Short-term outcomes after unilateral versus complete thyroidectomy for malignancy: A national perspective
Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA. The American surgeon
(Impact Factor: 0.82).
The extent of thyroidectomy for well-differentiated thyroid cancer (WDTC) remains controversial. We compared outcomes of patients undergoing unilateral thyroid lobectomy (UTL) versus complete thyroidectomy (CT) to determine the best operative management of WDTC. We compared outcomes of patients who underwent UTL or CT for malignancy using the 1999 to 2003 editions of the National Inpatient Sample database. A total of 13,854 patients underwent UTL (n = 4,238) and CT (n = 9,616). The CT group was more likely to have complications than the UTL group (15% vs 6%, P < 0.0001). Mean total charges were higher in the CT group ($11,432) versus the UTL group ($9,739), as was LOS (2 days versus 1 day); P < 0.0001. Complete thyroidectomy is associated with increased morbidity, total charges, and length of stay. The higher risk of short-term complications should be considered when considering performing a complete thyroidectomy for WDTC.
Available from: Chau T Nguyen
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ABSTRACT: recently, there has been a debate regarding total thyroidectomy vs hemithyroidectomy for papillary thyroid microcarcinoma (PTMC).
to determine whether there were significant differences in the treatment of PTMC depending on a physician's experience, age, training, and location.
a 10-question survey was distributed to otolaryngologists, general surgeons, and endocrine surgeons. It included 4 clinical scenarios, 2 questions querying clinical reasoning, and 4 demographic questions (training, surgical volume, location, and age). The demographic variables were used to analyze responses to the 4 clinical scenarios with bivariate and multivariate statistics.
a total of 438 responders completed the survey. Given a single subcentimeter PTMC, 70.3% of surgeons recommended no further surgery after a hemithyroidectomy, yet 29.7% believed that completion thyroidectomy was necessary. Otolaryngologists chose total thyroidectomy more frequently, as did surgeons from the South and West. Given PTMC with lymphatic invasion, 392 (89.5%) responders recommended completion thyroidectomy, with otolaryngologists again more inclined toward completion surgery. Given multifocal PTMC, 85.4% chose completion thyroidectomy, with surgeons in the South and West recommending total thyroidectomy more frequently compared with those in the Northeast. Improved survival, surgeon preference, and need for thyroid suppression were rated relatively insignificant. Ease of patient follow-up and multifocality of disease were judged very significant. Influence from national guidelines and current literature was rated as only somewhat or minimally significant.
in this survey, most surgeons seemed to follow national guidelines regarding the surgical treatment of PTMC. However, significant differences in the treatment and perception of PTMC exist based on surgical training and location.
Archives of otolaryngology--head & neck surgery 12/2010; 136(12):1182-90. DOI:10.1001/archoto.2010.193 · 2.33 Impact Factor
Available from: Sareh Parangi
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ABSTRACT: To assess whether perioperative surgical outcomes associated with thyroid operations were different in those with benign or malignant conditions, we queried the NSQIP, a multi-institutional, risk-adjusted, prospective U.S. database.
A total of 10,838 patients who underwent initial thyroid surgery as their principal operation during 2005-2007 were analyzed. Analysis focused on demographics, preoperative risk factors, operative details, postoperative complications, return to the operating room, and length of surgical stay.
Thirty-three percent of patients had a postoperative diagnosis of malignancy. Mean operating time was 121.8 min (119.3 min benign, 123.0 min malignant, P = .004) and average length of stay 1.16 days (1.12 days benign, vs. 1.21 days malignant, P = .007). Overall morbidity (return to the operating room plus medical complications) was 3.8% for the entire cohort, significantly higher in patients with malignant disease (4.9 vs. 3.3%, respectively, P < .001). On multivariate analysis, American Society of Anesthesiologists class, congestive heart failure (odds ratio [OR] 6.83, 95% confidence interval [CI] 1.81-25.80), dyspnea, and return to the operating room (OR 5.41, 95% CI 3.1-9.45) were significant risk factors for complications, while malignant disease (OR 2.25, 95% CI 1.75-2.9), outpatient status (OR 3.16, 95% CI 2.4-4.17), and other complications (OR 6.46, 95% CI 3.61-11.54) were risk factors for returning to the operating room.
Patients undergoing thyroid surgery for malignancy have a longer length of stay (1.21 days), longer operation times, and return to the operating room at higher rates compared to those with benign disease. Malignancy itself is only an independent risk factor for return to the operating room and not other complications; surgeons may consider keeping those patients overnight for observation.
Annals of Surgical Oncology 07/2011; 18(13):3551-8. DOI:10.1245/s10434-011-1938-2 · 3.93 Impact Factor
Available from: Iain James Nixon
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ABSTRACT: There remains controversy over the type of surgery appropriate for T1T2N0 well differentiated thyroid cancers (WDTC). Current guidelines recommend total thyroidectomy for all but the smallest lesions, despite previous evidence from large institutions suggesting that lobectomy provides similar excellent results. The objective of this study was to report our experience of T1T2N0 WDTC managed by either thyroid lobectomy or total thyroidectomy.
Eight hundred eighty-nine patients with pT1T2 intrathyroid cancers treated surgically between 1986 and 2005 were identified from a database of 1810 patients with WDTC. Total thyroidectomy was carried out in 528 (59%) and thyroid lobectomy in 361 (41%) patients. Overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) were determined by the Kaplan-Meier method. Factors predictive of outcome by univariate and multivariate analysis were determined using the log rank test and Cox proportional hazards method respectively.
With a median follow-up of 99 months, the 10-yr OS, DSS, and RFS for all patients were 92%, 99%, and 98% respectively. Univariate analysis showed no significant difference in OS by extent of surgical resection. Multivariate analysis showed that age over 45 yr and male gender were independent predictors for poorer OS, whereas T stage and type of surgery were not. Comparison of the thyroid lobectomy group and the total thyroidectomy group showed no difference in local recurrence (0% for both) or regional recurrence (0% vs 0.8%, P = .96).
Patients with pT1T2 N0 WDTC can be safely managed by thyroid lobectomy alone.
Surgery 10/2011; 151(4):571-9. DOI:10.1016/j.surg.2011.08.016 · 3.38 Impact Factor
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