Completion Thyroidectomy in Differentiated Thyroid Malignancy—A Prospective Analysis

Abstract

Completion thyroidectomy, being a surgically challenging procedure, choice of doing such procedure in differentiated thyroid cancer (DTC), remains unclear due to the complications involved following the procedure. So this study is intended to look into risk factors that will prompt completion thyroidectomy and surgery-related complications. A prospective analysis was done in 48 patients diagnosed with DTC during the year 2017. Completion thyroidectomy with or without neck dissection was performed as per institutional protocol. Clinico-radiological features were compared with histopathology in completion thyroidectomy specimen. The incidence of malignancy in completion thyroidectomy specimen and complications during the procedure were noted. Risk factors associated with malignancy were statistically analyzed. The incidence of malignancy in completion thyroidectomy specimen was 56.25%. Papillary carcinoma thyroid (PCT) had a statistically significant risk compared to follicular carcinoma thyroid (p = 0.042). Also, capsular invasion in primary specimen had a significant impact (p = 0.021) with odds of 7.20 times increase in incidence of malignancy and patients with age more than 55 years had a significantly increased risk of malignancy (p = 0.05). There was no statistically significant increase in complications following procedure, with respect to duration between surgeries or type of surgeries performed. Incidence of malignancy in completion thyroidectomy specimen was high. Completion thyroidectomy can be safely performed under experienced hands with an acceptable level of complications. It should be considered in places where patients are non-compliant and in those with PCT, tumor with capsular invasion and elderly patients.

What Should We Prefer in the Surgical Management of Differentiated Thyroid Carcinomas?

“…Park and Min reported that they made a diagnosis from lateral neck nodes in a group of patients with nonpalpable thyroid carcinoma, and they performed near-total lobectomy + cervical lymph node dissection in some of these patients and only hemithyroidectomy in some of them (20). Likewise, other authors, who believe that small carcinomas of the thyroid may be more aggressive than palpable tumours, turned to additional neck dissections along with total thyroidectomy for these tumours (21). Noguchi indicated that the radical neck dissection they performed in only 9 patients was quite an unnecessary intervention, and such an intervention could only be performed in the presence of nodal metastases defined in the contralateral deep cervical nodes (16).…”

“…The fact that the possibility of multicentric carcinoma increases the risk of subsequent local recurrence in the contralateral thyroid lobe and the expectation for a facilitating effect for ablation treatment when required after this approach is argued as the main indications for the method (22,23). The incidence of residual carcinoma in the contralateral lobe obtained with completion thyroidectomy was reported to be 28% by some authors and 27% by Rao et al (20)(21). Another author stated that the incidence of residual thyroid cancer in reoperation specimens was 31%, and they emphasised that completion thyroidectomy was an appropriate option for lesions larger than 1 cm in the first operation because 0% of these patients had the potential for residual cancer (22).…”

Diagnostic Accuracy of Ultrasonography in Revision Thyroid Surgery: Can It Predict Disease Outcomes?

“…Gimm et al and Pantvaidya et al had reported RLN palsy > 10% in their cohort of revision cases [25,27]. Patients having RLN palsy after revision surgery have also been shown to have a longer recovery time as compared to per primum surgery [24].…”

“…They reported an actuarial disease-specific survival at 20 years of 100%, 94%, and 60% in patients with no recurrence, one recurrence, and multiple recurrences, respectively [21]. Literature on thyroid reoperations for residual/recurrent disease report a RLN palsy rate of 0-25% and a hypocalcemia rate of 0-14.6% [22][23][24][25]. Publications with a minimum sample size of 100 quote a RLN palsy rate of 0-3% and a hypocalcemia rate of 10% [16,26].…”