Extended Resection for Thyroid Disease has Less Operative Morbidity than Limited Resection

Abstract

Background: Theodor Kocher, surgeon and Nobel laureate, has influenced thyroid surgery all over the world: his treatment for multinodular goiter-subtotal thyroidectomy-has been the ''Gold Standard'' for more than a century. However, based on a new understanding of molecular growth mechanisms in goitrogenesis, we set out to evaluate if a more extended resection yields better results. Methods: Four thousand three hundred and ninety-four thyroid gland operations with 5,785 ''nerves at risk'' were prospectively analyzed between 1972 and 2002 . From 1972, the limited Kocher resections were performed, and from 1991 to 2002 a more radical resection involving at least a hemithyroidectomy was performed. Results: The incidence of postoperative nerve palsy was 3.6% in the first study period and 0.9% in the second (P < 0.001, FisherÕs exact). Postoperative hypoparathyroidism decreased from 3.2% in the first period to 0.64% in the second (P < 0.01). The rate of reoperation for recurrent disease was 11.1% from 1972 to 1990 and 8.5% from 1991 to 2002 (P < 0.01). Conclusions: Extended resection for multinodular goiter not only significantly reduced morbidity, but also decreased the incidence of operations for recurrent disease. Our findings in a large cohort corroborate the suggestions that KocherÕs approach should be replaced by a more radical resection, which actually was his original intention more than 130 years ago.

Impact of surgical technique on operative morbidity and its socioeconomic benefit in thyroid surgery

“…The present results emphasize our previously reported findings [10], now over a period of 39 years, namely that an extended thyroid resection is associated with a significantly reduced rate of permanent nerve palsy and hypoparathyroidism compared to subtotal resection. The risk of morbidity was significantly lower in the second study period due to (a) change in general surgical strategy, meaning hemithyroidectomy in all eligible patients with unilateral benign thyroid diseases or total thyroidectomy in bilateral benign disease, and (b) change in surgical technique with obligatory visualization of the recurrent laryngeal nerves and the parathyroid glands.…”

“…In spite of sufficient dietary iodine intake in the present day, multinodular goiter remains an endemic disease in Switzerland [3]. Further research and understanding of the molecular growth mechanism in goitrogenesis [4][5][6] and an inacceptable high recurrence rate associated with subtotal thyroidectomy led endocrine surgeons to adopt a more extended surgical resection for benign multinodular goiter disease [7][8][9][10][11]. Previous studies showed that total thyroid resection is a safe procedure.…”

Totale Thyreoidektomie bei Knotenstruma

“…Aufgrund der hierdurch erreichten Reduktion des relativen und absoluten Risikos würde jeder 38. Patient von einer radikaleren Resektion profitieren [47]. Auch Dralle kal- [44,52].…”

Long-Term Follow-Up After Complete Resection of Well-Differentiated Cancer Confined to the Thyroid Gland

“…Previous studies on TR at our institution could not rectify limited resections based on nerve injury rates. 44 However, guidelines recommending TR as the treatment of choice also take into consideration that secondary total thyroidectomy for disease recurrence has a higher risk of complications than primary total thyroidectomy. Very recently, Bilimoria et al advocated TR in all PTC patients with tumors greater than 1 cm based on a very large population from the National Cancer Data Base.…”