Completion Thyroidectomy: Effect of Timing on Clinical Complications and Oncologic Outcome in Patients With Differentiated Thyroid Cancer

Abstract

Background Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial. Methods Between January 1993 and December 2009, a total of 128 patients underwent completion thyroidectomy for differentiated thyroid carcinoma: papillary (n = 87) and follicular (n = 41). These patients were divided into five groups according to the time of the completion thyroidectomy after primary surgery (groups A, 1–3 days; B, 4–7 days; C, 1–7 weeks; D, 7–12 weeks; E, >3 months). Clinical complications and oncologic outcomes were analyzed. The mean follow‐up was 82.5 ± 17 months. Results The overall rates of transient and persistent postoperative hypocalcemia were 7.0 and 3.1%, respectively. The rates of persistent hypocalcemia were significantly increased in groups B, C, and D in comparison to those in groups A and E (p < 0.003). The hypocalcemia rates were 7.1, 4.5, and 3.8% versus 0%, respectively. Transient or persistent vocal cord paresis was observed in eight (6.2%) and four patients (3.1%), respectively. The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups B, C, and D than in groups A and E (p < 0.003). The VCP rates were 7.1, 4.5, and 3.8% versus 0%, respectively. There was no significant difference regarding survival or recurrence among the five groups. Conclusions Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed either within 3 days or beyond 3 months after primary surgery.

Complications of Completion Versus Total Thyroidectomy

“…The results of the present study are compatible with literature. Reported complication rates of temporary RLN palsy ranges between 1.3-5.6 % and 0.9-5.6 for permanent RLN palsy for completion thyroidectomy in recent literature (Pezullo et al, 1997;Lefevre et al, 2007;Rafferty et al, 2007;Glockzin et al, 2012 ). Incidence of temporary hypoparathyroidism ranges between 3-15%, and incidence of permanent hypoparathyroidism ranges between 0-3.5% for completion thyroidectomy for DTC (Erdem et al, 2003;Makay et al, 2006;Varaldo et al, 2012).…”

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“…It often manifests as a complication of thyroid surgery. 1,2 Direct injury, ischemia, and unintended excision of parathyroid tissue are the most common causes of temporary or permanent hypoparathyroidism (PH). Temporary hypoparathyroidism (duration, < 6 mo) develops in 10% of patients after thyroid surgery, nearly half of whom develop PH (duration, > 6 mo).…”

Optimum Timing and Complication of Completion Thyroidectomy for Differentiated Thyroid Cancer

“…The indication for completion thyroidectomy in patients with incidentally established differentiated thyroid tumor after primary thyroid operation should consider patient-related, tumor-related, and treatment-related criteria [6].…”

“…While the indications for completion thyroidectomy for thyroid cancer diagnosed postoperatively are without excessive debate, the timing of such operation is still a matter of controversy [6]. Thus, in the current study we retrospectively evaluated 118 patients who underwent completion thyroidectomy at different time intervals after primary operation in regard to perioperative complications and long-term oncologic outcome.…”

“…Additionally, intraoperative frozen section may be useful to avoid an incomplete resection in patients with thyroid malignancies. On the other hand, in up to 10% of patients histological surprise of cancer thyroid were detected postoperatively in patients whose operated on for benign thyroid disease [1] [5] [6] [7] [8] [9].…”