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Medical Forum / Diseases and Disorders / Cancer / January 2008Paging Steph......and any other cognoscenti.... "more details"
Hi Steph... saw your reply thanks a lot... if you could PM me... I can send you more details with the names/specifics of the two surgeons involved...I talked again to the endoscopic guy this morning, and will be talking to the pervious one this afternoon... please bear with me for the long post... I have a real nutcracker of a dilemma, but need to make a quick decision and need a pro's opinion: I have muscle disease in my limbs for which they have suspended treatment until cancer surgery and this limb pain kills me... cancer does nothing... plus, I am a voice pro, and so, I need to know which one will not cause degradation of voice quality (not just the "hoarseness" thing, I have to worry about tonal quality and range- there is no clear literature for this- open or endoscopic). Option 1: Endoscopic guy- 1" incision max; does 40% endoscopic surgeries on a selective basis, does 100 thyroidectomies a year; no career stats on voice loss; "minimally invasive" mantra; says his procedure will be tailored to suit me and is not the simple "video assist"; is an ENT who specializes in thyroid surgery. He says he doesnt remove lymph nodes during surgery, UNLESS he can feel them and knows they are infected also, expects RAI to get them later on; says if RAI doesn't get anything, I'll need a second procedure anyway, be it endoscopic or open; based on my U/S scans he thinks I don't have to worry about spreading to lymph nodes. Doesnt even want to look at my second U/S scan which did a lymph study. Said he offered me endoscopic since he thought I was a good candidate for it, given what I needed done. promises to be extra careful with my cords. My tumor is 0.5" at max diameter. Option 2: Open surgery- 2-3" incision with central neck dissection, did do a lymph study and concluded that it hasnt spread; 0.04% chance of voice loss over career; 1000+thyroid operations; 1-2% chance of loss of voice quality. He said "endoscopy is a gimmick... went to Italy and learned it.. no medical advantage offering it... so we stopped doing it.." :) but sure as hell cosmetic advantage for some one else (not my concern of course..) First guy is part of a top-ranked ENT department and says he is publishing regularly about safety of his techniques and claims he has proved it is safer or at least as safe as open surgery; Second person is also from a top facility... and is supposed to be among the "top endocrine surgeons in the country" according to the brochure :) Neither has a clue about voice quality, since they haven't operated on pros before.. I am their guinea pig :) Of course, there are no clear articles about voice quality in general, and "pro" folks in particular... Now, ignoring the voice aspect, I am really tempted by the endoscopic option-- it is in town for me, smaller incision, lesser pain, I don't need to travel to the east coast etc. but if it is a foolhardy option, I would well avoid it... (not worried about size of scar... size of my biceps may be :) ) Also, specificially, I came across about 6-7 journal articles that claim endoscopic is just as safe- mainly from the Italian guy who pioneered this for thyroid- from what you say about credible evidence, do you think these articles hold no water? Specifically.. how about this paper? http://www.springerlink.com/content/t7q313088217031v/ In the US, most endoscopic surgeons are in their 40s at best, and several of them were trained in it, in Italy. I have spoken to a few about "voice"... Obviously "voice" worries me more than the cancer itself! So, I hope Steph and y'all don't mind my flood of info.. Thanks to steph and any others who have thoughts... > Hi Steph... saw your reply thanks a lot... if you could PM me... I can > send you more details with the names/specifics of the two surgeons [quoted text clipped - 7 lines] > just the "hoarseness" thing, I have to worry about tonal quality and > range- there is no clear literature for this- open or endoscopic). No PM's I'm afraid........too many loonies around. I'm unable to pass opinions on either your surgeons or your singing. It's not the number of thyroidectomies your endo guy has done, it's the number he's done for cancer that matters. Most thyroidectomies are not for cancer. If it were me, I'd go the conventional route, but you're in the driving seat. Sounds to me like your conventional surgeon has a better handle on the stats, btw. right. the endo guy is a thyroid cancer specialist and is both at the local cancer institute and ENT department, but there is the clear chance not all 100 a year are cancer operations. I can press him for cancer-stats monday. What worries me is what he says about "not operating more than necessary" and not wanting to see Ultrasounds of lymph nodes, and expecting RAI to pick it up, since there is no spread/tumor he can "feel". Is this a valid approach or is it foolhardy? Do you think all those guys frm Italy who have published that endo is safe arent credible? As a researcher from an "other" field, I obviously cannot tell. It only sounds to me, from the outside, like there are two schools of thought... apparently they are trigger happy with endo in Asia, and not so in the West etc. Personally, I am leaning towards the endo approach because multiple people have told me mine was a routine case, and the endo operation keeps it simple, and my ENT whom I REALLY trust, recommended this guy and his technique highly to me... my ENT is one of the best globally, and a terrific person to boot... and I havent heard anything from the endo that would cause my alarm bells to go off. barring this lymph theory, that I don't get. >> Hi Steph... saw your reply thanks a lot... if you could PM me... I can >> send you more details with the names/specifics of the two surgeons [quoted text clipped - 20 lines] > seat. Sounds to me like your conventional surgeon has a better handle on > the stats, btw. I think I should have said "head and neck" cancer specialist... he heads the head/neck cancer department at the local oncological institute... his procedure is similar to Inabnet's at Columbia, but is "general" anasthesia in my case, and night at hospital, not same day... > right. the endo guy is a thyroid cancer specialist and is both at the > local cancer institute and ENT department, but there is the clear chance [quoted text clipped - 17 lines] > would cause my alarm bells to go off. barring this lymph theory, that I > don't get. > right. the endo guy is a thyroid cancer specialist and is both at the > local cancer institute and ENT department, but there is the clear chance [quoted text clipped - 3 lines] > expecting RAI to pick it up, since there is no spread/tumor he can "feel". > Is this a valid approach or is it foolhardy? I wouldn't worry about nodes. It's the thyroid which has to come out - completely. > Do you think all those guys frm Italy who have published that endo is safe > arent credible? As a researcher from an "other" field, I obviously cannot > tell. It only sounds to me, from the outside, like there are two schools > of thought... apparently they are trigger happy with endo in Asia, and not > so in the West etc. How many of those Italian ops are cancer? The paper didn't say. > Personally, I am leaning towards the endo approach because multiple people > have told me mine was a routine case, and the endo operation keeps it [quoted text clipped - 3 lines] > would cause my alarm bells to go off. barring this lymph theory, that I > don't get. Go with what you think is best. But thyroid surgery for small cancers is standard stuff for a good head and neck surgeon, with excellent results. I'm just telling you what I (as an oncologist specialising in thyroid cancer) would do. It sounds like you've made your mind up, and "a man hears what he wants to hear, and disregards the rest" as Paul Simon sang. Actually, I was dead set against the endo and preferred the "focused" endocrine surgeon ... :) but the negatives I heard from the ThyCa group and elsewhere from the surgeons I talked to, were mainly from people who hadnt had or hadnt done endoscopic. But, when I talked to the endo again and the open person again yesterday, and found that the endo's particular technique was common in New York, and he was no quack. I am skeptical about either surgeon's complacence "Mine is the best" view, and am leaning towards a "simpler for me" procedure, since my thyca is only a detour, and far less painful and not life-stilling like my limb disease. The local medical college have given up on treating my medical disease and told me to show up at the Mayo even for a diagnosis... My general physician was enthusiatic about either surgeon, but I took that with a grain of salt, since I knew he didn't know either person personally, nor followed their work. Yes, I noticed too that that paper and several others didnt say "cancer"; I think there was one that did. To split hairs, the endo operates cancers regularly and publishes on head/neck cancer mainly not thyroid and as his PhD is in immunology, most of his papers are from that field. I wouldnt know if that disqualifies him to any extent as a thyroid surgeon; in my field this would be a rather coarse-grained and clear difference.... Not having to worry about lymph is reassuring; that was the oddity. Under what circumstances- or how could the endo screw up- in removing the entire thyroid? Is he disadvantaged severely as compared to an open surgeon? Btw, he does have me stay overnight for Calcium monitoring due to the potential parathyroid removal. >> right. the endo guy is a thyroid cancer specialist and is both at the >> local cancer institute and ENT department, but there is the clear chance [quoted text clipped - 28 lines] > cancer) would do. It sounds like you've made your mind up, and "a man > hears what he wants to hear, and disregards the rest" as Paul Simon sang. Steph, btw... if you would indulge me... PubMed.gov did come up with a bunch of papers on endoscopic for thyroid cancer, claiming it was fine... though most were not from the US... I didnt even seen the ones my endoscopic surgeon says he has written... though they could be in print. > Actually, I was dead set against the endo and preferred the "focused" > endocrine surgeon ... :) but the negatives I heard from the ThyCa group [quoted text clipped - 60 lines] >> cancer) would do. It sounds like you've made your mind up, and "a man >> hears what he wants to hear, and disregards the rest" as Paul Simon sang. > Not having to worry about lymph is reassuring; that was the oddity. Under > what circumstances- or how could the endo screw up- in removing the entire > thyroid? Is he disadvantaged severely as compared to an open surgeon? The throid is like wallpaper plastered to the trachea. The recurrent laryngeal nerves are buried in it. I would want my surgeon to have the maximum exposure to do the job right. |
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