Short-Term Outcomes after Unilateral Versus Complete Thyroidectomy for Malignancy: A National Perspective

ArticleinThe American surgeon 75(1):20-4 · January 2009with9 Reads
Source: PubMed
Abstract
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.
    • "Complication rates comparing lobectomy versus total thyroidectomy are quite variable in the literature even if Elaraj and Clark [43] demonstrated that they are similar in the hands of an experienced endocrine surgeon. A large Italian study of 14,934 patients reported higher complication rates following TT [59], and similar results were showed by Zerey et al. [60] demonstrating that TT was associated with increased morbidity, total charges, and length of hospital stay. Ryu et al. [61] observed that voice and throat dysfunction may occur following thyroidectomy , even in the absence of apparent laryngeal nerve injury and are more frequent after TT. "
    [Show abstract] [Hide abstract] ABSTRACT: In the last decades, a surprising increased incidence of differentiated thyroid cancer (DTC), along with a precocious diagnosis of "small" tumors and microcarcinomas have been observed. In these cases, better oncological outcomes are expected, and a "tailored" and "less aggressive" multimodal therapeutic protocol should be considered, avoiding an unfavorable even if minimal morbidity following an "overtreatment." In order to better define the most suitable surgical approach, its benefits and risks, we discuss the role of surgery in the current management of DTCs in the light of data appeared in the literature. Even if lymph node metastases are commonly observed, and in up to 90 % of DTC cases micrometastases are reported, the impact of lymphatic involvement on long-term survival is still argument of intensive research, and indications and extension of lymph node dissection (LD) are still under debate. In particular, endocrine and neck surgeons are still divided between proponents and opponents of routine central LD (RCLD). Considering the available evidence, there is agreement about total thyroidectomy, therapeutic LD in clinically node-positive DTC patients, and RCLD in "high risk" cases. Nevertheless, indications to the best surgical treatment of clinically node-negative "low risk" patients are still subject of research. Considering on the one hand, the recent trend toward routine central lymphadenectomy, avoiding radioactive treatment, and on the other hand, the satisfactory results obtained reserving prophylactic LD to "high risk" patients, we think that further prospective randomized trials are needed to evaluate the best choice between the different surgical approaches.
    Full-text · Article · Apr 2014
  • [Show abstract] [Hide abstract] 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.
    Full-text · Article · Dec 2010
  • Article · Jan 2011 · Archives of otolaryngology--head & neck surgery
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