Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
Department of Otolaryngology, Head and Neck Surgery, Kirkaldy, NHS Fife, UK.
Eur J Surg Oncol. 2019 Jul;45(7):1171-1174. doi: 10.1016/j.ejso.2019.03.018. Epub 2019 Mar 18.
The oncological benefit of completion thyroidectomy (CT) following thyroid lobectomy (TL) is presumed to be similar to that of upfront total thyroidectomy(TT), from a patient's perspective the risk and inconvenience of further surgery adds significantly to the impact of the overall treatment. The aim of this study is to assess the impact of CT in terms of the duration of admission and associated complications.
A study of consecutive patients with DTC identified from prospective MDT records of South-East Scotland from 2009 to 2015. Surgical data was extracted from electronic medical record.
Of 361 patients diagnosed with DTC, 161 (45%) had CT. The median postoperative stay was 1 day (range 1-5days). In total 22 patients (14%)suffered complications. Four patients (3%) developed postoperative haematoma. Two (1%) had an identified permanent nerve palsy on the completion side. 13 patients (8%) remained on calcium supplementation for more than 6 months postoperatively and three patients (2%) developed wound complications.
Our study confirms that CT is regularly performed (45%). Recent changes in international guidelines recognize increasing number of patients as eligible for a conservative approach but recommend CT based on whether upfront TT would have been recommended if the TL pathology were known from the outset. Such an approach fails to consider the additional risk and inconvenience of CT on the overall patient experience. Due to a relatively high rate of complications, only those patients who are most likely to benefit from further surgery to facilitate adjuvant radioactive iodine should be offered additional surgery.
完成甲状腺切除术（CT）对甲状腺叶切除术（TL）后的肿瘤学益处被认为与直接全甲状腺切除术（TT）相似，但从患者的角度来看，进一步手术的风险和不便会显著增加整体治疗的影响。本研究旨在评估 CT 在住院时间和相关并发症方面的影响。
从 2009 年至 2015 年，从苏格兰东南部的多学科治疗记录中连续选择患有 DTC 的患者进行研究。从电子病历中提取手术数据。
在 361 例诊断为 DTC 的患者中，有 161 例（45%）进行了 CT。术后中位住院时间为 1 天（范围 1-5 天）。共有 22 例（14%）患者发生并发症。4 例（3%）患者发生术后血肿。2 例（1%）在完成侧出现永久性神经麻痹。13 例（8%）患者术后仍需补钙超过 6 个月，3 例（2%）患者出现伤口并发症。
我们的研究证实 CT 经常进行（45%）。最近国际指南的变化认识到越来越多的患者有资格采取保守治疗方法，但建议根据 TL 病理在最初已知的情况下是否会推荐直接 TT 来进行 CT。这种方法未能考虑到 CT 对整体患者体验的额外风险和不便。由于并发症发生率相对较高，只有那些最有可能从进一步手术中受益以促进辅助放射性碘治疗的患者才应接受额外手术。
