The impact of completion thyroidectomy |
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| Affiliation: | 1. Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK;2. Department of Otolaryngology, Head and Neck Surgery, Kirkaldy, NHS Fife, UK;1. Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK;3. Department of General Surgery, Borders General Hospital, UK;4. Department of Endocrinology, NHS Lothian, Edinburgh, UK;1. Division of Endocrinology and Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN;2. Section of Endocrine Surgery, Mayo Clinic and College of Medicine, Rochester, MN;3. Division of Surgical Pathology, Mayo Clinic and College of Medicine, Rochester, MN;4. Division of Biostatistics, Mayo Clinic and College of Medicine, Rochester, MN;1. Department of Surgery, University Health Network, Toronto, ON, Canada;2. Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, the Netherlands;3. Department of Surgery, Hospital Group Twente Almelo, the Netherlands;4. ZGT Academy, Hospital Group Twente Almelo, the Netherlands;5. Department of Otolaryngology-Head Neck Surgery and Department of Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, ON, Canada;6. Department of Medicine, University Health Network, Toronto, ON, Canada;1. Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain;2. Departamento de Cirugía General y del Aparato Digestivo, Hospital da Luz Arrábida, Escola de Medicina, Universidade do Minho, Braga, Oport, Portugal;3. Departamento de Cirugía Endocrina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico |
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| Abstract: | IntroductionThe oncological benefit of completion thyroidectomy (CT) following thyroid lobectomy (TL) is presumed to be similar to that of upfront total thyroidectomy(TT), from a patient's perspective the risk and inconvenience of further surgery adds significantly to the impact of the overall treatment.The aim of this study is to assess the impact of CT in terms of the duration of admission and associated complications.MethodsA study of consecutive patients with DTC identified from prospective MDT records of South-East Scotland from 2009 to 2015. Surgical data was extracted from electronic medical record.ResultsOf 361 patients diagnosed with DTC, 161 (45%) had CT. The median postoperative stay was 1 day (range 1–5days). In total 22 patients (14%)suffered complications. Four patients (3%) developed postoperative haematoma. Two (1%) had an identified permanent nerve palsy on the completion side. 13 patients (8%) remained on calcium supplementation for more than 6 months postoperatively and three patients (2%) developed wound complications.ConclusionsOur study confirms that CT is regularly performed (45%). Recent changes in international guidelines recognize increasing number of patients as eligible for a conservative approach but recommend CT based on whether upfront TT would have been recommended if the TL pathology were known from the outset. Such an approach fails to consider the additional risk and inconvenience of CT on the overall patient experience.Due to a relatively high rate of complications, only those patients who are most likely to benefit from further surgery to facilitate adjuvant radioactive iodine should be offered additional surgery. |
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| Keywords: | Completion thyroidectomy Complications Hypocalcaemia Oncological benefits |
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