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Surgical treatment for multinodular goitres in geriatric patients

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Abstract

Background

Although age is not a contraindication for thyroid surgery, few elderly patients undergo surgery due to the greater risk of morbidity. The aims of this study are to determine in patients aged >65 years: (1) whether the indications for surgery on multinodular goitre (MG) differ with respect to younger patients; (2) the surgical results; and (3) whether the postsurgery morbidity and mortality rates are higher.

Patients and method

Eighty-one patients aged over 65 years who were receiving surgery for MG were analysed; 40 49%) presented with associated co-morbidities. Sixty percent had thyroid symptoms, either compressive and/or toxic. All underwent programmed surgery following stabilisation and strict control of their co-morbidities. As a control group we used 510 MG patients receiving surgery and aged between 30 and 65 years.

Results

Compared with the control group the geriatric patients had a longer time of goitre evolution (P=0.032), greater presence of symptoms (P=0.001) and a higher percentage of intrathoracic component (P=0.001). Compressive symptoms were the major indication for surgery (P=0.001). Postoperative complications occurred in 40% of the patients, a higher rate than in the control group (28%; P=0.011), although a large percentage of those complications were transitory. Definitive complications included two recurrent laryngeal nerve injuries (2.5%). The preoperative symptoms remitted in all the patients, and only three were associated with a thyroid carcinoma, one of which was anaplastic.

Conclusions

MG operated on in elderly patients has a longer evolution and an intrathoracic component, and surgery is indicated restrictively. With close monitoring of the co-morbidities and a programmed operation the results with regard to morbidity and mortality are similar to those obtained at younger ages.

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References

  1. Shetty KR, Duthie EH Jr (1995) Thyroid disease and associated illness in the elderly. Clin Geriatr Med 11:311–325

    CAS  PubMed  Google Scholar 

  2. Denham MJ, Wills EJ (1980) A clinico-pathological survey of thyroid glands in old age. Gerontology 26:160–166

    CAS  PubMed  Google Scholar 

  3. Ozbakir O, Dogukan A, Kelestimur F (1995) The prevalence of thyroid dysfunction among elderly subjects in an endemic goiter area of central Anatolia. Endocr J 42:713–716

    CAS  PubMed  Google Scholar 

  4. Hurley DL, Gharib H (1995) Thyroid nodular disease: is it toxic or nontoxic, malignant or benign? Geriatrics 50:24–31

    CAS  Google Scholar 

  5. Rolla AR (1995) Thyroid nodules in the elderly. Clin Geriatric Med 11:259–269

    CAS  PubMed  Google Scholar 

  6. Passler C, Avanessian R, Kaczireck K, Prager G, Scheuba C, Niederle B (2002) Thyroid surgery in the geriatric patient. Arch Surg 137:1243–1248

    Article  PubMed  Google Scholar 

  7. Lubin MF (1993) Is age a risk factor for surgery? Med Clin North Am 77:327–333

    CAS  PubMed  Google Scholar 

  8. Nusbaum NJ (1996) How do geriatric patients recover from surgery? South Med J 89:950–957

    CAS  PubMed  Google Scholar 

  9. Lehnert T, Roberts PJ (1998) Special issue on cancer surgery in the elderly (editorial). Eur J Surg Oncol 24:361

    Article  Google Scholar 

  10. Ryynanen OP, Myllykangas M, Kinnunen J, Takala J (1997) Doctors’ willingness to refer elderly patients for elective surgery. Fam Pract 14:216–219

    Article  CAS  PubMed  Google Scholar 

  11. Simpson WJ (1982) Thyroid malignancy in the elderly. Geriatrics 37:119–125

    CAS  Google Scholar 

  12. Miccoli P, Iacconi P, Cecchini M, Caldarelli F, Ricci E, Berti P, Puccini M (1994) Thyroid surgery in patients aged over 80 years. Acta Chir Belg 94:222–223

    CAS  PubMed  Google Scholar 

  13. McKenna RJ Sr (1994) Clinical aspects of cancer in the elderly: treatment decisions, treatment choices, and follow up. Cancer 74:2107–2117

    PubMed  Google Scholar 

  14. Rowe JW (1996) Health care myths at the end of life. Bull Am Coll Surg 81:11–18

    CAS  Google Scholar 

  15. Lehnert T, Pfitzenmaier J, Hinz U, Herfarth C (1998) Surgery for local recurrence or distant metastases in patients aged 75 years or older. Eur J Surg Oncol 24:418–422

    Article  CAS  PubMed  Google Scholar 

  16. Colorectal Cancer Collaborative Group (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 356:968–974

    Google Scholar 

  17. Dahan M, Gaillard J, Eschapase H (1989) Surgical treatment of goiters with intrathoracic development. In: Delarue NC, Eschapase H (eds) Thoracic surgery: frontiers and uncommon neoplasms. International trends in general thoracic surgery. Mosby, St. Louis, p 5

    Google Scholar 

  18. Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228:320–330

    Article  CAS  PubMed  Google Scholar 

  19. Levy EG (1991) Thyroid disease in the elderly. Med Clin North Am 75:151–167

    CAS  PubMed  Google Scholar 

  20. Whitman ED, Norton JA (1994) Endocrine surgical diseases of elderly patients. Surg Clin North Am 74:127–144

    CAS  PubMed  Google Scholar 

  21. Sikes ED Jr, Detmer DE (1979) Aging and surgical risk in older citizens of Wisconsin. WMJ 78:27–30

    Google Scholar 

  22. Linn BS, Linn MW, Wallen N (1982) Evaluation of results of surgical procedures in the elderly. Ann Surg 195:90–96

    CAS  PubMed  Google Scholar 

  23. Terracciano CA, Iannuzzi C, de Blasio R, Fuiano R, Gallo C (1992) Mortalitá e valenza clinico-prognostica di alcuni fattori di rischio in chirurgia geriatrica. Ann Ital Chir 63:147–150

    Google Scholar 

  24. Berger DH, Roslyn JJ (1997) Cancer surgery in the elderly. Clin Geriatr Med 13:119–141

    CAS  PubMed  Google Scholar 

  25. Rorbaek Madsen M, Dupont G, Kristensen K, Holm T, Sorensen J, Dahger H (1992) General surgery in patients aged 80 years and older. Br J Surg 79:1216–1218

    CAS  PubMed  Google Scholar 

  26. Tiret L, Desmonts JM, Hatton F, Vourc’h G (1986) Complications associated with anaesthesia: a prospective survey in France. Can Anaesth Soc J 33:336–344

    CAS  Google Scholar 

  27. Har-El G, Sidi J, Segal K, Kahan E, Abraham A (1987) Thyroid cancer in patients 70 years of age or older: retrospective study of 50 patients. Ann Otol Rhinol Laryngol 96:403–410

    CAS  PubMed  Google Scholar 

  28. Mehta V, Savino JA (1995) Surgical management of the patient with a thyroid disorder. Clin Geriatr Med 11:291–309

    CAS  PubMed  Google Scholar 

  29. Steen PA, Tinker JH, Tarhan S (1978) Myocardial reinfarction after anesthesia and surgery. JAMA 239:2566–2570

    Article  CAS  PubMed  Google Scholar 

  30. Bliss R, Patel N, Guinea A, Reeve TS, Delbridge L (1999) Age is no contraindication to thyroid surgery. Age Ageing 28:363–366

    Article  CAS  PubMed  Google Scholar 

  31. Smith SA, Hay ID, Goellner JR, Ryan JJ, McConahey WM (1988) Mortality from papillary carcinoma: a case–control study of 56 lethal cases. Cancer 62:1381–1399

    CAS  PubMed  Google Scholar 

  32. Hay ID (1990) Papillary thyroid carcinoma. Endocrinol Metab Clin N Am 19:545–576

    Google Scholar 

  33. Coburn MC, Wanebo HJ (1995) Age correlates with increased frequency of high risk factors in elderly patients with thyroid cancer. Am J Surg 170:471–475

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery and Digestive Apparatus I, Virgen de la Arrixaca University Hospital, Murcia, Spain

    Antonio Ríos, José Manuel Rodríguez, Pedro José Galindo & Pascual Parrilla

  2. Avenida de la Libertad no. 208 Casillas, 30007, Murcia, Spain

    Antonio Ríos

  3. Department of Biostatistics, Virgen de la Arrixaca University Hospital, Murcia, Spain

    Manuel Canteras

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  1. Antonio Ríos
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  2. José Manuel Rodríguez
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  3. Pedro José Galindo
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  4. Manuel Canteras
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  5. Pascual Parrilla
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Correspondence to Antonio Ríos.

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Ríos, A., Rodríguez, J.M., Galindo, P.J. et al. Surgical treatment for multinodular goitres in geriatric patients. Langenbecks Arch Surg 390, 236–242 (2005). https://doi.org/10.1007/s00423-004-0521-8

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  • DOI: https://doi.org/10.1007/s00423-004-0521-8

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