Background: Given the good prognosis of low-risk papillary thyroid microcarcinomas (lrPTMCs) accurate risk stratification is valuable to optimize management: active surveillance vs. surgery. BRAFV600E testing was associated with increased recurrence risk, hence AS seems reasonable for mutation-negative lrPTMC. However, when considering AS, patient perception is highly important as adherence and emotional aspects are challenging. In this study, we aimed to model the contribution of BRAFV600E testing for the management of PTMCs when tailored to the patient perspective. Methods: We developed a Markovian model to predict the role of BRAFV600E in prioritizing between hemithyroidectomy (HT) and active surveillance (AS) for lrPTMCs. We used a simulated cohort of lrPTMCs, with probabilities of each strategy driven from previous literature. Outcomes were measured as quality-of-life years (QALYs). One- and two-way sensitivity analyses were conducted to ascertain model robustness. Results: We found that the optimal strategy (e.g., that would maximize QALYs) varies according to BRAFV600E status for patients without a preset predilection between AS to HT. Using one-way sensitivity analysis, we found that the two main variables that have the strongest impact on the decision are the utility of AS and the utility of a disease-free state after HT. Two-way sensitivity analysis demonstrated that BRAFV600E status can define the optimal strategy for patients in the middle zone of the utility range (e.g., patients without clear preference). Conclusions: Our model suggests that BRAFV600E status can facilitate decision-making regarding AS vs. HT for patients without preset predilection. Our model supports further real-life studies of BRAFV600E testing for PTMCs.

Objectives: Drainless parotidectomy has been reported infrequently, mostly in patients undergoing limited partial parotidectomies. Evicel is a fibrin sealant (FS) glue whose use has not been reported in head and neck surgeries so far. The aim of the study was to investigate the impact of drainless parotidectomy using FS on the surgical outcome. Design: A retrospective matched case-control series. Settings: A single academic center, Participants: All cases of patients who underwent drainless parotidectomies, including deep lobe tumors and revision surgeries, were compared to age, sex, body mass index and tumor-matched controls in which a suction drain was inserted. Main outcome measures: length of hospital stay (LOS). Secondary outcomes included post-operative seroma and related complications. Results: A total of 123 patients (41 cases and 82 controls) were included in the study. Pre-operative and intra-operative characteristic did not differ significantly between the FS group and controls. A borderline significance was found for surgery type as the FS group had higher rates of total parotidectomy compared with the control group (25.0% vs. 10.5%, p=0.054). LOS was significantly shorter in the FS group (1.0±0.3 vs. 1.5±0.6 days, p<0.001). The rates of post-operative seroma, aspirations, local infection and post-operative antibiotic treatment were all lower in the FS group compared with the control group, but did not reach statistical significance. Conclusion: A drainless parotidectomy using the EVICEL FS is safe, reduces LOS, and may reduce post-operative seroma and its associated complications. This procedure may be applied to deep parotid tumors, parapharyngeal involvement and revision surgery.