Siteman Cancer Center Offers Scarless Surgery for Benign or Cancerous Thyroid Conditions

An innovative procedure for patients with benign or cancerous thyroid conditions offers less, even zero, scarring at Siteman Cancer Center, based at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis.

Washington University physicians at Siteman now offer scarless thyroidectomy and parathyroidectomy procedures. The minimally invasive, scarless procedures provide an alternative to frontal neck scars that are typical with traditional thyroid surgery.

“We make three small incisions inside the lower lip to endoscopically remove all or part of a thyroid gland,” said Washington University head and neck surgeon R. Alex Harbison, MD. “There is no outward scar on the neck anymore, and studies have shown that outcomes are consistently as good as traditional open thyroid surgery.”

Studies also have noted similarly shorter hospital stays, rapid healing and low complication rates. Patients undergoing the transoral partial thyroidectomies go home the same day after the procedure. Those needing total thyroidectomies are admitted for typically a one-day hospital stay.

Harbison, who is fellowship-trained, notes that there are minimal risks, including injury to the recurrent laryngeal nerve, which can lead to voice hoarseness, or hypocalcemia, which can necessitate calcium supplementation. Both are risks also associated with conventional thyroid surgery. In rare cases, excessive bleeding may warrant a change from a transoral procedure to the traditional frontal neck approach.

A desire for an improved appearance with no visible scar drove the development of the scarless technique, Harbison said. “Up to 20% of people who undergo a thyroidectomy are concerned about a scar on the neck years later,” he said. “With safety, costs and outcomes similar to that of the traditional approach, we can eliminate the scar.”

Sidharth Puram, MD, PhD, chief of head and neck surgery at Washington University and Siteman, noted that WashU physicians have been at the forefront of treatments for head and neck cancers for years. “We performed microvascular free tissue transfers in the 1990s and expanded into partial laryngeal procedures and then transoral robotic surgeries,” he said. “We also have been at the forefront of advances in voice preservation surgery and tissue reconstruction. I see scarless thyroidectomies as a natural evolution of our broader goal of providing excellent approaches to cancer control — and for treating certain benign conditions of the thyroid gland.”

Washington University head and neck surgeons at Siteman perform several hundred thyroid procedures annually. These specialists pioneered transoral laser microsurgery (TLM) for the treatment of early stage and advanced head and neck cancers. Last year, Washington University and Barnes-Jewish Hospital established the Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at Siteman, a multidisciplinary center comprising specialists who collaborate to provide care, offer leading-edge clinical trials and engage in transformative research. The center is co-led by Puram, medical oncologist Douglas Adkins, MD, and radiation oncologist Wade Thorstad, MD, and includes specialists in otolaryngology, medical oncology, radiation oncology, neurosurgery, ophthalmology, vascular surgery, thoracic surgery, plastic surgery, palliative care, endocrinology and radiology. The center also has dedicated patient navigators and a psychologist and social worker.

“It’s a one-of-a-kind center,” Puram said. “It is both a cancer center and a place to treat benign tumors and head and neck conditions. We have a fully integrated program.”

Siteman Cancer Center has the region’s largest and most comprehensive program for the treatment of head and neck cancers. Half of all head and neck cancers diagnosed in Missouri are treated at Siteman, including early, advanced, metastatic and recurrent cancers.

“We offer all approaches to treat thyroid conditions,” said Harbison, who organized Washington University’s Third Annual Head and Neck Cancer Research Symposium. “For those interested in the transoral, scarless approach, we carefully select patients who would benefit from the procedure. The interesting thing to note is that diagnosis of thyroid cancers is on the rise — probably due to increased imaging that can detect such cancers early.”

Harbison added, “General surgeons and otolaryngologists here at WashU have made great advances in the treatment of thyroid cancers. The legacy is strong, and we continue to research and offer the most innovative treatments available.”

To make an appointment at the Head & Neck Tumor Center at Siteman, call 314-747-7222 or 800-600-3606, or visit www.siteman.wustl.edu.