Causes, Timing, and Safety of Completion Thyroidectomy during the Follow-up Period after Lobectomy: a Single-Center Experience
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Purpose: Thyroid lobectomy is a standard procedure for patients with papillary thyroid carcinoma (PTC) with tumor size <4 cm and clinically negative lymph nodes (LNs) and is performed more frequently than total thyroidectomy. Completion thyroidectomy (CT) is an unexpected operation after lobectomy that has an unpredictable complication rate. In this study, we evaluated the causes, timing, and safety of CT based on our experience. Methods: From January 2005 to December 2016, 7,731 patients underwent thyroid surgery in our institution. In this study, we included 63 patients who underwent CT for recurrent or contralateral thyroid disease during the follow-up period after lobectomy for PTC through retrospective chart review. We analyzed the causes and timing of CT, initial clinicopathologic factors of PTC, and the complication rate. Results: All patients underwent initial thyroid lobectomy for PTC. On initial pathology, mean tumor size was 0.69 cm and 7.9% (5/63) patients had central LN metastasis. Patients underwent CT after a mean of 68.4 months (6–388 months). The cause of CT was local or regional recurrence in 52.4% (30/63) of patients, contralateral PTC in 49.2% (31/63), and contralateral benign nodule in 3.17% (2/63). After CT, persistent hypoparathyroidism occurred in 1.58% (1/63), hoarseness in 1.58% (1/63), and wound infection in 1.58% (1/63). Conclusion: CT may be performed for recurrent or non-recurrent causes anytime during the patient's lifetime after lobectomy. The postoperative complication rate is relatively low. Special attention should be paid during CT.
Abstract
Purpose: Thyroid lobectomy is a standard procedure for patients with papillary thyroid carcinoma (PTC) with tumor size <4 cm and clinically negative lymph nodes (LNs) and is performed more frequently than total thyroidectomy. Completion thyroidectomy (CT) is an unexpected operation after lobectomy that has an unpredictable complication rate. In this study, we evaluated the causes, timing, and safety of CT based on our experience. Methods: From January 2005 to December 2016, 7,731 patients underwent thyroid surgery in our institution. In this study, we included 63 patients who underwent CT for recurrent or contralateral thyroid disease during the follow-up period after lobectomy for PTC through retrospective chart review. We analyzed the causes and timing of CT, initial clinicopathologic factors of PTC, and the complication rate. Results: All patients underwent initial thyroid lobectomy for PTC. On initial pathology, mean tumor size was 0.69 cm and 7.9% (5/63) patients had central LN metastasis. Patients underwent CT after a mean of 68.4 months (6–388 months). The cause of CT was local or regional recurrence in 52.4% (30/63) of patients, contralateral PTC in 49.2% (31/63), and contralateral benign nodule in 3.17% (2/63). After CT, persistent hypoparathyroidism occurred in 1.58% (1/63), hoarseness in 1.58% (1/63), and wound infection in 1.58% (1/63). Conclusion: CT may be performed for recurrent or non-recurrent causes anytime during the patient's lifetime after lobectomy. The postoperative complication rate is relatively low. Special attention should be paid during CT.
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