Abstract
Re-operative thyroid surgery is a relatively uncommon procedure complicated by distorted anatomy and post-operative tissue changes. Surgery may follow initial benign or malignant pathology. Published outcomes vary widely in the literature. This study aims to report our outcomes from re-operative thyroid surgery. Patient demographics and complication rates for consecutive thyroidectomies performed by a single surgeon at a tertiary centre were collected between 1993 and 2013. Outcomes in re-operative surgery are analysed and compared with local and national data. Cases of re-operative surgery following benign disease are further analysed for histology, re-presenting symptoms and time between procedures. Our cohort comprised 1,657 cases including 164 re-operative procedures (101 malignant, 63 benign). Within our cohort re-operative cases were on average 4 years older (mean 49.9 vs 45.9 years, p = 0.001) and had a higher incidence of haematoma formation (4.3 vs 1.7 %, p = 0.033) and transient recurrent laryngeal nerve palsy (5.5 vs 2.5 %, p = 0.044) compared to primary surgery. Rates of permanent hypocalcaemia (2.4 vs 1.8 %, p = 0.540) and permanent RLN palsy (1.8 vs 0.4 %, p = 0.051) were higher in the re-operative group but did not reach significance. Comparison of complications following re-operation for benign and malignant disease revealed no significant differences. Mean interval to re-operation for benign cases was 17.4 years with 74.6 % found to have multinodular goitre at repeat procedure. Re-operative procedures comprised around 10 % of thyroid surgery at our centre. Re-operative cases experienced more complications than primary surgery but permanent rates were low. Re-operative surgery may therefore be safely considered in experienced hands.
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References
Calò PG, Pisano G, Medas F, Tatti A, Tuveri M, Nicolosi A (2012) Risk factors in reoperative thyroid surgery for recurrent goitre: our experience. G Chir 33:335–338
Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot J-P, Menegaux F (2007) Reoperative surgery for thyroid disease. Langenbecks Arch Surg Dtsch Ges Für Chir 392:685–691
Cooper DS, Doherty GM, Haugen BR, Hauger BR, Kloos RT, Lee SL et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214
Shaha AR (2008) Revision thyroid surgery—technical considerations. Otolaryngol Clin North Am 41:1169–1183
Stone HB, Coleman CN, Anscher MS, McBride WH (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4:529–536
Chao TC, Jeng LB, Lin JD, Chen MF (1997) Reoperative thyroid surgery. World J Surg 21:644–647
Kim JH, Chung MK, Son Y-I (2011) Reliable early prediction for different types of post-thyroidectomy hypocalcemia. Clin Exp Otorhinolaryngol 4:95–100
Terris DJ, Khichi S, Anderson SK, Seybt MW (2010) Reoperative thyroidectomy for benign thyroid disease. Head Neck 32:285–289
Levin KE, Clark AH, Duh QY, Demeure M, Siperstein AE, Clark OH (1992) Reoperative thyroid surgery. Surgery 111:604–609
Pironi D, Panarese A, Candioli S, Manigrasso A, La Gioia G, Romani AM et al (2008) Reoperative thyroid surgery: personal experience and review of the literature. G Chir 29:407–412
Menegaux F, Turpin G, Dahman M, Leenhardt L, Chadarevian R, Aurengo A et al (1999) Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery 126:479–483
Chadwick D, Kinsman R, Walton P (2012) British Association of endocrine and thyroid surgeons 4th National audit report 2012 (internet), 1st edn. Dendrite Clinical Systems Ltd, Henley-on-Thames. Available from: http://www.baets.org.uk/Pages/4th%20National%20Audit.pdf
Park H, Shin Y (2004) Measuring case-mix complexity of tertiary care hospitals using DRGs. Health Care Manag Sci 7:51–61
British Association of head and neck oncologists (2013). Head and neck cancer—surgeon level data—first report (internet). Available from: http://www.nhs.uk/choiceintheNHS/Yourchoices/consultant-choice/Documents/Head%20and%20Neck%20Cancer%20Surgeon%20Report.pdf
Lo CKK (2000) A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 135:204–207
Mehanna HM, Jain A, Randeva H, Watkinson J, Shaha A (2010) Postoperative hypocalcemia—the difference a definition makes. Head Neck 32:279–283
Grogan RH, Mitmaker EJ, Hwang J, Gosnell JE, Duh Q-Y, Clark OH et al (2012) A population-based prospective cohort study of complications after thyroidectomy in the elderly. J Clin Endocrinol Metab 97:1645–1653
Bliss R, Patel N, Guinea A, Reeve TS, Delbridge L (1999) Age is no contraindication to thyroid surgery. Age Ageing 28:363–366
Kim MK, Mandel SH, Baloch Z, Livolsi VA, Langer JE, Didonato L et al (2004) Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg 130:1214–1216
Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC (2005) Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J 52:199–206
General medical council. Good medical practice (internet) (2013). Available from: http://www.gmc-uk.org/guidance/good_medical_practice.asp
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Hardman, J.C., Smith, J.A., Nankivell, P. et al. Re-operative thyroid surgery: a 20-year prospective cohort study at a tertiary referral centre. Eur Arch Otorhinolaryngol 272, 1503–1508 (2015). https://doi.org/10.1007/s00405-014-3068-5
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DOI: https://doi.org/10.1007/s00405-014-3068-5