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Summer 2012

Coordinated Evaluation, Treatment for Endocrine Surgery

The UCSF Endocrine Surgery and Oncology Clinic provides multidisciplinary care and minimally invasive expertise for the treatment of thyroid cancer, as well as a full range of other malignant and benign diseases affecting the thyroid, parathyroid and adrenal glands.

Dr. Quan-Yang Duh

Dr. Quan-Yang Duh

"We frequently receive referrals for very difficult-to-do operations, such as recurrence of thyroid cancer or hyperparathyroidism,” said Quan-Yang Duh, M.D., chief of Endocrine Surgery. "The multidisciplinary aspect of care and expert application of localization technologies allow UCSF to successfully perform these complex operations, often with a minimally invasive approach."

UCSF is a high-volume center, performing more than 700 endocrine surgical operations annually. In addition to Duh, the surgical team includes Orlo Clark, M.D., Jessica Gosnell, M.D., and Wen Shen, M.D.

As well as caring for patients with thyroid cancer, endocrine surgeons at UCSF specialize in the treatment of thyroid nodules, lymph node metastases of thyroid cancer, goiters and Graves’ disease. The team also treats a number of parathyroid conditions, including primary and secondary hyperparathyroidism, and persistent or recurrent primary hyperparathyroidism. Commonly treated adrenal conditions include pheochromocytoma, Cushing's syndrome, hyperaldosteronism, adrenocortical cancer, adrenal metastases and incidentally discovered adrenal tumors. They also treat insulinoma, a pancreatic endocrine tumor.

For each condition, patients receive coordinated evaluation and treatment from a team of specialists who work in collaboration with the referring physician. Depending on the patient’s needs, that team may include an endocrine surgeon, endocrinologist, pathologist, cytopathologist, radiologist, nuclear medicine specialist and ultrasonographer. Complex cases are reviewed by a multidisciplinary tumor board.

Dr. Jessica Gosnell

Dr. Jessica Gosnell

One of the most commonly performed procedures is minimally invasive parathyroidectomy to treat hyperparathyroidism. By working closely with nuclear medicine and radiology experts, endocrine surgeons can frequently locate the diseased gland or glands prior to surgery, allowing for a minimally invasive approach using an incision of an inch or less, compared to a standard operation requiring a two-inch incision.

UCSF's endocrine surgeons frequently use the latest technologies when indicated, including surgeon-performed ultrasound, as well as intraoperative nerve monitoring to reduce risk of injury to the vocal cords.

The endocrine surgeons are skilled diagnosticians. "We have the ability, using intraoperative parathyroid hormone measurement, to document biochemical resolution of hyperparathyroidism in the operating room," Shen said. The surgeons also perform cryopreservation of parathyroid tissue for patients with a high risk of developing hypoparathyroidism following surgery, allowing for re-implantation to correct this condition.

In addition to treating patients with thyroid and parathyroid disorders, UCSF is a leading West Coast referral center for adrenal disease, including rare, complex conditions such as pheochromocytoma. UCSF's multidisciplinary approach ‐ including outstanding endocrinologists and anesthesiologists — allows minimally invasive laparoscopic adrenalectomy, minimizing the risk of complications and enabling patients to return home within a day or two.

Dr. Wen Shen

Dr. Wen Shen

UCSF is experienced in the care of patients with familial endocrine disease who often have different syndromes and require specialized care. A geneticist evaluates patients at risk for these conditions. UCSF also has a robust research program, with a particular emphasis on genetic conditions that can predispose the patient to cancer, as well as studying the molecular predictors of cancer aggressiveness, and the mechanisms by which these cancers grow and spread. The research is enhanced by an active research tissue bank. Other research efforts include molecular biology studies of adrenal disease and hyperparathyroidism.

UCSF participates in clinical trials, including those for investigational therapies for advanced thyroid cancer. UCSF endocrine surgeons have active national and international leadership roles, helping to shape treatment guidelines, and have a prestigious endocrine surgery fellowship program training future endocrine surgeons.

"We believe that it is our mission to take care of patients, but also to do research so we can provide better patient care, as well to train the next generation of endocrine surgeons,” Duh said.

Consultations and Referrals

For more information, call (415) 353-7687, or visit endocrine.surgery.ucsf.edu.

 

Inside Surgery — Summer 2012 Index

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