Completion thyroidectomy in differentiated thyroid cancer: When to perform?

Management of Patients with Cervicofacial Edema and Paresthesia during Perioperative Period of Transoral Endoscopic Thyroidectomy

Objective

To analyze the clinical intervention effect of transoral endoscopic thyroidectomy on the neck and face during perioperative period.

Method

From January 2019 to January 2020, 60 patients included in this study were randomly divided into observation group and control group according to the ratio of 1 : 1, with 30 cases in each group. Both groups underwent rapid surgical intervention during the perioperative period. The patients in the observation group received neck and face management. The degree of jaw swelling, the degree of facial microexpression completion, and the changes in jaw and neck sensation were compared between the two groups.

Results

There was no significant difference in neck and face swelling, pain, facial microexpression, and feeling between the two groups before operation. Patients with facial I/II swelling degree in the observation group were significantly more than in the control group, and the patients with III swelling degree were less than in the control group. There was significant difference for facial swelling between the two groups in the three intervention periods after the operation, and the difference was statistically significant (P < 0.05). The scores of facial microexpression in the observation group were higher than those in the control group during the three postoperative intervention periods, with statistical significance (P < 0.05). There was no significant difference in the pain score of the first day after surgery between the two groups (P = 0.298). In the other two postoperative intervention periods, the pain score of the observation group was lower than that of the control group, with a statistically significant difference, and the difference was statistically significant (P < 0.05). The threshold of chin and neck sensory pressure in the two groups was statistically significant (P < 0.05) except that the "cheek in area 4" (P = 0.290).

Conclusion

The results showed that these interventions, such as the elevation of bed after operation, 24-hour intermittent cryotherapy, ice cubes in mouth, and the "meter" functional training, have good clinical effects on the symptoms of facial swelling and abnormal sensation of neck and face. It can accelerate the speed of edema dissipation, improve the patients' postoperative comfort, and improve the satisfaction and quality of life of patients with the effect of surgery and beauty.

Robotic Completion Thyroidectomy via the Bilateral Axillo-Breast Approach

BACKGROUND

Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been successfully performed for thyroid cancer patients with excellent cosmetic results. Completion thyroidectomy is sometimes necessary after thyroid lobectomy, and whether it has a higher complication rate than the primary operation due to the presence of adhesions remains controversial. The aim of this study was to evaluate surgical outcomes, including operation time and postoperative complications, in patients who underwent BABA robotic completion thyroidectomy.

METHODS

From Jan 2012 to Aug 2020, 33 consecutive patients underwent BABA robotic completion thyroidectomy for a thyroid malignancy after BABA robotic thyroid lobectomy. The procedures were divided into five steps: (1) robot setting and surgical draping, (2) flap dissection, (3) robot docking, (4) thyroidectomy, and (5) closure. Clinicopathological characteristics, operation time, and postoperative complications were reviewed.

RESULTS

The total operation time was shorter for completion thyroidectomy than for the initial operation (164.8 ± 31.7 min vs. 179.8 ± 27.1 min, p = 0.043). Among the robotic thyroidectomy steps, the duration of the thyroidectomy step was shorter than that of the initial operation (69.6 ± 20.9 min vs. 83.0 ± 19.5 min, p = 0.009. One patient (1/33, 3.0%) needed hematoma evacuation under the flap area immediately after surgery. Three patients (3/33, 9.1%) showed transient hypoparathyroidism, and one patient (1/33, 3.0%) had permanent hypoparathyroidism. Two patients (2/33, 6.1%) showed transient vocal cord palsy and recovered within 3 months following the completion thyroidectomy. There were no cases of open conversion, tracheal injury, flap injury or wound infection.

CONCLUSIONS

BABA robotic completion thyroidectomy could be performed safely without completion-related complication.

Completion thyroidectomy: is timing important for transcervical and remote access approaches?

Completion thyroidectomy (CT) is employed after lobectomy when histopathological results mandates total removal of the gland as in case of well differentiated thyroid carcinoma (DTC). It is also employed as a second stage thyroid surgery when unfavorable events occur as in recurrent laryngeal nerve injury or when the surgeon finds out the case is beyond his/her expertise in an attempt to protect the contralateral side and allowing time for recovery or for an expert surgeon to help.

Hypocalcemia After Completion Thyroidectomy for Papillary Thyroid Carcinoma

Surgical management of papillary thyroid carcinoma (PTC) includes total thyroidectomy and lobectomy. After lobectomy, a reoperation called completion thyroidectomy is occasionally required. Postoperative hypocalcemia is the most common complication associated with thyroid surgery. Our main goal was to determine if there is a significant difference between the incidence rate of postoperative hypocalcemia in patients who underwent total thyroidectomy for PTC compared with patients who underwent completion thyroidectomy for PTC. Apart from that, we analyzed the following potential predictive factors for the occurrence of hypocalcemia: sex, age, size of tumor, side of tumor, maximum diameter of individual lobe, occult metastasis, and operating surgeon. The study involved 340 patients who underwent surgery for PTC at the Department of ENT and Head and Neck Surgery, Zagreb University Hospital Centre, between February 25, 2013 and January 3, 2016. Postoperative hypocalcemia incidence rates were higher in the total thyroidectomy group than in the completion thyroidectomy group (37.8% and 29.0%, respectively). However, these differences were not statistically significant. Every analyzed potential predictive factor was proven not to have any correlation with postoperative hypocalcemia. This study demonstrated that there was no significant difference between postoperative hypocalcemia rates in patients who underwent completion thyroidectomy compared with patients who underwent total thyroidectomy for PTC.

Completion Thyroidectomy in Differentiated Thyroid Malignancy-A Prospective Analysis

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.

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

Background

Despite a number of studies, the optimal timing of completion thyroidectomy is still controversial. This systematic review and meta-analysis aims to compare the outcomes of early versus delayed completion thyroidectomy regarding post-operative complications.

Methods

We performed a systematic review in electronic databases including: bumped, Scopus, Medline and Google Scholar to identify relevant studies. Eligibility criteria included studies comparing the outcomes of early versus delayed completion thyroidectomy with no language restriction. Publication bias was assessed by funnel plot, and Heterogeneity was assessed using I² statistic. Finally, pooled odds ratios (OR) with a 95% confidence interval (CI) was reported for comparing the overall complications rate.

Results

Eventually 7 studies were included. Delayed completion thyroidectomy was found to be associated with significantly lower rates of post-operative complications (OR =1.55; 95% CI, 1.00-2.42; Z=1.95; P=0.05) with low heterogeneity (I²=0%, P=0.55), and low risk of publication bias. The rate of transient hypocalcemia and persistent hypocalcemia were 8.97% and 1.52% in early completion thyroidectomy group, and 8.2% and 0.72%, in delayed completion thyroidectomy group. Transient vocal cord paresis occurred in 5.38% of the early CT group versus 3.27% in the delayed CT group.

Conclusions

This review is the first to summarize the outcome of early verse delayed completion thyroidectomy. The result of our systematic review and meta-analysis suggest that delayed completion thyroidectomy is associated with lower rate of post-operative complications compared to early completion thyroidectomy.

Safety of Completion Thyroidectomy for Initially Misdiagnosed Thyroid Carcinoma

INTRODUCTION

Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures of less than total or near-total thyroidectomy. Whether thyroid reoperations are associated with an increased complication risk is controversial.

OBJECTIVE

A retrospective analysis was done of patients undergoing completion thyroidectomy for cancer of the thyroid who had undergone surgery elsewhere for solitary thyroid nodule. The incidence of surgical complications in these patients after reoperation was investigated in this study.

MATERIAL AND METHODS

The study included a total of 53 patients who had undergone thyroid lobectomy for a solitary nodule as initial surgery elsewhere and were referred to our institute for completion thyroidectomy when the histopathology revealed malignancy.

RESULTS

There were 53 patients, 43 females and 10 males. Their mean age was 34.7±12.12 years (range 19-65 years). After initial surgery, the histopathology revealed papillary carcinoma in 46 patients (86.8%), follicular carcinoma in 7 (13.2%). Fourteen out of 53 patients had recurrent laryngeal nerve palsy after initial surgery (26.4%). None of the patients had clinical hypocalcemia after the first surgery. One or more parathyroid glands were identified and preserved in 52 patients (98.1%) in the process of completion thyroidectomy. No patient had additional recurrent nerve injury at the second surgery. The mean serum calcium value preoperatively was 8.96±0.39 mg/dL, and six months after surgery serum calcium was 8.74±0.56 mg/dL. Mean follow-up was 18 months. Transient hypoparathyroidism occurred in 24.5% patients. Five patients were lost to follow-up. Permanent and symptomatic hyperparathyroidism occurred in eight patients (16.67%).

CONCLUSIONS

Completion thyroidectomy is a safe and appropriate option in the management of well-differentiated thyroid cancer. It removes disease on the ipsilateral and contralateral side of the thyroid and carries a low risk of recurrent laryngeal nerve damage, but a higher risk of permanent hypoparathyroidism.