Van Remortel B J, Chehab L, Bauer A J, Isaza A, Yimei Li, Baumgarten Heron D, Franco Aime T, Laetsch Theodore W, Kazahaya Ken, Adzick N Scott, Mostoufi-Moab Sogol
Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatr Blood Cancer. 2022 Jun;69(6):e29674. doi: 10.1002/pbc.29674. Epub 2022 Mar 26.
Childhood cancer survivors (CCS) are at increased risk for thyroid disease, and many require definitive management with thyroid surgery. Despite this, there is limited evidence on surgical outcomes among CCS. We sought to evaluate postoperative outcomes at our institution among CCS undergoing thyroid surgery compared to patients without a history of primary childhood malignancy.
Medical records were reviewed for 638 patients treated at the Children's Hospital of Philadelphia Pediatric Thyroid Center between 2009 and 2020. Rates of surgical complications, including recurrent laryngeal nerve (RLN) paralysis and hypoparathyroidism, among CCS were compared to patients with sporadic/familial thyroid cancer, Graves' disease, and other benign thyroid conditions. Operative time and intraoperative parathyroid hormone levels were also evaluated.
There were no significant differences in long-term surgical complication rates, such as permanent RLN paralysis and hypoparathyroidism, between CCS and patients without a history of primary childhood malignancy (all p > .05). For all surgical outcomes, there were no significant differences in complication rates when CCS were compared to those undergoing surgery for sporadic/familial thyroid cancer or Graves' disease (all p > .05). CCS with benign final pathology had significantly higher rates of transient hypoparathyroidism compared to patients with benign thyroid conditions (p < .001).
Our study suggests that CCS are not at higher risk of long-term complications from thyroid surgery when treated by high-volume surgeons within a multidisciplinary team.
儿童癌症幸存者（CCS）患甲状腺疾病的风险增加，许多人需要通过甲状腺手术进行明确治疗。尽管如此，关于CCS手术结果的证据有限。我们试图评估在我们机构中接受甲状腺手术的CCS与无儿童期原发性恶性肿瘤病史的患者相比的术后结果。
回顾了2009年至2020年期间在费城儿童医院儿科甲状腺中心接受治疗的638例患者的病历。将CCS中手术并发症的发生率，包括喉返神经（RLN）麻痹和甲状旁腺功能减退，与散发性/家族性甲状腺癌、格雷夫斯病和其他良性甲状腺疾病患者进行比较。还评估了手术时间和术中甲状旁腺激素水平。
CCS与无儿童期原发性恶性肿瘤病史的患者之间，在长期手术并发症发生率方面，如永久性RLN麻痹和甲状旁腺功能减退，没有显著差异（所有p>.05）。对于所有手术结果，将CCS与接受散发性/家族性甲状腺癌或格雷夫斯病手术的患者相比，并发症发生率没有显著差异（所有p>.05）。最终病理为良性的CCS与良性甲状腺疾病患者相比，短暂性甲状旁腺功能减退的发生率显著更高（p<.001）。
我们的研究表明，在多学科团队中由经验丰富的外科医生治疗时，CCS甲状腺手术发生长期并发症的风险并不更高。
