Completion thyroidectomy in differentiated thyroid cancer: When to perform?

Abstract

Objective: Completion thyroidectomy is recommended in patients who have been diagnosed with differentiated thyroid cancer on histopathological evaluation, if their first operation was a conservative approach. The critical issue is when to do the second operation. Material and Methods:The medical records of 66 patients who underwent completion thyroidectomy for the treatment of differentiated thyroid cancer in our clinic between 2006-2013 were retrospectively analyzed. All data were compared after patients were divided into two groups according to the interval between the first surgery and completion thyroidectomy.Results: Fifty-two patients (78.8%) were women and 14 patients (21.2%) were male. Completion thyroidectomy was performed 10-90 days after the initial surgery (group 1) in 26 patients, whereas it was performed later than 90 days in 40 patients (group 2). Temporary hypoparathyroidism occurred in two patients (7.7%) in group 1, and in 3 patients (7.5%) in group 2. Transient recurrent laryngeal nerve palsy was observed in 1 patient (3.9%) in group 1, and in 1 patient (2.5%) in group 2. There were no permanent morbidities in both groups. Residual tumor rate after completion thyroidectomy was 45.5%. There was no statistically significant difference between the two groups in terms of complications after completion thyroidectomy. Conclusion:Although in some studies it is recommended that completion thyroidectomy should be performed either before scar tissue development or after clinical remission of scar tissue, edema and inflammation, we believe that timing of surgery has no effect on morbidity.Key Words: Thyroid cancer, thyroidectomy, intraoperative complication, repeat surgery INTRODUCTIONAlthough the type of surgery in the treatment of differentiated thyroid cancer (DTC) is still being debated, in recent years many authors recommend total thyroidectomy in these patients with good prognosis due to the metastasis potential, even though it is rare (1, 2). Udelsman and Shaha (3) advocate total thyroidectomy stating that with limited surgery the risk of recurrence, reoperation and morbidity increase and that radioactive iodine (RAI) ablation occurs at lower doses. In contrast, some authors suggest conservative approaches based on the findings that risk of anaplastic transformation is below 1%, multicentric tumors do not significantly affect the clinical course, and in limited surgery; RAI therapy is possible with lower morbidity, the prognosis does not change and the complication rate is lower (4, 5). Similarly, although what needs to be done in patients pathologically diagnosed with DTC and in whom a conservative approach had been preferred during the first surgery is still controversial, a completion thyroidectomy is often suggested in high-risk patients in order not to leave any thyroid tissue behind (6, 7). The critical point is the timing of the second operation.In our study, we retrospectively evaluated patients who underwent completion thyroidectomy for DTC with emphasis on the importance of timing of the...

Impact of completion thyroidectomy timing on post-operative complications: a systematic review and meta-analysis

“…Most common complications reported were transient hypocalcemia, persistent hypocalcemia, transient vocal cord paresis, persistent vocal cord paresis and transient hypoparathyroidism. In Most patients the histopathologic examination of the restricted thyroid gland, after the primary procedure showed papillary cancer (1,13,17,18). The heterogeneity in our meta-analysis was low (I 2 =0), indicating that the studies included in our systematic review and meta-analysis were statistically reliable.…”

“…Completion thyroidectomy is the removal of the remaining thyroid tissues with a second operation in patients who have had a lobectomy as the primary operation that revealed thyroid malignancy (1). The indication of completion thyroidectomy fall under three categories.…”

Safety of Completion Thyroidectomy for Initially Misdiagnosed Thyroid Carcinoma

“…Extent of resection and surgical technique had a greater impact on the rates of permanent postoperative hypoparathyroidism than thyroid pathologic condition 19. Other series have reported an incidence of temporary hypoparathyroidism of 0% to 14%, and a permanent hypoparathyroidism incidence around 2% to 8% 5–10,13,20–22…”

Completion Thyroidectomy for Initially Misdiagnosed Differentiated Thyroid Carcinoma-Study of 51 cases

“…20 Other series have reported an incidence of temporary hypoparathyroidism of 0% to 14%, and a permanent hypoparathyroidism incidence around 2% to 8%. [2][3][4][5][6][7]10,[21][22][23] With improvements in surgical technique and experience, complication rates of thyroidectomy performed for benign or malignant diseases are reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidism are the main complications in completion thyroidectomies, which need special attention.…”