Large goiters and postoperative complications: does it really matter?
Complications
Goiter
Hypoparathyroidism
Recurrent injury
Thyroidectomy
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
29 May 2023
29 May 2023
Historique:
received:
23
02
2023
accepted:
24
05
2023
medline:
31
5
2023
pubmed:
29
5
2023
entrez:
29
5
2023
Statut:
epublish
Résumé
Thyroidectomy is one of the most commonly performed surgical procedures worldwide. Although the mortality rate is currently approaching 0%, the incidence of complications in such a frequent surgery is not insignificant. The most frequent are postoperative hypoparathyroidism, recurrent injury, and asphyxial hematoma. The size of the thyroid gland has traditionally been considered one of the most important risk factors, but there is currently no study that analyzes it independently. The objective of this study is to analyze whether the size of the thyroid gland is an isolated risk factor for the development of postoperative complications. A prospective review of all patients who underwent total thyroidectomy at a third-level hospital between January 2019 and December 2021 was conducted. The thyroid volume was calculated preoperatively using ultrasound and, together with the weight of the definitive piece, was correlated with the development of postoperative complications. One hundred twenty-one patients were included. When analyzing the incidence of complications based on the quartiles of weight and glandular volume, there were no significant differences in the incidence of transient or permanent hypoparathyroidism in any of the groups. No differences were found in terms of recurrent paralysis. No fewer parathyroid glands were visualized intraoperatively in patients with larger thyroid glands, nor did the number of them accidentally removed during surgery increase. In fact, a certain protective trend was observed with regard to the number of glands visualized and glandular size or in the relationship between thyroid volume and accidental gland removal, with no significant differences. The size of the thyroid gland has not been shown to be a risk factor for the development of postoperative complications, contrary to what has traditionally been considered.
Identifiants
pubmed: 37247029
doi: 10.1007/s00423-023-02959-5
pii: 10.1007/s00423-023-02959-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
213Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Halsted WS (1920) The operative story of goitre. Johns Hopkins Hosp Rep. 19:71–257
Kocher T (1883) Uber Kropfextirpation und ihre Folgen. Arch Klin Chirurgie. 29:254–337
Mayo CH, Pemberton JJ (1923) Surgery of the thyroid and its mortality. Ann Surg. 78(2):145–149
doi: 10.1097/00000658-192308000-00003
pubmed: 17864875
pmcid: 1400500
Beahrs OH, Ryan RF, White RA (1956) Complications of thyroid surgery. J Clin Endocrinol Metab. 16(11):1456–1469
doi: 10.1210/jcem-16-11-1456
pubmed: 13385296
Gómez-Ramírez J, Sitges-Serra A, Moreno-Llorente P, Zambudio AR, Ortega-Serrano J, Rodríguez MT et al (2015) Mortality after thyroid surgery, insignificant or still an issue? Langenbecks Arch Surg. 400(4):517–522. https://doi.org/10.1007/s00423-015-1303-1
doi: 10.1007/s00423-015-1303-1
pubmed: 25900848
Musholt TJ, Bränström R, Kaderli RM, Pérez NM, Raffaelli M, Stechman MJ (2019) Accreditation of endocrine surgery units. Langenbecks Arch Surg. 404(7):779–793. https://doi.org/10.1007/s00423-019-01820-y
doi: 10.1007/s00423-019-01820-y
pubmed: 31494716
D'Orazi V, Sacconi A, Trombetta S, Karpathiotakis M, Pichelli D, Di Lorenzo E et al (2019) May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score. BMC Surg. 18(Suppl 1):116. https://doi.org/10.1186/s12893-018-0447-7
doi: 10.1186/s12893-018-0447-7
pubmed: 31074389
pmcid: 7402572
Chen AY, Bernet VJ, Carty SE, Davies TF, Ganly I, Inabnet WB 3rd et al (2014) American Thyroid Association statement on optimal surgical management of goiter. Thyroid. 24(2):181–189
doi: 10.1089/thy.2013.0291
pubmed: 24295043
Jin S, Sugitani I (2021) Narrative review of management of thyroid surgery complications. Gland Surg. 10(3):1135–1146. https://doi.org/10.21037/gs-20-859
doi: 10.21037/gs-20-859
pubmed: 33842257
pmcid: 8033047
David F Schneider 1 , Haggi Mazeh, Sarah C Oltmann, Herbert Chen, Rebecca S Sippel. Novel thyroidectomy difficulty scale correlates with operative times. World J Surg.2014 ;38(8):1984-1989. doi: https://doi.org/10.1007/s00268-014-2489-z .
Daher R, Lifante JC, Voirin N, Peix JL, Colin C, Kraimps JL et al. Is it possible to limit the risks of thyroid surgery? Ann Endocrinol (Paris). 2015 Feb;76(1 Suppl 1):1S16-1S26. doi: https://doi.org/10.1016/S0003-4266(16)30010-5 .
Snyder SK, Lairmore TC, Hendricks JC, Roberts JW (2008) Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. J Am Coll Surg 206:123–130. https://doi.org/10.1016/j.jamcollsurg.2007.07.017
doi: 10.1016/j.jamcollsurg.2007.07.017
pubmed: 18155577
Ríos A, Rodríguez JM, Canteras M, Riquelme J, Illana J, Balsalobre MD (2005) Multivariate study of risk factors for developing complications after multinodular goiter surgery. Cir Esp. 77(2):79–85. https://doi.org/10.1016/s0009-739x(05)70812-5
doi: 10.1016/s0009-739x(05)70812-5
pubmed: 16420892
Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A (2015) Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 102(4):359–367. https://doi.org/10.1002/bjs.9676
doi: 10.1002/bjs.9676
pubmed: 25605285