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The Journal of Clinical Endocrinology... Jan 2021Evidence on follow-up duration for patients with sporadic pheochromocytomas is absent, and current guidelines of the European Society of Endocrinology, American... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence on follow-up duration for patients with sporadic pheochromocytomas is absent, and current guidelines of the European Society of Endocrinology, American Association of Clinical Endocrinologists and Endocrine Surgeons, and the Endocrine Society are ambiguous about the appropriate duration of follow-up. The aim of this systematic review and meta-analysis is to evaluate the recurrence rate of sporadic pheochromocytomas after curative adrenalectomy.
MATERIALS AND METHODS
A literature search in PubMed, Embase, and the Cochrane Library was performed. A study was eligible if it included a clear report on the number of sporadic patients, recurrence rate, and follow-up duration. Studies with an inclusion period before 1990, <2 years of follow-up, <10 patients, and unclear data on the sporadic nature of pheochromocytomas were excluded. A meta-analysis on recurrence was performed provided that the heterogeneity was low (I2 < 25%) or intermediate (I2 26-75%). Hozo's method was used to calculate weighted mean follow-up duration and weighted time to recurrence with combined standard deviations (SDs).
RESULTS
A total of 13 studies, including 430 patients, were included in the synthesis. The meta-analysis results describe a pooled recurrence rate after curative surgery of 3% (95% confidence interval: 2-6%, I2 = 0%), with a weighted mean time to recurrence of 49.4 months (SD = 30.7) and a weighted mean follow-up period of 77.3 months (SD = 32.2).
CONCLUSIONS
This meta-analysis shows a very low recurrence rate of 3%. Prospective studies, including economical and health effects of limited follow-up strategies for patients with truly sporadic pheochromocytomas should be considered.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Humans; Neoplasm Recurrence, Local; Pheochromocytoma; Prognosis
PubMed: 33125073
DOI: 10.1210/clinem/dgaa794 -
Journal of Cancer Research and... Dec 2020Thyroid paragangliomas are distinctly rare primary thyroid neoplasms with nearly 75 cases reported worldwide. Due to their similar embryological origin and...
Thyroid paragangliomas are distinctly rare primary thyroid neoplasms with nearly 75 cases reported worldwide. Due to their similar embryological origin and cytohistomorphology with other thyroid neoplasms, they may pose great diagnostic challenges for pathologists, radiologists, endocrinologists, as well as surgeons leading to unnecessary aggressive therapy. With recent advances in molecular genetics, the prognostic significance of such seemingly innocuous thyroid neoplasms has been better understood. In this manuscript, we describe such a case and present a systematic review of all reported cases till date giving an update on our current knowledge regarding their diagnostic pitfalls, pathology, and molecular genetics.
Topics: Adult; Biomarkers, Tumor; Biopsy, Fine-Needle; Diagnosis, Differential; Goiter; Humans; Male; Paraganglioma; Prognosis; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler
PubMed: 33380646
DOI: 10.4103/jcrt.JCRT_713_18 -
Otolaryngology--head and Neck Surgery :... Apr 2020To perform an evidence-based review evaluating presenting symptoms, imaging, and management for primary paragangliomas of the facial canal (PPFCs).
OBJECTIVES
To perform an evidence-based review evaluating presenting symptoms, imaging, and management for primary paragangliomas of the facial canal (PPFCs).
DATA SOURCES
PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science.
REVIEW METHODS
Studies were assessed for quality of evidence and bias with the Cochrane bias tool, GRADE, and MINORS criteria. Demographic data, imaging modalities, management strategies, and status at last follow-up were obtained.
RESULTS
Sixteen studies met inclusion criteria. In total, 21 patients with PPFCs were identified, 19 of which were histologically confirmed. Most common presenting symptoms included unilateral facial nerve dysfunction (n = 14, 73.7%) and pulsatile tinnitus (n = 8, 42.1%). Mean time from reported onset of facial dysfunction was 17.8 months. Computed tomography findings included an expanded descending facial nerve canal (n = 13, 76.5%). All cases with magnetic resonance imaging reported enhancement with contrast. Of the 18 patients who had surgery, 16 (88.9%) underwent full tumor resection while 1 (5.6%) had partial tumor debulking with adjuvant radiotherapy. Overall improvement in facial weakness was documented in 5 of 9 patients (55.6%) with initial facial nerve dysfunction and >6-month follow-up. No evidence of tumor recurrence was reported.
CONCLUSIONS
PPFCs are extraordinarily rare vascular neoplasms of the temporal bone. Early imaging with both computed tomography and magnetic resonance imaging is essential for narrowing the differential diagnosis, assessing the extent of tumor invasion, and accurate surgical planning. Surgical tumor resection with subsequent facial nerve reconstruction is recommended for patients with facial nerve dysfunction, while tumor biopsy or debulking may be indicated when normal facial movement in present.
Topics: Bone Neoplasms; Evidence-Based Medicine; Head and Neck Neoplasms; Humans; Paraganglioma; Temporal Bone
PubMed: 32093508
DOI: 10.1177/0194599820907303 -
World Journal of Urology Feb 2022
Correction to: Differences in clinical presentation and management between pre- and postsurgical diagnoses of urinary bladder paraganglioma: is there clinical relevance? A systematic review.
PubMed: 34792634
DOI: 10.1007/s00345-021-03888-y -
Cancer Radiotherapie : Journal de La... Oct 2021Considering intracranial tumours, only few indications of protontherapy, such as chordoma, chondrosarcoma or uveal melanoma, are uniformly approved in the world. Other...
Considering intracranial tumours, only few indications of protontherapy, such as chordoma, chondrosarcoma or uveal melanoma, are uniformly approved in the world. Other indications, excluding paediatric pathologies, are still debated. The aim of this article is to describe the rationale for the use of protonbeam irradiation for meningioma, pituitary adenoma, craniopharyngioma, paraganglioma, glioma, and schwannoma, and to inform the radiation oncologists if prospective studies or randomized studies are opened for inclusions. This article deals only with indications for adults.
Topics: Adenoma; Adult; Brain Neoplasms; Chordoma; Craniopharyngioma; Glioma; Humans; Meningeal Neoplasms; Meningioma; Neurilemmoma; Paraganglioma; Pituitary Neoplasms; Prospective Studies; Radiotherapy Dosage; Randomized Controlled Trials as Topic
PubMed: 34175224
DOI: 10.1016/j.canrad.2021.06.009 -
Journal of Integrative Neuroscience Jun 2021Metastatic pheochromocytoma of the spine (MPS) represents an extremely rare and challenging entity. While retrospective studies and case series make the body of the...
Metastatic pheochromocytoma of the spine (MPS) represents an extremely rare and challenging entity. While retrospective studies and case series make the body of the current literature and case reports, no systematic reviews have been conducted so far. This systematic review aims to perform a systematic review of the literature on this topic to clarify the status of the art regarding the surgical management of MPS. A systematic review according to PRISMA criteria has been performed, including all studies written in English and involving human participants. 15 papers for a total of 44 patients were finally included in the analysis. The median follow-up was 26.6 months. The most common localization was the thoracic spine (54%). In 30 out of 44 patients (68%), preoperative medications were administered. Open surgery was performed as the first step in 37 cases (84%). Neoadjuvant treatments, including preoperative embolization were reported in 18 (41%) cases, while adjuvant treatments were administered in 23 (52%) patients. Among those patients who underwent primary aggressive tumor removal and instrumentation, 16 out of 25 patients (64%) showed stable disease with no progression at the final follow-up. However, the outcome was not reported in 14 patients. Gross total resection of the tumor and spinal reconstruction appear to offer good long-term outcomes in selected patients. Preoperative alpha-blockers and embolization appear to be useful to enhance hemodynamic stability, avoiding potential detrimental complications.
Topics: Adrenal Gland Neoplasms; Humans; Orthopedic Procedures; Pheochromocytoma; Spinal Neoplasms
PubMed: 34258952
DOI: 10.31083/j.jin2002053 -
The British Journal of Surgery Jan 2020Preoperative α-blockade in phaeochromocytoma surgery is recommended by all guidelines to prevent intraoperative cardiocirculatory events. The aim of this meta-analysis... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Preoperative α-blockade in phaeochromocytoma surgery is recommended by all guidelines to prevent intraoperative cardiocirculatory events. The aim of this meta-analysis was to assess the benefit of such preoperative treatment compared with no treatment before adrenalectomy for phaeochromocytoma.
METHODS
A systematic literature search was undertaken in MEDLINE, Web of Science and CENTRAL without language restrictions. Randomized and non-randomized comparative studies investigating preoperative α-blockade in phaeochromocytoma surgery were included. Data on perioperative safety, effectiveness and outcomes were extracted. Pooled results were calculated as an odds ratio or mean difference with 95 per cent confidence interval.
RESULTS
A total of four retrospective comparative studies were included investigating 603 patients undergoing phaeochromocytoma surgery. Mortality, cardiovascular complications, mean maximal intraoperative systolic and diastolic BP, and mean maximal intraoperative heart rate did not differ between patients with or without α-blockade. The certainty of the evidence was very low owing to the inferior quality of studies.
CONCLUSION
This meta-analysis has shown a lack of evidence for preoperative α-blockade in surgery for phaeochromocytoma. RCTs are needed to evaluate whether preoperative α-blockade can be abandoned.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Adrenergic alpha-Antagonists; Cardiovascular Diseases; Humans; Pheochromocytoma; Preoperative Care
PubMed: 31903584
DOI: 10.1002/bjs.11348 -
Journal of Clinical Epidemiology May 2024The aim of this systematic review was to summarize national and international guidelines that made recommendations for monitoring patients diagnosed with low-risk...
OBJECTIVES
The aim of this systematic review was to summarize national and international guidelines that made recommendations for monitoring patients diagnosed with low-risk cancer. It appraised the quality of guidelines and determined whether the guidelines adequately identified patients for monitoring, specified which tests to use, defined monitoring intervals, and stated triggers for further intervention. It then assessed the evidence to support each recommendation.
STUDY DESIGN AND SETTING
Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched PubMed and Turning Research into Practice databases for national and international guidelines' that were written in English and developed or updated between 2012 and 2023. Quality of individual guidelines was assessed using the AGREE II tool.
RESULTS
Across the 41 published guidelines, 48 different recommendations were identified: 15 (31%) for prostate cancer, 11 (23%) for renal cancer, 6 (12.5%) for thyroid cancer, and 10 (21%) for blood cancer. The remaining 6 (12.5%) were for brain, gastrointestinal, oral cavity, bone and pheochromocytoma and paraganglioma cancer. When combining all guidelines, 48 (100%) stated which patients qualify for monitoring, 31 (65%) specified which tests to use, 25 (52%) provided recommendations for surveillance intervals, and 23 (48%) outlined triggers to initiate intervention. Across all cancer sites, there was a strong positive trend with higher levels of evidence being associated with an increased likelihood of a recommendation being specific (P = 0.001) and the evidence for intervals was based on expert opinion or other guidance.
CONCLUSION
With the exception of prostate cancer, the evidence base for monitoring low-risk cancer is weak and consequently recommendations in clinical guidelines are inconsistent. There is a lack of direct evidence to support monitoring recommendations in the literature making guideline developers reliant on expert opinion, alternative guidelines, or indirect or nonspecific evidence.
Topics: Humans; Practice Guidelines as Topic; Neoplasms; Male; Female
PubMed: 38360377
DOI: 10.1016/j.jclinepi.2024.111280 -
World Neurosurgery Sep 2019Carotid body tumors (CBTs) are highly vascularized tumors which can render tumor resection surgery challenging. There is evidence suggesting that preoperative selective... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Carotid body tumors (CBTs) are highly vascularized tumors which can render tumor resection surgery challenging. There is evidence suggesting that preoperative selective embolization can reduce blood loss during surgery and decrease the risk of perioperative complications; however, recent reports have questioned the benefits that preoperative embolization provides. The objective of this study is to investigate the impact of preoperative embolization on CBT surgical resection.
METHODS
This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies were identified through a search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials until March 2019. A random effects model meta-analysis was conducted, and the I statistic was used to assess for heterogeneity.
RESULTS
Twenty-five studies comprising 1326 patients were included. Patients who received preoperative embolization had statistically significant lower intraoperative blood loss (weighted mean difference [WMD], -135.32; 95% confidence interval [CI], -224.58 to -46.06; I = 78.6%). Duration of the procedure was statistically significantly shorter in the preembolization group than the nonembolization group (WMD, -38.61; 95% CI, -65.61 to -11.62; I = 71.9%). There were no differences in the rates of cranial nerve (CN) injuries (odds ratio [OR], 1.13; 95% CI, 0.68-1.86; I = 12.9%), stroke (OR, 1.75; 95% CI, 0.70-4.36; I = 0%), transient ischemic attacks (TIAs) (OR, 0.55; 95% CI, 0.11-2.65; I = 0%), or length of stay (WMD, 0.32; 95% CI, -1.35 to 1.98; I = 96.4%) between the 2 groups.
CONCLUSIONS
Patients who received embolization prior to CBT resection had statistically significant lower blood loss and shorter duration of operation. The rates of CN palsy, stroke, TIA, and length of stay were similar between patients who had preoperative embolization and those who did not.
Topics: Blood Loss, Surgical; Carotid Body Tumor; Embolization, Therapeutic; Humans; Preoperative Care
PubMed: 31154101
DOI: 10.1016/j.wneu.2019.05.209 -
Perfusion May 2020Phaeochromocytoma is a catecholamine-secreting tumour associated with clinical presentation ranging from paroxysmal hypertension to intractable cardiogenic shock....
INTRODUCTION
Phaeochromocytoma is a catecholamine-secreting tumour associated with clinical presentation ranging from paroxysmal hypertension to intractable cardiogenic shock. Extracorporeal life support, in veno-arterial mode, application in refractory acute heart dysfunction is sharply increasing worldwide. However, its clinical utility in phaeochromocytoma-induced cardiogenic shock remains still unclear.
METHODS
A systematic review of published reports was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Searches were accomplished on PubMed, Embase and Google Scholar to identify articles describing the use of extracorporeal life support in the setting of phaeochromocytoma-induced cardiogenic shock (PROSPERO: CRD42019125225).
RESULTS
Thirty-five reports, including 62 patients supported with extracorporeal life support because of intractable phaeochromocytoma crisis, were included for the analysis. Almost all the subjects underwent peripheral cannulation for extracorporeal life support. The median duration of the mechanical circulatory support was 5 days, and most of the patients recovered normal myocardial function (left ventricular ejection fraction ⩾50%). In-hospital survival was 87%. Phaeochromocytoma was removed surgically during extracorporeal life support in 10 patients (16%), while in the remaining after haemodynamic stabilization and weaning from the mechanical support.
CONCLUSION
Successful management of phaeochromocytoma-induced cardiogenic shock depends on prompt recognition and immediate treatment of shock. In this scenario, extracorporeal life support may play a significant role allowing cardiac and end-organ recovery and giving time for accurate diagnosis and specific treatment.
Topics: Adrenal Gland Neoplasms; Adult; Extracorporeal Membrane Oxygenation; Female; Humans; Male; Middle Aged; Pheochromocytoma; Shock, Cardiogenic
PubMed: 32397890
DOI: 10.1177/0267659120908413