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Extended Resection for Thyroid Disease has Less Operative Morbidity than Limited Resection

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Abstract

Background

Theodor Kocher, surgeon and Nobel laureate, has influenced thyroid surgery all over the world: his treatment for multinodular goiter—subtotal thyroidectomy—has been the “Gold Standard” for more than a century. However, based on a new understanding of molecular growth mechanisms in goitrogenesis, we set out to evaluate if a more extended resection yields better results.

Methods

Four thousand three hundred and ninety-four thyroid gland operations with 5,785 “nerves at risk” were prospectively analyzed between 1972 and 2002. From 1972 to 1990, the limited Kocher resections were performed, and from 1991 to 2002 a more radical resection involving at least a hemithyroidectomy was performed.

Results

The incidence of postoperative nerve palsy was 3.6%; in the first study period and 0.9%; in the second (P < 0.001, Fisher’s exact). Postoperative hypoparathyroidism decreased from 3.2%; in the first period to 0.64%; in the second (P < 0.01). The rate of reoperation for recurrent disease was 11.1%; from 1972 to 1990 and 8.5%; from 1991 to 2002 (P < 0.01).

Conclusions

Extended resection for multinodular goiter not only significantly reduced morbidity, but also decreased the incidence of operations for recurrent disease. Our findings in a large cohort corroborate the suggestions that Kocher’s approach should be replaced by a more radical resection, which actually was his original intention more than 130 years ago.

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ACKNOWLEDGEMENTS

We would like to thank Prof. R. Berchtold, M.D.; Prof. L.H. Blumgart, M.D.; Prof. M.W. Büchler, M.D. former chairmen of the Department of Visceral and Transplantation Surgery at the University of Bern for their continuous support. We would especially like to thank H.E. Wagner, M.D. for his personal contribution and J. Wurz for the proofreading of the manuscript.

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Authors and Affiliations

  1. Department of Visceral and Transplantation Surgery, Inselspital, University of Bern, 3010, Bern, Switzerland

    Christian A. Seiler MD, MHA, Stephan A. Vorburger MD, MCR, Daniel Candinas MD & Stefan W. Schmid MD

  2. Department of General Internal Medicine, Inselspital, University of Bern, 3010, Bern, Switzerland

    Ulrich Bürgi MD

Authors
  1. Christian A. Seiler MD, MHA
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  2. Stephan A. Vorburger MD, MCR
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  3. Ulrich Bürgi MD
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  4. Daniel Candinas MD
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  5. Stefan W. Schmid MD
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Corresponding author

Correspondence to Christian A. Seiler MD, MHA.

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Seiler, C.A., Vorburger, S.A., Bürgi, U. et al. Extended Resection for Thyroid Disease has Less Operative Morbidity than Limited Resection. World J Surg 31, 1005–1013 (2007). https://doi.org/10.1007/s00268-006-0054-0

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  • DOI: https://doi.org/10.1007/s00268-006-0054-0

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