Objective To analyze the surgical indication and type and postoperative complication of reoperation for thyroid carcinoma retrospectively. Methods A total of 110 cases with thyroid reoperations performed by same thyroid surgeon group in our hospital were studied between January 2014 and December 2017. The indication of reoperation and postoperative complication, pathological diagnosis and interval duration between two operations were analyzed. Results The indications of reoperation of all 110 cases were recurrent thyroid carcinoma. The median interval between two operations was 11.5 (2-336) months with 54 cases (49.1%) less than 12 months. Thirty cases with recurrent thyroid carcinoma, of which 17 cases (56.7%) were bilateral and 10 cases (33.3%) were multifocal, had reoperation. There were 50 cases with thyroid reoperation for central lymph node dissection including 7 cases diagnosed as central lymph nodes metastasis and 6 cases as both central and lateral lymph nodes metastasis, in which 6 cases (85.7%) and 4 cases (66.7%) were confirmed by postoperative pathology respectively. The other 37 cases had usual central lymph node dissection for recurrent thyroid carcinoma in which 18 cases (48.6%) were found lymph node metastasis by postoperative pathology. A total of 73 cases were diagnosed as lateral lymph node metastasis and had lateral lymph node dissection, in which 67 cases (91.8%) were confirmed by postoperative pathology. Twenty cases (27.4%) in 73 cases had supplemented lateral lymph node dissection for metastasis. Post-reoperation complication was analyzed including thyroidectomy, central lymph node dissection and lateral lymph node dissection. There were 52 cases with thyroidectomy during reoperation including 48 cases with unilateral resection and 4 cases with bilateral resection. Eight cases (22.9%) in 35 cases with thyroidectomy and 6 case (46.2%) in 13 cases with residual thyroid resection were found postoperative complications. Postoperative complication was present in all 4 cases with bilateral resection. Fifteen cases (30.0%) in 50 cases with central lymph node dissection had postoperative complication including 2 cases (20.0%) in 10 cases with unilateral re-dissection and 5 cases (18.5%) in 27 cases in unilateral dissection without previous lymph node dissection and 8 cases (61.5%) in 13 cases with bilateral central lymph node dissection. As to 73 cases with lateral lymph node dissection, postoperative complication was seen in 15 cases (32.6%) of 46 cases with unilateral lymph node dissection and 2 cases (28.6%) of 7 cases with bilateral lymph node dissection and 3 cases (15.0%) of 20 cases with supplemented lateral lymph node dissection. Conclusions Reoperation would be secondary injury to the patients with thyroid carcinoma both psychologically and physically and risk of postoperative complication increases. The first operation for thyroid carcinoma should be standardized. The diagnosis and localization of pre-reoperation could be clear and reoperation might be avoided as less as possible.
SHEN Xiaohui, DING Jiazeng, CHEN Haizhen, CUI Ang, CHEN Xi
. Reoperative thyroid surgery: a report of 110 cases[J]. Journal of Surgery Concepts & Practice, 2019
, 24(01)
: 79
-84
.
DOI: 10.16139/j.1007-9610.2019.01.017
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