Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2013
Neural monitored revision thyroid cancer surgery: surgical safety and thyroglobulin response.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Phelan Eimear, Kamani Dipti, Shin Jennifer, Randolph Gregory W
Аннотация
OBJECTIVE: To evaluate the postoperative complications and to evaluate and stratify thyroglobulin (Tg) response associated with revision surgery for thyroid malignancy.
STUDY DESIGN: Case series with chart review.
SETTINGS: Academic, tertiary care center.
SUBJECTS AND METHODS: All patients with regionally recurrent thyroid carcinoma and who underwent revision thyroid surgery by the senior author (GWR) during a 5-year period were identified. All patients had pre- and postoperative laryngeal examination and underwent surgery with standardized neural monitoring. Postoperative complications and thyroglobulin (Tg) response were recorded.
RESULTS: One hundred seventeen cases meeting the criteria for revision surgery for recurrent thyroid cancer were identified. Among this group, 30% presented for their third or higher revision procedure. Preoperative permanent vocal cord palsy was present in 14% (n = 16), and 19% (n = 22) had preoperative permanent hypocalcaemia. There were no new cases of either temporary or permanent vocal cord palsy in our study group. Approximately 5% developed temporary and 3% permanent hypocalcaemia requiring medical treatment. The mean basal Tg following revision surgery was 5.6 ng/ml (range, 0.2-32.7), which represented a mean postoperative significant decline in Tg of approximately 90%. In nearly 40%, basal Tg was undetectable postoperatively. Tg response was stratified based on the number of revision surgeries, Tg decline was observed in 90% of all cases, 92% after first revision surgery, 85% after second, 34% after third, and 70% after fifth revision surgeries.
CONCLUSION: Revision thyroid cancer surgery can be performed with low rates of complications and significant impact on Tg levels even after multiple revision surgeries.
STUDY DESIGN: Case series with chart review.
SETTINGS: Academic, tertiary care center.
SUBJECTS AND METHODS: All patients with regionally recurrent thyroid carcinoma and who underwent revision thyroid surgery by the senior author (GWR) during a 5-year period were identified. All patients had pre- and postoperative laryngeal examination and underwent surgery with standardized neural monitoring. Postoperative complications and thyroglobulin (Tg) response were recorded.
RESULTS: One hundred seventeen cases meeting the criteria for revision surgery for recurrent thyroid cancer were identified. Among this group, 30% presented for their third or higher revision procedure. Preoperative permanent vocal cord palsy was present in 14% (n = 16), and 19% (n = 22) had preoperative permanent hypocalcaemia. There were no new cases of either temporary or permanent vocal cord palsy in our study group. Approximately 5% developed temporary and 3% permanent hypocalcaemia requiring medical treatment. The mean basal Tg following revision surgery was 5.6 ng/ml (range, 0.2-32.7), which represented a mean postoperative significant decline in Tg of approximately 90%. In nearly 40%, basal Tg was undetectable postoperatively. Tg response was stratified based on the number of revision surgeries, Tg decline was observed in 90% of all cases, 92% after first revision surgery, 85% after second, 34% after third, and 70% after fifth revision surgeries.
CONCLUSION: Revision thyroid cancer surgery can be performed with low rates of complications and significant impact on Tg levels even after multiple revision surgeries.