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IJSU1417_proof ■ 29 May 2014 ■ 1/1
International Journal of Surgery xxx (2014) 1
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Editorial
Endocrine surgery: Current and future issues Endocrine surgery represents a challenging field of uses, rich of pathophysiologic consequences, subject of never-ending research and controversies. During the last twenty years brilliant improvements in technology, in the mininvasive techniques and in the perioperative support have allowed the short-lasting low-morbidity resolution of diseases of thyroid, parathyroid, pancreas and adrenal glands. Genetics has proved to be of great help for familial screening, and for leading, by targeting genomic mutations, “preventive” surgery, such as in the medullary thyroid carcinoma. Also, molecular biology has showed with a remarkable accuracy the cell-based pathogenesis, and has identified markers of great clinical and prognostic value. Beyond any doubt, the development of diagnostic imaging has allowed the recognition of subcentimetric neoplasms with an incredible precision, and as a consequence detection studies have replaced diagnostic laparotomies. The best knowledge of regulatory mechanisms in the hormonal activity and in the relationships between endocrine glands and their related target, and an unlimited incitement for the research has produced a reasonable and evidence-based proposal of new diagnostic therapeutic paths for the patients suffering from endocrine diseases. The employment of shared international protocols represents the real next challenge, which will enable a homogeneous analysis of the therapeutic results. Healing, a best quality of life following surgery, rationalization of approaches and cost-effective policies remain the undisputed objectives of a target-aimed clinical research. Regarding thyroid gland, a better preoperative assessment of suspicious lesions is still a scope of great interest, such as, in the treatment of differentiated carcinoma, lymphectomies and radioablative therapy are subject of discussions. Mininvasive surgery, sometimes suggested by means of more elaborated accesses, has showed results comparable to the ones achieved by surgeons in a classical approach. In this field, the value of robotics must be confirmed also by costs. Indications to parathyroidectomy for primary HPT are still subject of debates across guidelines, while detection studies have conclusively allowed less invasive approaches for an ambulatory surgery. The diffusion of calcimimetics has revolutionized therapies of the secondary forms, but a comparison among long-term results between drugs and surgery is still subject of research, also in terms of costs. It is also sure that mininvasive approach of adrenal glands is already a “gold-standard”, also for pheochromocytomas and some metastatic forms, while the one-trocar retroperitoneal technique
seems to be a next-coming approach. The right indications to the treatment of incidental lesions are subject of debating, such as the role of the “sparing adrenalectomy”, mainly in the treatment of the bilateral disease, where it needs perspective randomized trials. Gastroenteropancreatic neuroendocrine tumors (GEP-NET) appear to be a clinical challenge, showing a high incidence (because of missed diagnoses in the past time) and a significant possibility of cure. In this area, immunohistochemical studies, and overall instrumental diagnoses, has reported surprising improvements. Biological drugs represent a real therapeutic innovation, and they are strictly tied to the hope of improving the results, still inadequate, of some rare aggressive forms. Targeted therapies in a multidisciplinary environment still represent a challenge for the future. In brief, endocrine surgery of the twenty-first century has to be intended as a tile in the wide mosaic of approaches to the diseases, where only a strict partnership among researchers, endocrinologists, radiologists, oncologists and surgeons, in referral units, can produce the best therapeutic outcomes. The Italian Society of Endocrine Surgery is one of the most ancient and famous surgical societies in our country, and its next Spring Meeting will be held in Naples on the 26th and 27th of May 2014. Differentiated thyroid carcinomas, hyperparathyroidism, adrenal diseases, pancreatic neuroendocrine tumors, breast cancer and obesity surgery will be the main topics, with over one hundred lecturers from all the Italian regions. During these two days, the meeting, accredited by the Ministry of Health, will be divided into two preceding workshops and seven scientific sessions of relevant interest. A special prize will be awarded by a special jury of national experts led by a President to a young surgeon (“under 40”) for the best oral presentation of an endocrine clinical case of special interest. We hope that a certain contribution to the advancement of the most recent knowledge in endocrine surgery, especially in terms of technological innovation, will be achieved. Welcome to the Congress, Luigi Santini and Giovanni Conzo. Luigi Santini E-mail address: [email protected]. Available online xxx
http://dx.doi.org/10.1016/j.ijsu.2014.05.075 1743-9191/© 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.
Please cite this article in press as: L. Santini, Endocrine surgery: Current and future issues, International Journal of Surgery (2014), http:// dx.doi.org/10.1016/j.ijsu.2014.05.075
55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 Q2,1 109 110 111 112 113 114 115 116 117
IJSU1417_proof ■ 29 May 2014 ■ 1/1
International Journal of Surgery xxx (2014) 1
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Editorial
Endocrine surgery: Current and future issues Endocrine surgery represents a challenging field of uses, rich of pathophysiologic consequences, subject of never-ending research and controversies. During the last twenty years brilliant improvements in technology, in the mininvasive techniques and in the perioperative support have allowed the short-lasting low-morbidity resolution of diseases of thyroid, parathyroid, pancreas and adrenal glands. Genetics has proved to be of great help for familial screening, and for leading, by targeting genomic mutations, “preventive” surgery, such as in the medullary thyroid carcinoma. Also, molecular biology has showed with a remarkable accuracy the cell-based pathogenesis, and has identified markers of great clinical and prognostic value. Beyond any doubt, the development of diagnostic imaging has allowed the recognition of subcentimetric neoplasms with an incredible precision, and as a consequence detection studies have replaced diagnostic laparotomies. The best knowledge of regulatory mechanisms in the hormonal activity and in the relationships between endocrine glands and their related target, and an unlimited incitement for the research has produced a reasonable and evidence-based proposal of new diagnostic therapeutic paths for the patients suffering from endocrine diseases. The employment of shared international protocols represents the real next challenge, which will enable a homogeneous analysis of the therapeutic results. Healing, a best quality of life following surgery, rationalization of approaches and cost-effective policies remain the undisputed objectives of a target-aimed clinical research. Regarding thyroid gland, a better preoperative assessment of suspicious lesions is still a scope of great interest, such as, in the treatment of differentiated carcinoma, lymphectomies and radioablative therapy are subject of discussions. Mininvasive surgery, sometimes suggested by means of more elaborated accesses, has showed results comparable to the ones achieved by surgeons in a classical approach. In this field, the value of robotics must be confirmed also by costs. Indications to parathyroidectomy for primary HPT are still subject of debates across guidelines, while detection studies have conclusively allowed less invasive approaches for an ambulatory surgery. The diffusion of calcimimetics has revolutionized therapies of the secondary forms, but a comparison among long-term results between drugs and surgery is still subject of research, also in terms of costs. It is also sure that mininvasive approach of adrenal glands is already a “gold-standard”, also for pheochromocytomas and some metastatic forms, while the one-trocar retroperitoneal technique
seems to be a next-coming approach. The right indications to the treatment of incidental lesions are subject of debating, such as the role of the “sparing adrenalectomy”, mainly in the treatment of the bilateral disease, where it needs perspective randomized trials. Gastroenteropancreatic neuroendocrine tumors (GEP-NET) appear to be a clinical challenge, showing a high incidence (because of missed diagnoses in the past time) and a significant possibility of cure. In this area, immunohistochemical studies, and overall instrumental diagnoses, has reported surprising improvements. Biological drugs represent a real therapeutic innovation, and they are strictly tied to the hope of improving the results, still inadequate, of some rare aggressive forms. Targeted therapies in a multidisciplinary environment still represent a challenge for the future. In brief, endocrine surgery of the twenty-first century has to be intended as a tile in the wide mosaic of approaches to the diseases, where only a strict partnership among researchers, endocrinologists, radiologists, oncologists and surgeons, in referral units, can produce the best therapeutic outcomes. The Italian Society of Endocrine Surgery is one of the most ancient and famous surgical societies in our country, and its next Spring Meeting will be held in Naples on the 26th and 27th of May 2014. Differentiated thyroid carcinomas, hyperparathyroidism, adrenal diseases, pancreatic neuroendocrine tumors, breast cancer and obesity surgery will be the main topics, with over one hundred lecturers from all the Italian regions. During these two days, the meeting, accredited by the Ministry of Health, will be divided into two preceding workshops and seven scientific sessions of relevant interest. A special prize will be awarded by a special jury of national experts led by a President to a young surgeon (“under 40”) for the best oral presentation of an endocrine clinical case of special interest. We hope that a certain contribution to the advancement of the most recent knowledge in endocrine surgery, especially in terms of technological innovation, will be achieved. Welcome to the Congress, Luigi Santini and Giovanni Conzo. Luigi Santini E-mail address: [email protected]. Available online xxx
http://dx.doi.org/10.1016/j.ijsu.2014.05.075 1743-9191/© 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.
Please cite this article in press as: L. Santini, Endocrine surgery: Current and future issues, International Journal of Surgery (2014), http:// dx.doi.org/10.1016/j.ijsu.2014.05.075
55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 Q2,1 109 110 111 112 113 114 115 116 117
