These guidelines aim to establish the standard practice for diagnosing and treating patients with differentiated thyroid cancer (DTC). Based on the Korean Thyroid Association (KTA) Guidelines on DTC management, the “Treatment of Advanced DTC” section was revised in 2024 and has been provided through this chapter. Especially, this chapter covers surgical and nonsurgical treatments for the local (previous surgery site) or regional (cervical lymph node metastasis) recurrences. After drafting the guidelines, it was finalized by collecting opinions from KTA members and related societies. Surgical resection is the preferred treatment for local or regional recurrence of advanced DTC. If surgical resection is not possible, nonsurgical resection treatment under ultrasonography guidance may be considered as an alternative treatment for local or regional recurrence of DTC. Furthermore, if residual lesions are suspected even after surgical resection or respiratory-digestive organ invasion, additional radioactive iodine and external radiation treatments are considered.

Pediatric differentiated thyroid cancers (DTCs), mostly papillary thyroid cancer (PTC, 80-90%), are diagnosed at more advanced stages with larger tumor sizes and higher rates of locoregional and/or lung metastasis. Despite the higher recurrence rates of pediatric cancers than of adult thyroid cancers, pediatric patients demonstrate a lower mortality rate and more favorable prognosis. Considering the more advanced stage at diagnosis in pediatric patients, preoperative evaluation is crucial to determine the extent of surgery required. Furthermore, if hereditary tumor syndrome is suspected, genetic testing is required. Recommendations for pediatric DTCs focus on the surgical principles, radioiodine therapy according to the postoperative risk level, treatment and follow-up of recurrent or persistent diseases, and treatment of patients with radioiodine-refractory PTCs on the basis of genetic drivers that are unique to pediatric patients.

Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.

The primary objective of initial treatment for thyroid cancer is minimizing treatment-related side effects and unnecessary interventions while improving patients’ overall and disease-specific survival rates, reducing the risk of disease persistence or recurrence, and conducting accurate staging and recurrence risk analysis. Appropriate surgical treatment is the most important requirement for this purpose, and additional treatments including radioactive iodine therapy and thyroid-stimulating hormone suppression therapy are performed depending on the patients’ staging and recurrence risk. Diagnostic surgery may be considered when repeated pathologic tests yield nondiagnostic results (Bethesda category 1) or atypia of unknown significance (Bethesda category 3), depending on clinical risk factors, nodule size, ultrasound findings, and patient preference. If a follicular neoplasm (Bethesda category 4) is diagnosed pathologically, surgery is the preferred option. For suspicious papillary carcinoma (suspicious for malignancy, Bethesda category 5), surgery is considered similar to a diagnosis of malignancy (Bethesda category 6). As for the extent of surgery, if the cancer is ≤1 cm in size and clinically free of extrathyroidal extension (ETE) (cT1a), without evidence of cervical lymph node (LN) metastasis (cN0), and without obvious reason to resect the contralateral lobe, a lobectomy can be performed. If the cancer is 1-2 cm in size, clinically free of ETE (cT1b), and without evidence of cervical LN metastasis (cN0), lobectomy is the preferred option. For patients with clinically evident ETE to major organs (cT4) or with cervical LN metastasis (cN1) or distant metastasis (M1), regardless of the cancer size, total thyroidectomy and complete cancer removal should be performed at the time of initial surgery. Active surveillance may be considered for adult patients diagnosed with low-risk thyroid papillary microcarcinoma. Endoscopic and robotic thyroidectomy may be performed for low-risk differentiated thyroid cancer when indicated, based on patient preference.

Hepatocellular carcinoma (HCC) is the 2nd most common cause of cancer related death in Korea and well-known malignancy with poor prognosis. Sorafenib is the first-line molecular targeted agent in patients with extra-hepatic spread of HCC. However, complete response is extremely rare in patients treated with sorafenib and the disease control rate is only 43%. We report a 53-year-old man with advanced HCC with pulmonary metastasis who showed complete response by cytotoxic chemotherapy with doxorubicin and cisplatin with relatively tolerable adverse effects after failure of treatment with sorafenib.
Carcinoma, Hepatocellular* ; Cisplatin ; Doxorubicin ; Drug Therapy* ; Humans ; Korea ; Middle Aged ; Neoplasm Metastasis* ; Prognosis

BACKGROUND/AIMS: Recently, treatment using an endoscopic device is actively being developed. Techniques for incision and bleeding control have been developed, but endoscopic suturing remains to be perfected. Using an endoscopic suturing technique, a variety of diseases could be managed noninvasively. We have attempted to use a new endoscopic suturing device which enables a continuous suture using a flexible upper endoscope. METHODS: A suturing device was designed where a semicircular needle could sew through tissue by rotation making a continuous suture possible. RESULTS: We successfully sutured the stomach tissue of a dog using an optimized suturing device model. CONCLUSIONS: The initial model was found to have some problems. However, we hope to develop a continuous suturing device for flexible upper endoscope procedures in Korea.
Animals ; Dogs ; Endoscopes ; Endoscopes, Gastrointestinal* ; Endoscopy ; Hemorrhage ; Hope ; Korea ; Needles ; Stomach ; Sutures*

BACKGROUND: The pilots with cardiovascular events have a possibility for a risk of suffering from sudden incapacitation which is closely related to flying safety. The coagulation factors such as fibrinogen, factor VII, and factor VIII are possibly related to cardiovascular events. Several studies for general population have shown that an increase of those coagulation factors with age, a correlation of Factor VII and fibrinogen with BMI, and of fibrinogen with smoking. However, this study is to find out whether pilots' age, body weight, body mass index (BMI) and smoking are related to the baseline measurement of coagulation factor VII, factor VIII and fibrinogen. METHOD: Samples were taken from 21 pilots from Asiana Airlines: 11 smokers and 10 non-smokers. In order to measure the relationship between age, body weight, BMI, and the coagulation factors, Pearson correlation was used in this analysis. Independent two sampled t-test was used to analyze the correlation between smoking and the coagulation factors. RESULTS: Mean age, mean height, mean body weight and mean BMI of pilots were examined: 38 years, 171.81 cm, 70.67 Kg and 23.94 Kg/m(2). Mean fibrinogen, mean factor VII, and mean factor VIII were also obtained: 236.0 mg/dl, 92.93%, and 60.16%. The coagulation factor VII, factor VIII and fibrinogen were not significant related to age, body weight, BMI, smoking of pilots. CONCLUSION: This study has no correlation between age, body weight, BMI, smoking and the coagulation factors because the age of this study does not have pilots with over 60 years old and healthy behaviors (e.g., exercise, smoking, drinking, etc.) of most pilots are relatively well.
Blood Coagulation Factors* ; Body Height* ; Body Mass Index ; Body Weight* ; Cardiovascular Diseases ; Diptera ; Drinking ; Factor VII* ; Factor VIII ; Fibrinogen* ; Humans ; Middle Aged ; Smoke* ; Smoking*

BACKGROUND: Pulmonary artery banding (PAB)in the functional univentricular heart (UVH)is a palliative procedure for staging toward the Fontan procedure;however,it is known to be a risk factor. MATERIALS AND METHOD: The records of all 37 patients with functional UVHs who underwent surgical palliation using PAB between September 1989 and August 1999 were reviewed retrospectively.We investigated the aortic arch obstruction,the development and progression of subaortic stenosis after PAB,and risk factor of mortality according to surgical method. RESULT: In 37 neonates and infants with single ventricular physiology,aortic arch obstruction was combined in 7.There were 6 early deaths (16.2%)after PAB and 3 late deaths (8.1%)after Fontan operation.The actuarial overall survival including early mortality at 3 and 5 years were 8 0 .7+/-6.6%,72.2 +/-8.2% respectively. Among 31 patients who survived PAB,27 patients (87.1%)could become candidates for Fontan operation;22 patients(71.0%)completed Fontan operation with 3 deaths and 5 were waiting bidirectional cavopulmonary shunt(BCPS)or Fontan operation (follow-up mean 4.5 year,minimal 2 year). Subaortic stenosis developed in 8 patients after PAB (8/29,27.6%);3 cases in the patients without arch anomaly (3/22,13.6%)and 5 in those with arch anomal y (5/7,71.4%).The subaortic stenosis was managed with Damus-Kaye-Stansel procedure (DKS)in 6 patients without operative mortality and conal septum resection in 2 without long-term survivor. Analysis of risk factors established that aortic arch obstruction was strongly associated with subaortic stenosis (p<0.001).The only risk factor of late mortality was Fontan procedure without staged palliation by BCPS (p=0.001). CONCLUSION: PAB is effective as an initial palliative step in functional UVH.And the high risk group of patients with aortic obstruction can undergo effective short-term PAB as an initial palliative step,with subsequent DKS for subaortic stenosis.This strategy,initial PAB and careful surveillance,and early relief of subaortic stenosis can maintain acceptable anatomy and hemodynamics for later Fontan procedures.
Aorta, Thoracic ; Constriction, Pathologic ; Fontan Procedure ; Heart* ; Hemodynamics ; Humans ; Infant ; Infant, Newborn ; Mortality ; Pulmonary Artery* ; Risk Factors ; Survivors

Cystic lymphangiomas are comparatively rare, benign tumors of lymphatic system and their histogenesis are uncertain. About 75% of theses lesions are in the neck, 20% are in the axillary region, and 5% are in the mediastinum, retroperitoneal region or groin. But retroperitoneal cystic lymphangiomas are very rare. Retroperitoneal cystic lymphangiomas are usually found incidentally during diagnostic procedures performed for unrelated clinical reasons or at surgery. Although retroperitoneal cystic lymphangioma is a benign lesion, it may cause significant morbidity due to its large size and its often invasive character with a strong tedency to secondary infection. They generally present as a palpable mass or abdominal pain and fever related to hemorrhage or inflammation of the cystic wall. The treatment of choice is surgical excision. We experienced a case of retroperitoneal cystic lymphangioma in a 4-year-old boy who had developed rapid abdominal distention and abdominal pain for 4 days. We have completely excised large cystic mass & histologically confirmed cystic lymphangioma. A brief review of literature was made.
Abdominal Pain ; Child, Preschool ; Coinfection ; Fever ; Groin ; Hemorrhage ; Humans ; Inflammation ; Lymphangioma, Cystic* ; Lymphatic System ; Male ; Mediastinum ; Neck

Despite improvements in surgical technique, immunosuppressive therapy, and follow-up care, a considerable number of patients with kidney transplants die as a consequence of sepsis and throm-boembolism. The incidence of thromboembolism is higher in patients older than 40 years of age. Prominent among these is an increased incidence of acute myocardial infarction(AMI) in patients receiving corticosteroids. We encountered a rare case that septic shock due to artificial abortion, ARF, and DIC complicated by AMI. A 25-year-old female complained of fever, and watery diarrhea. She was emmergently admitted due to shock. Physical examination demonstrated hypotension and fever. WBC count was 45,300/mL. Elevated FDP, D dimer, CK with dominance of the MB isoenzyme, and troponin-I. EKG showed ST segment elevation in leads aVF, V3-V6. She was treated with cefuroxime, netilmycin, and dalteparin. Cultures obtained from the sputum, urine, and blood did not yield any microorganisms. Although sepsis could not be confirmed, sepsis was highly suspected from the clinical features. This is a rare case in which septic shock, ARF, and DIC complicated by AMI in a young female renal allograft patient. Since AMI in the absence of underlying conditions has been rarely described, we wish to bring attention to the diagnosis of this disorder in a young female allograft recipient and without any other predisposing abnormality.
Adrenal Cortex Hormones ; Adult ; Allografts* ; Cefuroxime ; Dacarbazine ; Dalteparin ; Diagnosis ; Diarrhea ; Electrocardiography ; Female ; Fever ; Follow-Up Studies ; Humans ; Hypotension ; Incidence ; Kidney ; Kidney Transplantation ; Myocardial Infarction* ; Physical Examination ; Sepsis* ; Shock ; Shock, Septic ; Sputum ; Thromboembolism ; Troponin I