Completion Thyroidectomy for Differentiated Thyroid Cancer (Results in a Consecutive Series of 68 Patients)

D.I.S.C., Unità Operativa di Chirurgia Generale ad Indirizzo Endocrino, Università degli Studi di Genova, Italy.
Acta chirurgica Belgica (Impact Factor: 0.41). 01/2012; 112(1):40-3.
Source: PubMed


Completion thyroidectomy plays an important role in the management of patients with thyroid cancer. The aim of this study is to determine the indications for and timing of a second surgery, as well as surgical complications.
Operative reports, as well as the hospital and outpatient records of 686 consecutive patients, who had undergone surgery for differentiated thyroid cancer, were reviewed. Among these, 68 (9,9%) patient records of a completion thyroidectomy for cancer were analyzed.
The mean time interval between the first and second operation was 3.6 months (range: 1-9). Post-operative complications occurred in 9 patients (12,9%). Among three patients with inferior laryngeal nerve palsy (4,4%) one had definitive palsy (1.4%). Hypoparathyroidism occurred in 6 patients (8,8%) being permanent in one of them (1.4%). No significant difference either for definitive inferior laryngeal nerve lesions (p = 0.9) or for definitive hypocalcemia (p = 1) was found between the groups of patients who had a completion thyroidectomy and those who had a one-step total thyroidectomy for cancer.
Correct indications for re-operation, total lobectomy as a primary surgical procedure as well as lateral access to the residual thyroid gland could all reduce the high risks of complications related to this kind of surgery.

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    ABSTRACT: Background Thyroid cancer is the most common neck malignancies which accounts for 1% of all malignancies and 4% of thyroid diseases. Its incidence rate is increasing year by year. It is more frequent in women. Most thyroid cancer is well differentiated and lower malignant. Surgery is the main effective treatment. Because of the lack of specific symptoms and coexisting with benign thyroid disease, the preoperative diagnosis rate is low. And these patients often are re-operated because of misdiagnosis and mistreatment. We will discuss the causes of misdiagnosis of thyroid cancer, countermeasures and reoperation in this article. Methods Analysis misdiagnosed causes of 77 cases of thyroid cancer and the effect of reoperation. Results 77 cases were diagnosed only according to preoperative physical, ultrasound and laboratory tests. 71 cases outsides of our hospital were caused misdiagnosis because of initial surgery without frozen section; 6 cases misdiagnosed by our hospital, In these 2 cases without the frozen section, 2 cases with frozen sections misdiagnosed as benign adenomas and 2 cases could not give qualitative diagnosis. All 77 cases were done a repeat operation. The residual cancer diagnosis coincidence rate that we calculated was 71.4% before reoperation. After reoperation, pathology confirmed 35 cases remained thyroid cancer, residual cancer rate is 45.45%; Preoperative clinical examination show lymph node metastasis coincidence rate is 80%; 60 cases underwent routine central area or regional selective and modified neck lymph node dissection. 40 patients were pathologically confirmed lymph node metastasis. 3 cases had transient hypocalcemia. From reoperation to the last follow-up the time was 3 to 41 months. No case had cancer recurrence, complications and death. Conclusions Single preoperative diagnosis method and no intra-operative frozen section are the mam reasons for misdiagnosis. The patients of misdiagnosed thyroid cancer should be given reoperation ti- ely. According to the individual condition, we can choose a reasonable surgical method and the reoperation effect is satisfactory.
    No preview · Conference Paper · Aug 2012
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    ABSTRACT: Introduction: The objective of this study was to analyze the complication rates after completion thyroidectomy and compare them with primary total benign and malign thyroidectomy causes in total of 647 patients. Patients and methods: Among 647 patients, there were 159 receiving completion thyroidectomy for differentiated thyroid cancer (DTC) (Group 1); 217 patients receiving total thyroidectomy for DTC (Group 2) and 271 given total thyroidectomy for benign diseases (Group 3). Results: When groups were compared for complications, there were no significant difference except temporary hypocalcemia between completion thyroidectomy and total thyroidectomy for DTC. When the total thyroidectomies were compared (Group 2 and 3), there were no significant difference observed except unilateral temporary RLN palsy. Conclusion: With improvements in surgical technique and experience, complication rates of thyroidectomy performed for benign or malign diseases are reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidism are the main complications in completion thyroidectomies which need special attention. To evaluate the patients more carefully in preoperative period and performing adequate thyroidectomy appears more logical.
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