon and another member of the surgical team (surgeon, anaesthetist, or nurse), and were trained to conduct team meetings, display posters in operating rooms, maintain a logbook, and devise an improvement plan.

Main Outcome Measures: The primary outcome was a composite of major adverse events (inpatient death, intensive care stay, reoperation, and severe complications) within 30 days after surgery. Changes in surgical outcomes were compared before and after implementation of the programme between intervention and control hospitals, with adjustment for patient mix and clustering.

Results: 75 047 patients were analysed in the intervention hospitals (37 579 before and 37 468 after programme implementation) versus 80 315 in the control hospitals (41 548 and 38 767). After introduction of the control chart, the absolute risk of a major adverse event was reduced by 0.9% (95% confidence interval 0.4% to 1.4%) in intervention compared with control hospitals, corresponding to 114 patients (70 to 280) who needed to receive the intervention to prevent one major adverse event. A significant decrease in major adverse events (adjusted ratio of odds ratios 0.89, 95% confidence interval 0.83 to 0.96), patient death (0.84, 0.71 to 0.99), and intensive care stay (0.85, 0.76 to 0.94) was found in intervention compared with control hospitals. The same trend was observed for reoperation (0.91, 0.82 to 1.00), whereas severe complications remained unchanged (0.96, 0.87 to 1.07). Among the intervention hospitals, the effect size was proportional to the degree of control chart implementation witnessed. Highly compliant hospitals experienced a more important reduction in major adverse events (0.84, 0.77 to 0.92), patient death (0.78, 0.63 to 0.97), intensive care stay (0.76, 0.67 to 0.87), and reoperation (0.84, 0.74 to 0.96).

Conclusions: The implementation of control charts with feedback on indicators to surgical teams was associated with concomitant reductions in major adverse events in patients. Understanding variations in surgical outcomes and how to provide safe surgery is imperative for improvements.

Trial Registration: ClinicalTrials.gov NCT02569450.
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http://dx.doi.org/10.1136/bmj.m3840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610189PMC
November 2020

Risk stratification of adrenal masses by [ F]FDG PET/CT: Changing tactics.

Clin Endocrinol (Oxf) 2021 02 26;94(2):133-140. Epub 2020 Nov 26.

Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, Marseille, France.

Context: [ F]FDG PET/CT improves adrenal tumour characterization. However, there is still no consensus regarding the optimal imaging biomarkers of malignancy.

Objectives: To assess the performance of Tumour standardized uptake value (SUV) :Liver SUV for malignancy-risk and to build and evaluate a prediction model.

Design/methods: The cohort consisted of consecutive patients with adrenal masses evaluated by [ F]FDG PET/CT. The gold standard for malignancy was based on histology or a multidisciplinary consensus in nonoperated cases. The performance of the previously reported cut-off for Tumour SUV :Liver SUV (>1.5) was evaluated in this independent cohort. Additionally, a predictive model of malignancy was built from the training cohort (previous study) and evaluated in the validation cohort (current study).

Results: Sixty-four patients were evaluated; 28% of them had a Cushing's syndrome. Fifty-four adrenal masses were classified as benign and 10 as malignant (including 7 adrenocortical carcinomas). Compared to benign masses, malignant lesions were larger in size, had higher unenhanced densities and higher [ F]FDG uptake. CT-derived anthropometric parameters did not differ between benign and malignant masses. A tumour SUV :Liver SUV  > 1.5 showed a good diagnostic performance: Se = 90.0%/Sp = 92.6%/PPV = 69.2%/NPV = 98.0% and accuracy = 92.2%. A predictive model based on tumour size and tumour-to-liver uptake SUV ratio for malignancy-risk was validated and provides a complementary approach to the ratio.

Conclusions: Tumour SUV :Liver SUV uptake ratio is a useful biomarker for diagnosis of adrenal masses. Another tactic would be to calculate with the model an individual risk of malignancy and integrate this information into a shared decision-making process.
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http://dx.doi.org/10.1111/cen.14338DOI Listing
February 2021

Risk Factors of Redo Surgery After Unilateral Focused Parathyroidectomy: Conclusions From a Comprehensive Nationwide Database of 13,247 Interventions Over 6 Years.

Ann Surg 2020 11;272(5):801-806

General and Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille, France.

Background: Surgical removal of hyperfunctional parathyroid gland is the definitive treatment for primary hyperparathyroidism (pHPT). Postoperative follow-up shows variability in persistent/recurrent disease rate throughout different centers.

Objective: To evaluate the incidence of redo surgery after targeted parathyroidectomy for pHPT.

Methods: We performed a nationwide retrospective cohort study on the "Programme de Medicalisation des Systemes d'Information," the French administrative database that collects information on all healthcare facilities' discharges. We extracted data from 2009 to 2018 for all patients who underwent parathyroidectomy for pHPT between January 2011 to December 2016. The primary outcome was the reoperation rate within 2 years since first surgery. Patients who had a first attempt of surgery within the previous 24 months, familial hyperparathyroidism, multiglandular disease, and renal failure were excluded. Results were adjusted according to sex and the Elixhauser Comorbidity Index. Operative volume thresholds to define high-volume centers were achieved by the Chi-Squared Automatic Interaction Detector method.

Results: In the study period, 13,247 patients (median age 63, F/M=3.6) had a focused parathyroidectomy by open (88.7%) or endoscopic approach. Need of remedial surgery was 2.8% at 2 years. In multivariate analysis, factors predicting redo surgery were: cardiac history (P=0.008), obesity (P=0.048), endoscopic approach (P=0.005), and low-volume center (P<0.001). We evaluated that an annual caseload of 31 parathyroidectomies was the best threshold to discriminate high-volume centers and carries the lowest morbidity/failure rate.

Conclusion: Although focused parathyroidectomy represents a standardized operation, cure rate is strongly associated with annual hospital caseload, type of procedure (endoscopic), and patients' features (obesity, cardiac history). Patients with risk factors for redo surgery should be considered for an open surgery in a high-volume center.
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http://dx.doi.org/10.1097/SLA.0000000000004269DOI Listing
November 2020

Cytological features and nuclear scores: Diagnostic tools in preoperative fine needle aspiration of indeterminate thyroid nodules with RAS or BRAF K601E mutations?

Cytopathology 2021 01 12;32(1):37-44. Epub 2020 Oct 12.

Centre de Biologie et Pathologie Sud, Centre Hospitalier Lyon Sud, Pierre Bénite, France.

Introduction: The cytological diagnosis of follicular-patterned thyroid lesions is challenging, especially since the World Health Organisation classification has recognised non-invasive follicular thyroid neoplasm with papillary-like features. These entities are often classified as indeterminate on cytology. Molecular testing has been proposed to help classify indeterminate nodules. RAS and K601E BRAF mutations are mostly encountered in follicular-patterned lesions, but their diagnostic value is not well established. Nuclear scores have also been proposed to help classify indeterminate lesions.

Objective: To investigate the correlation between cytological features and histology and to assess nuclear scores in a series of indeterminate RAS or BRAF K601E positive thyroid nodules.

Methods: The cytological parameters of 69 indeterminate RAS or BRAF K601E-positive thyroid nodules were evaluated. The Strickland and Maletta scores and a new nuclear score were assessed. Diagnosis of malignant, benign or indolent neoplasms was confirmed in each case by histology. Malignant and indolent nodules were considered surgical nodules, and adenomas non-surgical nodule.

Results: Surgical nodules were associated with the presence of ground glass nuclei (P = .001), grooves (P < .001) or irregular nuclear membranes (P = .01) on cytology. Nuclear scores were more often ≥2 in surgical nodules compared to benign ones (P < .001), with high sensitivity, but a low negative predictive value.

Conclusions: Analysis of nuclear features is useful to distinguish non-surgical from surgical nodules in indeterminate FNAs. Although nuclear scores are not ideal rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they seem useful to screen non-molecular tested or non-mutated indeterminate FNAs. This work shows that meticulous analysis of nuclear features on cytological specimens can be useful to distinguish non-surgical nodules (adenoma) from surgical nodules in indeterminate FNAs. Although nuclear scores are not rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they are useful in screening non-molecular tested or non-mutated indeterminate FNAs for surgery.
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http://dx.doi.org/10.1111/cyt.12904DOI Listing
January 2021

Influence of Care Pathway on Thyroid Nodule Surgery Relevance: A Historical Cohort Study.

J Clin Med 2020 Jul 17;9(7). Epub 2020 Jul 17.

Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.

Background: Guidelines recommend using fine-needle aspiration cytology (FNAC) to guide thyroid nodule surgical indication. However, the extent to which these guidelines are followed remains unclear. This study aimed to analyze the quality of the preoperative care pathway and to evaluate whether compliance with the recommended care pathway influenced the relevance of surgical indications.

Methods: Nationwide historical cohort study based on data from a sample (1/97th) of French health insurance beneficiaries. Evaluation of the care pathway of adult patients operated on between 2012 and 2015 during the year preceding thyroid nodule surgery. The pathway containing only FNAC was called "FNAC", the pathway including an endocrinology consultation (ENDO) with FNAC was called "FNAC+ENDO", whereas the no FNAC pathway was called "NO FNAC". The main outcome was the malignant nature of the nodule.

Results: Among the 1080 patients included in the study, "FNAC+ENDO" was found in 197 (18.2%), "FNAC" in 207 (19.2%), and "NO FNAC" in 676 (62.6%) patients. Cancer diagnosis was recorded in 72 (36.5%) "FNAC+ENDO" patients and 66 (31.9%) "FNAC" patients, against 119 (17.6%) "NO FNAC" patients. As compared to "NO FNAC", the "FNAC+ENDO" care pathway was associated with thyroid cancer diagnosis (OR 2.67, 1.88-3.81), as was "FNAC" (OR 2.09, 1.46-2.98). Surgeries performed in university hospitals were also associated with thyroid cancer diagnosis (OR 1.61, 1.19-2.17). Increasing the year for surgery was associated with optimal care pathway (2015 vs. 2012, OR 1.52, 1.06-2.18).

Conclusions: The recommended care pathway was associated with more relevant surgical indications. While clinical guidelines were insufficiently followed, compliance improved over the years.
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http://dx.doi.org/10.3390/jcm9072271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408692PMC
July 2020

Reoperation Incidence and Severity Within 6 Months After Bariatric Surgery: a Propensity-Matched Study from Nationwide Data.

Obes Surg 2020 Sep;30(9):3378-3386

Department of Medical Information Evaluation and Research, Lyon University Hospital, Lyon, France Health Services and Performance Research Lab (EA 7425 HESPER), Lyon 1 Claude Bernard University, Lyon, France.

Background: Data about incidence and severity of reoperations up to 6 months after bariatric surgery are currently limited. The aim of this cohort study was to evaluate the incidence and severity of reoperations after initial bariatric surgical procedures and to compare this between the 3 most frequent current surgical procedures (sleeve, gastric bypass, gastric banding).

Study Design: Nationwide observational cohort study using data from French Hospital Information System (2013-2015) to evaluate incidence and severity of reoperations within 6 months after bariatric surgery. Hazard ratios (HR) of longitudinal comparison between historical propensity-matched cohorts were estimated from a Fine and Gray's model using competing risk of death.

Results: Cumulative reoperation rates increased from postoperative day-30 to day-180. Consequently, 31.1 to 90.0% of procedures would have been missed if the reoperation rate was based solely on a 30-day follow-up. Reoperation rate at 6 months was significantly higher after gastric bypass than after sleeve (HR 0.64; IC 95% [0.53-0.77]) and corresponded to moderate-risk reoperations (HR 0.65; IC 95% [0.53-0.78]). Reoperation rate at 6 months was significantly higher after gastric banding than after sleeve (HR 0.08; IC 95% [0.07-0.09]) and corresponded to moderate-risk reoperations (HR 0.08; IC 95% [0.07-0.10]).

Conclusion: Cumulative incidence of reoperations increased from 30 days to 6 months after sleeve, gastric bypass, or gastric banding and corresponded to moderate-risk surgical procedures. Consequently, 30-day reoperation rate should no longer be considered when evaluating complications and surgical performance after bariatric surgery.
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http://dx.doi.org/10.1007/s11695-020-04570-9DOI Listing
September 2020

Influence of trends in hospital volume over time on patient outcomes for high-risk surgery.

BMC Health Serv Res 2020 Apr 1;20(1):274. Epub 2020 Apr 1.

Health Data Department, Hospices Civils de Lyon, F-69003, Lyon, France.

Background: The "practice makes perfect" concept considers the more frequent a hospital performs a procedure, the better the outcome of the procedure. We aimed to study this concept by investigating whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level.

Methods: We included all patients who underwent one of 10 digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Individual hospital learning effect was investigated by considering the interaction between hospital groups and procedure year.

Results: Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients' mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95-1.08] and 0.99 [0.92-1.05] respectively for colectomy).

Conclusions: Trend in hospital volume over time did not appear to influence patient outcomes based on real-world data.

Trial Registration: NCT02788331, June 2, 2016.
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http://dx.doi.org/10.1186/s12913-020-05126-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114802PMC
April 2020

Adrenalectomy Risk Score: An Original Preoperative Surgical Scoring System to Reduce Mortality and Morbidity After Adrenalectomy.

Ann Surg 2019 11;270(5):813-819

General Endocrine Surgery, Lille University Hospital CHU Lille, EGID - UMR 1190, Translational Research Laboratory for Diabetes, Lille University, Lille, France.

Objective: To explore the determinants of postoperative outcomes of adrenal surgery in order to build a proposition for healthcare improvement.

Summary Of Background Data: Adrenalectomy is the recommended treatment for many benign and malignant adrenal diseases. Postoperative outcomes vary widely in the literature and their determinants remain ill-defined.

Methods: We based this retrospective cohort study on the "Programme de médicalisation des systèmes d'information" (PMSI), a national database that compiles discharge abstracts for every admission to French acute health care facilities. Diagnoses identified during the admission were coded according to the French adaptation of the 10th edition of the International Classification of Diseases (ICD-10). PMSI abstracts for all patients discharged between January 2012 and December 2017 were extracted. We built an Adrenalectomy-risk score (ARS) from logistic regression and calculated operative volume and ARS thresholds defining high-volume centers and high-risk patients with the CHAID method.

Results: During the 6-year period of the study, 9820 patients (age: 55 ± 14; F/M = 1.1) were operated upon for adrenal disease. The global 90-day mortality rate was 1.5% (n = 147). In multivariate analysis, postoperative mortality was independently associated with age ≥75 years [odds ratio (OR): 5.3; P < 0.001], malignancy (OR: 2.5; P < 0.001), Charlson score ≥2 (OR: 3.6; P < 0.001), open procedure (OR: 3.2; P < 0.001), reoperation (OR: 4.5; P < 0.001), and low hospital caseload (OR: 1.8; P = 0.010). We determined that a caseload of 32 patients/year was the best threshold to define high-volume centers and 20 ARS points the best threshold to define high-risk patients.

Conclusion: High-risk patients should be referred to high-volume centers for adrenal surgery.
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http://dx.doi.org/10.1097/SLA.0000000000003526DOI Listing
November 2019

Self-assessment of voice outcomes after total thyroidectomy using the Voice Handicap Index questionnaire: Results of a prospective multicenter study.

Surgery 2020 01 13;167(1):129-136. Epub 2019 Sep 13.

Clinique de Chirurgie Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, Nantes, France; Université de Nantes, quai de Tourville, Nantes, France. Electronic address:

Background: Voice disorders are frequent after thyroidectomy. We report the long-term voice quality outcomes after thyroidectomy using the voice handicap index self-questionnaire.

Methods: Eight hundred patients who underwent total thyroidectomy between 2014 and 2017 in 7 French hospitals were prospectively included. All patients filled in voice handicap index questionnaires, preoperatively and 2 and 6 months after surgery.

Results: Median (range) voice handicap index scores were significantly increased at month 2 (4 [0; 108]) compared to preoperative values (2 [0; 76]) and were unchanged at month 6 (2 [2; 92]). Clinically significant voice impairment (voice handicap index score difference ≥18 points) was reported in 19.7% at month 2 and 13% at month 6. Thirty-seven (4.6%) had postoperative vocal cord palsy. In patients with vocal cord palsy compared to those without, median voice handicap index scores were increased at month 2 (14 [0; 107] vs 4 [0; 108]; P = .0039), but not at month 6 (5 [0; 92] vs 2 [0; 87]; P = .0702). Clinically significant impairment was reported in 38% vs 19% at month 2 (P = .010), and in 19% vs 13% at month 6 (P = .310). Thyroid weight, postoperative hypocalcemia, vocal cord palsy, and absence of intraoperative neuromonitoring utilization were associated with an increased risk of clinically significant self-perceived voice impairment at month 2.

Conclusion: Thyroidectomy impairs patients' voice quality perception in patients with and without vocal cord palsy.
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http://dx.doi.org/10.1016/j.surg.2019.05.090DOI Listing
January 2020

One-Year Postoperative Mortality in MEN1 Patients Operated on Gastric and Duodenopancreatic Neuroendocrine Tumors: An AFCE and GTE Cohort Study.

World J Surg 2019 11;43(11):2856-2864

Department of Digestive and Endocrine Surgery, Dijon University Hospital, Dijon, France.

Importance: In MEN1 patients with gastric and duodenopancreatic neuroendocrine tumors (GPD-NET), surgery aims to control secretions or to prevent metastatic spread, but after GPD-NET resection, postoperative mortality may be related to the surgery itself or to other associated MEN1 lesions with their own uncontrolled secretions or metastatic behavior.

Objective: To analyze the causes of death within 1 year following a GPD-NET resection in MEN1 patients.

Design: An observational study collecting data from the Groupe d'étude des Tumeurs Endocrines (GTE) database. The analysis considered the time between surgery and death (early deaths [<1 month after surgery] versus delayed deaths [beyond 1 month after surgery]) and the period (before 1990 vs after 1990). Causes of death were classified as related to GDP surgery, related to surgery for other MEN1 lesions or not related to MEN1 causes.

Setting: GTE database which includes 1220 MEN1 patients and 441 GPD-NET resections.

Participants: Four hundred and forty-one GPD-NET resections.

Main Outcome Measures: The primary end point was postoperative mortality within 1 year after surgery.

Results: Twenty-four patients met the inclusion criteria (2%). Median age at death was 50.5 years. Sixteen deaths occurred in the 30-day postoperative period (76%). Among the 8 delayed deaths, 3 occurred as a result of medical complications between 30 and 90 postoperative days. After 1990, mean age at death increased from 48 to 58 years (p = 0.09), deaths related to uncontrolled acid secretion disappeared (p < 0.001) and deaths related to associated MEN1 lesions increased from 8 to 54% (p = 0.16).

Conclusion: Surgery and uncontrolled secretions remain the two main causes of death in MEN1 patients operated for a GPD-NET tumor. Improving the prognosis of these patients requires a strict evaluation of the secretory syndrome and MEN1 aggressiveness before GDP surgery.
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http://dx.doi.org/10.1007/s00268-019-05107-7DOI Listing
November 2019

Influence of Daily Variations in Individual Surgeon's Operative Time on Patient Outcomes.

World J Surg 2019 11;43(11):2720-2727

Health Data Centre, Public Health Department, Hospices Civils de Lyon, Lyon, France.

Background: Evidence is lacking regarding the potential association between daily variation in individual surgeon's operative time, procedure after procedure, and risk of patient complication. We assumed that surgeon deviation from the expected procedure duration may be harmful for patient.

Method: All patients who underwent a thyroidectomy undertaken in five hospitals during a 1-year period were included prospectively. For each thyroidectomy, we estimated the expected operative time from a multilevel linear regression considering the attending surgeon who performed the operation, the patient preoperative risk, and the procedure complexity. Three groups of thyroidectomies were identified according to whether the observed duration is: slower than expected, as expected, or faster than expected. Rates of permanent recurrent laryngeal nerve palsy and hypoparathyroidism at 6 months were then compared between these groups.

Results: A total of 3102 patients who underwent a thyroidectomy undertaken by 22 surgeons were considered. Risk of laryngeal nerve palsy was higher in the "slow" group than in the "normal" group (OR = 4.63, 95% confidence interval 2.21-9.70), as was that of hypoparathyroidism (OR = 2.43, 95% confidence interval 1.21-4.88). There was no significant difference between "fast" and "normal" groups for either complication. Deviation from expected procedure duration was more frequent at the end than at the beginning of the daily operation schedule (29.4% vs. 18.3%, respectively, P < .001).

Conclusion: Patients had a greater risk of complication when the surgeon performed thyroidectomy slower than expected. Surgeons avoiding excessive deviations from their expected procedures durations reflect safer practice.
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http://dx.doi.org/10.1007/s00268-019-05081-0DOI Listing
November 2019

Impact of body mass index on post-thyroidectomy morbidity.

Head Neck 2019 09 19;41(9):2952-2959. Epub 2019 Apr 19.

CHU de Nantes, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Nantes Cedex 1, France.

Background: The impact of obesity on total thyroidectomy (TT) morbidity (recurrent laryngeal nerve palsy and hypocalcaemia) remains largely unknown.

Methods: In a prospective study (NCT01551914), patients were divided into five groups according to their body mass index (BMI): underweight, normal weight, overweight, obese, and severely obese. Preoperative and postoperative serum calcium was measured. Recurrent laryngeal nerve (RLN) function was evaluated before discharge, and if abnormal, at 6 months.

Results: In total 1310 patients were included. Baseline characteristics were similar across BMI groups except for age and sex. Postoperative hypocalcaemia was more frequent in underweight compared to obese patients but the difference was not statistically significant in multivariate analysis. There was no difference between groups in terms of definitive hypocalcaemia, transient and definitive RLN palsy, and postoperative pain.

Conclusion: Obesity does not increase intraoperative and postoperative morbidity of TT, despite a longer duration of the procedure.
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http://dx.doi.org/10.1002/hed.25773DOI Listing
September 2019

Impact of Enhanced Recovery Program after Surgery in Patients Undergoing Pancreatectomy on Postoperative Outcomes: A Controlled before and after Study.

Dig Surg 2020 22;37(1):47-55. Epub 2019 Feb 22.

Service de Chirurgie Digestive, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.

Background: Implementation of enhanced recovery after surgery (ERAS) program after pancreatic surgery was associated with decreased length of stay (LOS). However, there were only retrospective uncontrolled before-after study, and care protocols were heterogeneous. We aimed to evaluate the impact of ERAS program on postoperative outcomes after pancreatectomy through a prospective controlled study.

Methods: A before/after study with a contemporary control group was undertaken in patients undergoing pancreatectomy. We compared 2 groups: the intervention hospital that implemented ERAS program and the control hospital that performed traditional care; and 2 periods: the preimplementation and the post-implementation period. A difference-in-differences approach was used to evaluate whether implementation of ERAS program was associated with improved LOS and postoperative morbidity.

Results: About 97 and 75 patients were included in intervention and control hospital. In multivariate analysis, implementation of ERAS was associated with a significantly shorten LOS (hazard ratio 1.61; 95% CI 1.07-2.44) and higher compliance rate (OR 1.34; 95% CI 1.18-1.53). Difference-in-differences analysis revealed that LOS, morbidity, and readmission did not differ after ERAS implementation.

Conclusion: Implementation of ERAS program was safe and effective after pancreatectomy with high compliance rate. LOS was significantly reduced without compromising morbidity.
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http://dx.doi.org/10.1159/000496510DOI Listing
August 2020

Hospital Length of Stay Reduction Over Time and Patient Readmission for Severe Adverse Events Following Surgery.

Ann Surg 2020 07;272(1):105-112

Health Data Center, Public Health Department, Lyon University Hospital, Lyon, France.

Objective: The aim of the study was to investigate whether patients who undergo surgery in hospitals experiencing significant length of stay (LOS) reductions over time are exposed to a higher risk of severe adverse events in the postoperative period.

Summary Background Data: Surgical care innovation has encouraged hospitals to shorten LOS under financial pressures with uncertain impact on patient outcomes.

Methods: We selected all patients who underwent elective colectomy or urgent hip fracture repair in French hospitals between 2013 and 2016. For each procedure, hospitals were categorized into 3 groups according to variations in their median LOS as follows: major decrease, moderate decrease, and no decrease. These groups were matched using propensity scores based on patients' and hospitals' potential confounders. Potentially avoidable readmission for severe adverse events and death at 6 months were compared between groups using Cox regressions.

Results: We considered 98,713 patients in 540 hospitals for colectomy and 206,812 patients in 414 hospitals for hip fracture repair before matching. After colectomy, patient outcomes were not negatively impacted when hospitals reduced their LOS [hazard ratio (95% confidence interval): 0.93 (0.78-1.10)]. After hip fracture repair, patients in hospitals with major decreases in LOS had a higher risk of severe adverse events [1.22 (1.11-1.34)] and death [1.17 (1.04-1.32)].

Conclusions: Patients who underwent surgical procedures in hospitals experiencing major decreases in LOS were demonstrated worse postoperative outcomes after urgent hip fracture repair and not after elective colectomy. Development of care bundles to enhance recovery after emergency surgeries may allow better control of LOS reduction and patient outcomes.
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http://dx.doi.org/10.1097/SLA.0000000000003206DOI Listing
July 2020

TERT promoter mutations identify a high-risk group in metastasis-free advanced thyroid carcinoma.

Eur J Cancer 2019 02 12;108:41-49. Epub 2019 Jan 12.

Hospices Civils de Lyon, Fédération D'Endocrinologie, Bron Cedex, F-69677, France; Université Lyon 1, HESPER EA 7425, Lyon, F-69008, France.

Background: TERT promoter mutations are associated with adverse clinicopathological characteristics in thyroid carcinomas and considered as a major indicator of poor outcomes. Nevertheless, most studies have pooled heterogeneous types of thyroid carcinomas and have been conducted retrospectively. We investigated the association between TERT promoter mutations and recurrence in a prospective series of 173 intermediate- to high-risk patients with thyroid cancer.

Patients: Patients referred for radioiodine treatment after thyroidectomy for intermediate- to high-risk differentiated thyroid carcinoma were included in a prospective observational study and tested for TERT promoter, BRAF, and RAS mutations of their primary tumours. We analysed the relationship between TERT promoter mutations and outcomes.

Results: The prevalence of TERT promoter mutations was 20.2% (35/173) in the total population. It was significantly higher in tumours harbouring aggressive histological features (poorly differentiated carcinoma, tall cell variant of papillary cancer or widely invasive follicular cancer) than in non-aggressive tumours: 32.7% (16/49) versus 15.3% (19/124; p = 0.020). TERT promoter mutations were also strongly associated with age ≥45 years (p = 0.005), pT4 stage (p = 0.015), metastatic disease (p = 0.014), and extrathyroidal extension (p = 0.002). TERT promoter mutations were associated with poor outcomes in the total population (p < 0.001) but not in the subgroup of non-metastatic patients (p = 0.051). However, they were associated with a worse outcome in patients both free of metastases and devoid of aggressive histological features. Neither BRAF nor RAS mutations were associated with event-free survival in non-metastatic patients.

Conclusion: Although their prognostic value does not seem to overcome that of histology, TERT promoter mutations may help to better define the prognosis of localized thyroid cancer patients without aggressive histology.
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http://dx.doi.org/10.1016/j.ejca.2018.12.003DOI Listing
February 2019

Metastatic Potential and Survival of Duodenal and Pancreatic Tumors in Multiple Endocrine Neoplasia Type 1: A GTE and AFCE Cohort Study (Groupe d'étude des Tumeurs Endocrines and Association Francophone de Chirurgie Endocrinienne).

Ann Surg 2020 12;272(6):1094-1101

INSERM, U1231, Epidemiology and Clinical Research in Digestive Cancers Team, Dijon, France.

Objective: To assess the distant metastatic potential of duodeno-pancreatic neuroendocrine tumors (DP-NETs) in patients with MEN1, according to functional status and size.

Summary Background Data: DP-NETs, with their numerous lesions and endocrine secretion-related symptoms, continue to be a medical challenge; unfortunately they can become aggressive tumors associated with distant metastasis, shortening survival. The survival of patients with large nonfunctional DP-NETs is known to be poor, but the overall contribution of DP-NETs to metastatic spread is poorly known.

Methods: The study population included patients with DP-NETs diagnosed after 1990 and followed in the MEN1 cohort of the Groupe d'étude des Tumeurs Endocrines (GTE). A multistate Markov piecewise constant intensities model was applied to separate the effects of prognostic factors on 1) metastasis, and 2) metastasis-free death or 3) death after appearance of metastases.

Results: Among the 603 patients included, 39 had metastasis at diagnosis of DP-NET, 50 developed metastases during follow-up, and 69 died. The Markov model showed that Zollinger-Ellison-related tumors (regardless of tumor size and thymic tumor pejorative impact), large tumors over 2 cm, and age over 40 years were independently associated with an increased risk of metastases. Men, patients over 40 years old and patients with tumors larger than 2 cm, also had an increased risk of death once metastasis appeared.

Conclusions: DP-NETs of 2 cm in size or more, regardless of the associated secretion, should be removed to prevent metastasis and increase survival. Surgery for gastrinoma remains debatable.
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http://dx.doi.org/10.1097/SLA.0000000000003162DOI Listing
December 2020

Unexpected discrepancies in hospital administrative databases can impact the accuracy of monitoring thyroid surgery outcomes in France.

PLoS One 2018 6;13(12):e0208416. Epub 2018 Dec 6.

Department of General and Endocrine Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France.

Objective: To determine the validity of hospital administrative databases compared to prospective collection of medical data assessing thyroid surgery complications.

Background: Administrative data are increasingly used to track surgical outcomes.

Methods: All patients undergoing thyroid surgery at three French university hospitals between April 2008 and April 2009 were prospectively included. Using diagnosis and procedural codes from hospital administrative database, we designed three indicators for measuring complications of thyroid surgery: recurrent laryngeal nerve palsy, postoperative hypoparathyroidism, and postoperative hemorrhage. Gold standard was obtained from a prospective collection of medical data after systematically screening each patient for the above-mentioned complications. Their ability to monitor surgical outcomes over time within individual hospitals was estimated using control charts. Spatial comparison between hospitals was performed by funnel plots.

Results: A total of 1909 patients were included. Complication rates extracted from administrative data were significantly lower compared to medical data (nerve palsy 2.4% vs. 6.7%, hypoparathyroidism 10.6% vs. 22.3%, p<0.0001). Indicator sensitivity was 30.4% for nerve palsy, 45.4% for hypoparathyroidism and 71.4% for postoperative hemorrhage. Corresponding positive predictive values were 84.4%, 95.1% and 68.2%. In two of the three hospitals, administrative data were not able to track temporal variations in complications rates. Regarding inter-hospital comparisons, 2 out of 3 hospitals were considered outliers according to administrative data despite having an average performance based on medical data.

Conclusions: The ability of indicators extracted from administrative databases to measure thyroid surgery outcomes depends on the quality of underlying data coding. Validation in every center should be a prerequisite before implementing such metrics for tracking performance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208416PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283582PMC
May 2019

Comment on Regarding Manuscript "Impact of Centralized Management of Bariatric Surgery Complications on 90-day Mortality".

Ann Surg 2019 08;270(2):e47-e48

Université de Lorraine, Department of Surgery, CHU NANCY (Hopital Brabois), Lorraine, France Unité INSERM U1256 Department of Medical Information Evaluation and Research, Lyon University Hospital, Lyon, France Health Services and Performance Research Lab (EA 7425 HESPER), Lyon 1 Claude Bernard University, Lyon, France Department of General and Endocrine Surgery, Lyon University Hospital, Lyon, France Department of Medical Information Evaluation and Research, Lyon University Hospital, Lyon, France Health Services and Performance Research Lab (EA 7425 HESPER), Lyon 1 Claude Bernard University, Lyon, France.

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http://dx.doi.org/10.1097/SLA.0000000000003113DOI Listing
August 2019

Bilateral adrenalectomy in Cushing's disease: Altered long-term quality of life compared to other treatment options.

Ann Endocrinol (Paris) 2019 Feb 19;80(1):32-37. Epub 2018 Sep 19.

Fédération d'endocrinologie, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France; Inserm U1052, CNRS UMR5286, Lyon I university, signaling, metabolism and tumor progression, cancer center of Lyon, centre Léon-Bérard, bâtiment Cheney D-5th Floor, 28, rue Laennec, 69008 Lyon, France.

Objective: Bilateral adrenalectomy (BADX) has become an important treatment of Cushing's disease (CD), especially when other treatment options have failed. The aim of this study was to evaluate the long-term quality of life (QoL) of patients having undergone BADX for CD, in comparison to other therapeutic options.

Methods: Thirty-four patients with CD were identified in two French centers: 17 underwent BADX and the remaining 17 one or more of the following treatments: surgery, medical therapy or radiotherapy. Three questionnaires were filled in by each patient in order to evaluate their QoL: Short Form-36 Health Survey (SF-36), Cushing QoL questionnaire and Beck depression inventory (BDI).

Results: The mean age of patients was 49.3±15.2 years. Average time lapse between diagnosis and BADX was 6.1 years. Results from each questionnaire adjusted to age showed a lower QoL among patients who underwent BADX. These were significant in most aspects of the SF-36 questionnaire (bodily pain P<0.01, general health P<0.01, vitality P≤0.05, social functioning P≤0.05), as well as in the Cushing QoL questionnaire (P<0.05) and BDI (P≤0.05). Adrenal insufficiency appeared to be the major predictor of poor QoL whatever their initial treatment.

Conclusions: Despite their clinical remission, patients who undergo BADX appear to be at a greater risk of suffering an impaired QoL due to more prolonged period of time with imperfectly controlled hypercortisolism combined with definitive adrenal insufficiency.
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http://dx.doi.org/10.1016/j.ando.2018.01.002DOI Listing
February 2019

Impact of thyroid surgery volume and pathologic detection on risk of thyroid cancer: A geographical analysis in the Rhône-Alpes region of France.

Clin Endocrinol (Oxf) 2018 12 11;89(6):824-833. Epub 2018 Sep 11.

Hospices Civils de Lyon, Registre Rhône Alpin des Cancers Thyroïdiens - Centre de Médecine Nucléaire et Fédération d'Endocrinologie, Groupement Hospitalier Est, Lyon, France.

Objective: To investigate the impact of the volume of thyroid surgery and pathologic detection on the risk of thyroid cancer.

Methods: We investigated the influence of the volume of thyroid surgery in a first study that included 23 384 thyroid surgeries and 5302 thyroid cancers collected between 2008 and 2013. Standardized incidence ratios (SIRs) and thyroid intervention rates (STIRs) were used as indicators of cancer risk and surgery volume, respectively. The influence of pathologic detection, using the number of cuts per gram of tissue as the indicator, was studied in a second study that included 1257 thyroid specimens, collected in 2014.

Results: We found departmental variations in SIRs and a significant effect of the STIR on the SIR (men, P = 0.0008; women, P < 0.0001). A 1/100 000 increase in the STIR resulted in a 3% and 1.3% increase in the SIR in men and women, respectively. This effect was greatest for microcancers and absent for tumours >4 cm. The risk of cancer diagnosis was significantly associated with the number of cuts per gram of tissue (OR 6.1, P < 0.001), and was greater for total thyroidectomy than for lobectomy (P = 0.014) and when FNA cytology had been preoperatively performed (P < 0.001). The prevalence of incidental microcancers was highest in the centres performing the highest number of cuts per gram.

Conclusions: The risk of thyroid cancer, particularly microcancer, is related to the volume of surgery and to the level of pathologist scrutiny. Both factors contribute to the increase in overdiagnosis. This further advocates for appropriate selection of patients for thyroid surgery.
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http://dx.doi.org/10.1111/cen.13833DOI Listing
December 2018

Reply to Dr Ozden et al.

Cytopathology 2018 12 11;29(6):599. Epub 2018 Sep 11.

Service de Biochimie et Biologie moléculaire, Hospices Civils de Lyon, Pierre-Bénite, France.

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http://dx.doi.org/10.1111/cyt.12620DOI Listing
December 2018

Advanced age does not increase morbidity after total thyroidectomy. Result of a prospective study.

Am J Surg 2019 04 25;217(4):767-771. Epub 2018 Jul 25.

CHU de Nantes, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Nantes Cedex 1, 44093, France. Electronic address:

Background: It is well known that total thyroidectomy is feasible on elderly patients but is linked to complications because of their underlying comorbidities. In this study we analyzed the specific risks linked to surgery, hypoparathyroidism and recurrent nerve palsy.

Methods: materials-methods:Prospective, multicentre trial conducted at 13 hospital sites. The primary endpoint was the percentage of patients with postoperative hypocalcaemia (albumin-corrected serum calcium level <2 mmol/L at day 2). Secondary endpoints included recurrent nerve palsy rate at day 2, the percentage of patients with hypocalcaemia (serum calcium level <2 mmol/L) and recurrent nerve palsy at month 6, operating durations and postoperative pain. Patients were separated in two groups: <70 years and ≥70 years old.

Results: In total, 1329 patients who underwent total thyroidectomy were included (median age 51.17 years [18.10; 80.90], 80% women, and hyperthyroidism in 20%, 101 ≥ 70 years old). Rates of hypocalcaemia at day 2 and month 6 were 20.02% and 1.98% respectively. Nasofibroscopy showed postoperative abnormal vocal cord motility in 9.92% cases (hypo-motility 5.76% - immobility 4.16%) and 0.95% at month 6 (hypo-motility 0.48%, immobility 0.48%). Patients ≥70 years had a lower (but non-significant) postoperative and definitive hypocalcaemia rate than patients < 70 years: 14.85% vs 20.44% at day 2 (p = 0.1773) and 0% vs 2.15% at month 6 respectively (p = 0.2557). Abnormal vocal cord motility rate was 12.00% in patients ≥70 years vs 9.75% in patients <70 years at day 2 (p = 0.4702), and 2.06% in patients ≥70 years vs 0.86% at month 6 (p = 0.2340).

Conclusions: Total thyroidectomy in patients ≥70 years is feasible and safe. Age does not increase the morbidity. The study is registered with ClinicalTrials.gov number NCT01551914.
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http://dx.doi.org/10.1016/j.amjsurg.2018.07.029DOI Listing
April 2019

Clinicopathological description of 43 oncocytic adrenocortical tumors: importance of Ki-67 in histoprognostic evaluation.

Mod Pathol 2018 11 19;31(11):1708-1716. Epub 2018 Jun 19.

Department of Endocrinology, Diabetes and Nutrition, L'institut du Thorax, CHU Nantes, 44093, Nantes, France.

Oncocytic adrenocortical tumors are a rare subtype of adrenal tumors with challenging diagnosis and histoprognostic assessment. It is usually believed that oncocytic adrenocortical tumors have a more indolent clinical behavior than conventional adrenocortical tumors. As the Weiss score overestimates the malignancy of oncocytic adrenocortical tumors owing to intrinsic parameters, alternative scores have been proposed. The Lin-Weiss-Bisceglia score is currently recommended. We performed a large nationwide multicenter retrospective clinicopathologic study of oncocytic adrenocortical tumors. Among the 43 patients in our cohort, 40 patients were alive without disease, 2 patients died of their disease and 1 patient was alive with relapse after a median follow-up of 38 months (20-59). Our data revealed that over 50% of the oncocytic adrenocortical tumor cases were diagnosed as carcinoma whatever the classification systems used, including the Lin-Weiss-Bisceglia score. The exception is the Helsinki score, which incorporates the Ki-67 proliferation index and was the most specific prognostic score for oncocytic adrenocortical tumor malignancy without showing a loss in sensitivity. A comparison of malignant oncocytic adrenocortical tumors with conventional adrenocortical carcinomas matched for age, sex, [email protected] stage and surgical resection status showed significant better overall survival of malignant oncocytic adrenocortical tumors.
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http://dx.doi.org/10.1038/s41379-018-0077-8DOI Listing
November 2018

[DICER1 mutated, solid/trabecular thyroid papillary carcinoma in an 11-year-old child].

Ann Pathol 2018 Oct 5;38(5):316-320. Epub 2018 Jun 5.

Service d'anatomie et cytologie pathologique, centre hospitalier Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.

We report the case of an 11-year-old patient diagnosed with a solid variant of papillary thyroid carcinoma. Papillary thyroid carcinoma (PTC) is the most common thyroid cancer, representing 80-90% of all newly diagnosed thyroid cancers. Among the many variants described, solid/trabecular variant of papillary thyroid carcinoma is a rare entity and account for 3% of thyroid cancers. It is more common in children and young adults, and it is seen in higher proportion in post radiation papillary thyroid carcinoma cases. Histologically, solid variant papillary carcinoma is characterized by a predominantly solid, trabecular or insular growth pattern, and the presence of cytological features typical of PTC. Its main differential diagnosis is poorly differentiated thyroid carcinoma. It has a less favorable prognosis than the classical papillary type, with a higher risk of distant metastasis, extrathyroidal extension and lympho-vascular invasion. It is associated with a slightly lower long-term survival in adult cases, but not in children. The management of solid variant PTC includes surgery, associated or not with postoperative radioiodine ablation, according to the aggressiveness criteria. Our patient had a DICER1 somatic mutation. Carriers of germline DICER1 mutations are predisposed to a rare cancer syndrome, the DICER1 syndrome, with a higher risk of numerous tumors and infrequently differentiated thyroid carcinomas.
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http://dx.doi.org/10.1016/j.annpat.2018.04.003DOI Listing
October 2018
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