The purpose of this study was to evaluate the factors influencing morbidity after total thyroidectomy for carcinoma, such as the histotype, the extension of surgery, the primary surgery versus reoperation, and the surgeon’s experience.
We performed a retrospective analysis on inferior laryngeal nerve (ILN) injury and permanent hypoparathyroidism (HPT) rates in 504 consecutive patients with thyroid carcinoma who were operated on by the same surgeon from 1999 to 2006. The following parameters were assessed at univariate analysis: histotype, total thyroidectomy with or without central node dissection (level VI), primary surgery versus reoperation, and early (group 1: 1999–2002, 143 patients) and late (group 2: 2003–2006, 361 patients) experience.
The global incidence rates of ILN palsy and permanent HPT were 2.18% and 6.3%, respectively. The incidence of ILN damage after total thyroidectomy plus node dissection versus total thyroidectomy without node excision was 2.87% vs. 0.36% (p = 0.029). The incidence of permanent HPT in group 1 was 13.2% vs. 3.6% in group 2 (p = 0.0001). Moreover, the incidence rate of ILN palsy resulted higher in group 1 (2.8%) and in reoperation (3.4%), while the permanent HPT resulted higher in thyroidectomy with node dissection (6.8%) and reoperation (6.9%), although the difference was not significant.
The complications after total thyroidectomy were progressively reduced as a result of a more accurate technique. Nevertheless, our study showed that the incidence of complications is mostly related to the dissection of central lymph node (level VI) and the surgeon’s experience.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Deaconson TF (1986) Total or near total thyroidectomy versus limited resection for radiation-associated thyroid nodules. Surgery 100(6):1116–1120
Clark OH, Levin K, Zeng Q, et al. (1988) Thyroid cancer: the case for total thyroidectomy. Eur J Cancer Clin Oncol 24:305–313
Hermann M, Alk G, Roka R, et al. (2002) Laryngeal recurrent nerve injury in surgery for benign thyroid diseases. Ann Surg 235: 261–268
Serpell JW, Phan D (2007) Safety of total thyroidectomy. ANZ J Surg 77:15–19
Erbil Y, Barbaros U, Issever H, et al. (2007) Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol 32:32–37
Rosato L, Avenia N, Bernante P, et al. (2004) Complications of thyroid surgery: analysis of a multicentric study. World J Surg 28:271–276
Roher HD, Goretzki PE, Hellmann P, et al. (1999) Complications in thyroid surgery. Incidence and therapy. Chirurg 70:999–1010
Henry JF, Gramatica L, Denizot A (1998) Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbacks Arch Surg 383:167–169
Menegaux F, Dahman M, Leenhardt L (2001) Morbidity of lymph node excision associated with total thyroidectomy for well differentiated thyroid carcinoma. Int J Surg Investig 2:107–114
Chiang F, Wang L, Huang Y, et al. (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137:342–347
Lo CY, Kwok KF, Yuen PW (2000) A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 135:204–207
Bergamaschi R, Becouarn G, Ronceray J, et al. (1998) Morbidity of thyroid surgery. Am J Surg 176:71–75
Evans WE, Mendelowitz DS, Liapis CD (1982) Motor speech deficit following carotid endoarterectomy. Ann Surg 196:461–464
Myssiorek D (2004) Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am 37:25–44
Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24:971–975
Campana FP, Marchesi M, Biffoni M (1996) Technique of total thyroidectomy. Ann Ital Surg 1:566–576
Moley JF, Lairmore TC, Doherty GM (1999) Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations. Surgery 126:673–679
Noguchi S, Murakami N, Toda M (1998) Papillary thyroid carcinoma. Modified radical neck dissection improves prognosis. Arch Surg 133:276–280
Grebe SK, Hay ID (1996) Thyroid cancer nodal metastases: Biologic significance and therapeutic considerations. Surg Oncol Clin N Am 5:43–63
Ballantyne AJ (1991) Neck dissection for thyroid cancer. Semin Surg Oncol 7:100–106
Hermann M, Hellebart C, Freissmuth M (2004) Neuromonitoring in thyroid surgery. Ann Surg 240:9–17
Otto RA, Cochran CS (2002) Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation in predicting postoperative nerve paralysis. Ann Otol Rhinol Laryngol 111:1005–1007
About this article
Cite this article
Toniato, A., Boschin, I.M., Piotto, A. et al. Complications in Thyroid Surgery for Carcinoma: One Institution’s Surgical Experience. World J Surg 32, 572–575 (2008). https://doi.org/10.1007/s00268-007-9362-2
- Thyroid Carcinoma
- Papillary Thyroid Carcinoma
- Parathyroid Gland
- Total Thyroidectomy
- Permanent Hypoparathyroidism