ABSTRACT

Aim:

We aimed to compare primary total thyroidectomy and completion thyroidectomy in terms of postoperative morbidity.

Methods:

The morbidity of primary thyroidectomy operations and completion thyroidectomy operations performed in the general surgery clinic at Haseki Research and Training Hospital Hospital was retrospectively evaluated. Consecutive patients, in whom neuromonitoring was not done according to the surgeon’s choice, were enrolled for primary thyroidectomy and completion thyroidectomy groups.

Results:

There were no statistically significant difference in age, sex (p=0.998), hormonal status (p=0.287), presence of nodule (p=0.287), number of lobes removed (p=0.695), multicentricity (p=0.081) in regard to complications between the two groups. It was seen that the risk ratio (the odds ratio) was 11.9 times higher in patients in whom appropriate time was not waited for the second operation. When all patients were evaluated, the distribution of complication was found to be significantly higher in group 2 than in group 1 (p=0.003). The probability of developing complications in group 2 was 10.6 fold (odds ratio) higher than in group 1. Neither nerve nor parathyroid damage was permanent.

Conclusion:

Although technological developments and preoperative diagnostic methods reduce the need for completion thyroidectomy nowadays, the probability of complication is higher than that in patients who initially underwent total thyroidectomy. However, in experienced hands, the rate of permanent complications does not change.

References

1Li YJ, Wang YZ, Yi ZB, Chen LL, Zhou XD. Comparison of Completion Thyroidectomy and Primary Total Surgery for Differentiated Thyroid Cancer: A Meta-Analysis. Oncol Res Treat 2015;38:528-31.

2Gulcelik MA, Kuru B, Dincer H, et al. Complications of completion versus total thyroidectomy. Asian Pac J Cancer Prev 2012;13:5225-8.

3Corso C, Gomez X, Sanabria A, Vega V, Dominguez LC, Osorio C. Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis. Int J Surg 2014;12:837-42.

4Cirocchi R, Trastulli S, Randolph J, et al. Total or near-total thyroidectomy versus subtotal thyroidectomy for multinodular non-toxic goitre in adults. Cochrane Database Syst Rev 2015;7:CD010370.

5Machens A, Hinze R, Lautenschlager C, Thomusch O, Dralle H. Prophylactic completion thyroidectomy for differentiated thyroid carcinoma: prediction of extrathyroidal soft tissue infiltrates. Thyroid 2001;11:381-4.

6Pacini F, Elisei R, Capezzone M, et al. Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in low- and high-risk patients. Thyroid 2001;11:877-81.

7Agarwal A, Mishra SK. Completion total thyroidectomy in the management of differentiated thyroid carcinoma. Aust N Z J Surg 1996;66:358-9.

8Erbil Y, Bozbora A, Ademoğlu E, Salmaslıoğlu A, Özarmağan S. J Otolaryngeol Head Neck Surg 2008;37:56-64.

9Walgenbach S, Junginger T. Is the timing of completion thyroidectomy for differentiated thyroid carcinoma prognostic significant? Zentralbl Chir 2002;127:435-8.

10El-Zohairy M, Zaher A. Re-operation for the treatment of well differentiated thyroid cancer: Necessity, safety and impaction on further management. J Egypt Natl Canc Inst 2004;1:130-6.

11Pasieka JL, Thompson NW, McLeod MK, et al. The incidence of bilateral welldifferentiated thyroid cancer found at completion thyroidectomy. World J Surg 1992;16:711-3.

12De Groot LJ, Kaplan EL. Second operations for “completion” of thyroidectomy in treatment of differentiated thyroid cancer. Surgery 1991;110:936-7.

13Untch BR, Palmer FL, Ganly I, et al. Oncologic outcomes after completion thyroidectomy for patients with well-differentiated thyroid carcinoma. Ann Surg Oncol 2014;21:1374-8.

14Kısaoğlu A, Özoğul B, Akçay MN, et al. Completion thyroidectomy in differentiated thyroid cancer: When to perform? Ulus Cerrahi Derg 2014;30:18-21.

15Chao TC, Jeng LB, Lin JD, Chen MF. Completion thyroidectomy for differentiated thyroid carcinoma. Otolaryngol Head Neck Surg 1998;118:896-9.

16Wax MK, Briant TD. Completion thyroidectomy in the management of welldifferentiated thyroid carcinoma. Otolaryngol Head Neck Surg 1992;107:63-5.

17Eroğlu A, Berberoğlu U, Buruk F, et al Completion thyroidectomy for differentiated thyroid carcinoma. J Surg Oncol 1995;59:261-3.

18Kupferman ME, Mandel SJ, DiDonato L, Wolf P. Safety of completion thyroidectomy following unilateral lobectomy for well-differentiated thyroid cancer. Laryngoscope 2002;112:1209-12.

19Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS.Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res 2015;197:348-53.

20Ito Y, Kihara M, Kobayashi K, Miya A, Miyauchi A. Permanent hypoparathyroidism after completion total thyroidectomy as a second surgery: How do we avoid it? Endocr J 2014;6:403-8.

21Erdem E, Gülcelik MA, Kuru B, Alagol H. Comparison of completion thyroidectomy. Eur J Surg Oncol 2003;29:747-9.

22Reeve TS, Delbridge L, Brady P, et al. Secondary thyroidectomy: a twenty-year experience. World J Surg 1991;12:449-5.

23Spies WG, Wojtowize CH, Shah AY. Value of post therapy I-131 whole body scan in the evaluation of patients with thyroid carcinoma having undergone high dose I-131 therapy. Clin Nucl Med1989;14:793-800.

24Haugen BR.Radioiodine remnant ablation: current indications and dosing regimens. Endocr Pract 2012;18:604-10.

25Hamming JF, Van de Velde CJ, Groslings BM, et al. Prognosis and morbidity after total thyroidectomy for papillary, follicular and medullary thyroid cancer. Eur J Cancer Clin Oncol 1989;25:1317-23.

26Arnold RE, Edge BK. A descriptive experience of total thyroidectomy as the initial operation for differentiated carcinoma of the thyroid. Am J Surg 1989;158:396-8.

27Harness JK, McLeod MK, Thompson NW, Noble WC, Burney RE. Death due to differentiated thyroid cancer. World J Surg 1988;12:623-9.

28Brooks JR, Starnes HF, Brooks DC, Pelkey JN. Surgical therapy for thyroid carcinoma: a review of 1249 solitary thyroid nodules. Surgery 1988;104:940-6.

29Leblanc G, Tabah R, Liberman M, Sampalis J, Younan R, How J. Large remnant I-131 ablation as an alternative to completion/total thyroidectomiy in the treatment of well-differentiated thyroid cancer. Surgery 2004;136:1275-80.

30Ramacciotti C, Pretorius HT, Line BR, Goldman JM, Robbins J. Ablation of nonmalignant thyroid remnants with low doses of radioactive iodine: concise communication. J Nuc Med 1982;23:483-9.

31Wax MK, Briant TD. Completion thyroidectomy in the management of well-differentiated thyroid carcinoma. Otolaryngol Head Neck Surg 1992;107:63-5.

32Pezzullo L, Delrio P, Losito NS, et al. Postoperative complications after completion thyroidectomy for differentiated thyroid cancer. Eur J Surg Oncol 1997;23:215-8.

33Kim ES, Kim TY, Koh YI, Hong SJ, Kim WB, Shong YK. Completion thyroidectomy in patients with thyroid cancer who initially underwent unilateral operation. Clin Endocrinol 2004;61:145-8.

34Chao T, Jeng L, Lin J, Chen M. Reoperative thyroid surgery. World J Surg 1997;21:644-7.

Is Morbidity High in Completion Thyroidectomy?

ABSTRACT

References