Abstract
Background and aims
Reoperative surgery for thyroid disease is rare. However, it is sometimes indicated for nodular recurrence after partial surgery for initially benign thyroid disease or for a completion total thyroidectomy when a final diagnosis of well-differentiated thyroid cancer (WDTC) is confirmed on a permanent section of a partially removed thyroid gland. This surgery can expose the patient to postoperative complications such as recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism. The aims of our study were to describe the population subjected to reoperative thyroid surgery and to evaluate postoperative morbidity to find the risk factor.
Patients and methods
The present study is a retrospective analysis of our experience with completion thyroidectomy: 685 consecutive patients underwent this procedure in a 14-year period, for a recurrent uninodular (85 patients) or multinodular (333 patients) goiter, recurrent thyrotoxicosis (42 patients), or a completion thyroidectomy for WDTC after partial resection of the thyroid gland (225 patients). The operative technique was standardized with identification of the RLN and parathyroid glands before removal of the thyroid gland. l-Thyroxin treatment was started the day after surgery. Postoperative rates of suffocating hematoma, wound infection, RLN palsy, hypoparathyroidism, and persistence or recurrence of hyperthyroidism were studied and compared to the same parameters in patients who underwent primary bilateral thyroid gland resection during the same period.
Results
The transient morbidity rate was 8%, with 5% hypoparathyroidism, 1.2% RLN palsy, 0.9% suffocating hematoma, and 0.2% wound infection. These results were higher than those from cases of primary thyroid resection for bilateral disease. Within the secondary surgery group, postoperative complications depended on the mean weight of the resected thyroid gland, hyperthyroidism, and the bilaterality of thyroid exploration during the previous surgery. The permanent morbidity rate was 3.8%, including 1.5% RLN palsy and 2.5% hypoparathyroidism. Permanent complication rates were higher than those for primary thyroid resection. Incidental carcinoma was found in 92 patients (13%): 10% (42 of 418) in patients with recurrent euthyroid nodular disease, 7% (3 of 42) in patients with recurrent hyperthyroidism, and 21% (47 of 225) in patients who underwent a completion thyroidectomy for cancer.
Conclusion
Because reoperative thyroid surgery can lead to potential complications, especially permanent RLN palsy or hypoparathyroidism, it should be reserved for patients who need it. The importance of respecting specific technical rules should be emphasized.
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References
Calabro S, Auguste LJ, Attie JN (1998) Morbidity of completion thyroidectomy for initially misdiagnosed thyroid carcinoma. Head Neck Surg 10:235–238
Chao TC, Jeng LB, Lin JD, Chen MF (1997) Reoperative thyroid surgery. World J Surg 21:644–647
Levin KE, Clark AH, Duh QY, Demeure M, Siperstein AE, Clark OH (1992) Reoperative thyroid surgery. Surgery 111:604–609
Menegaux F, Turpin G, Dahman M, Leenhardt L, Chadarevian R, Aurengo A, Du Pasquier L, Chigot JP (1999) Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: A study if 203 cases. Surgery 125:479–483
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer (The American Thyroid Association Guidelines Taskforce). Thyroid 16(2):1–34
Alzahrani AS, Al Mandil M, Chaudhary MA, Ahmed M, Mohammed GE (2002) Frequency and predictive factors of malignancy in residual thyroid tissue and cervical lymph nodes after partial thyroidectomy for differentiated thyroid cancer. Surgery 131:443–449
Esnaola NF, Cantor SB, Sherman SI, Lee JE, Evans DB (2001) Optimal treatment strategy in patients with papillary thyroid cancer: a decision analysis. Surgery 130:921–930
Hay ID, Grant CS, Bergstralh EJ, Thompson GB, Heerden JA, Goellner JR (1998) Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma. Surgery 124:958–966
Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137:342–347
Sierra M, Herrera MF, Herrero B, Jimenez F, Sepulveda J, Lozano RR, Gamino R, Gonzalez O, Correa-Rotter R (1998) Prospective biochemical and scintigraphic evaluation of autografted normal parathyroid glands in patients undergoing thyroid operations. Surgery 124:1005–1010
Pasieka JL, Thompson NW, McLeod MK, Burney RE, Macha M (1992) The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J Surg 16:711–717
Pasieka JL (2003) Reoperative thyroid surgery. In: Randolph GW (ed) Surgery of the thyroid and the parathyroid glands. Elsevier, Philadelphia, pp 385–391
Menegaux F, Ruprecht T, Chigot JP (1993) The surgical treatment of Graves’ disease. Surg Gynecol Obstet 176:277–282
Miccoli P, Vitti P, Rago T, Iacconi P, Bartalena L, Bogazzi F, Fiore E, Valeriano R, Chiovato L, Rocchi R, Pinchera A (1996) Surgical treatment of Graves’ disease: subtotal or total thyroidectomy? Surgery 120:1020–1025
Tan MP, Agarwal G, Reeve TS, Barraclough BH, Delbridge LW (2002) Impact of timing on completion thyroidectomy for thyroid cancer. Br J Surg 89:802–804
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Lefevre, J.H., Tresallet, C., Leenhardt, L. et al. Reoperative surgery for thyroid disease. Langenbecks Arch Surg 392, 685–691 (2007). https://doi.org/10.1007/s00423-007-0201-6
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DOI: https://doi.org/10.1007/s00423-007-0201-6