Noorudheen N.K.1 , Ramesh P.K.2
BACKGROUND Total Thyroidectomy is the surgical choice of therapy for patients with differentiated thyroid cancer (DTC) with > 4 cm or with specific risk factors. This is followed by radioiodine therapy (when indicated) and thyroid hormone suppression therapy. Patients with DTC with less than 1 cm growth without risk factors are recommended for lobectomy alone. For tumours measuring 1 – 4 cms, the choice of aggressive surgery is usually personalized decision. We wanted to evaluate the post-operative morbidity in relation to the surgical extent of primary and completion thyroidectomy in patients with DTC. METHODS 64 adult patients who underwent thyroid gland surgery after a histopathological diagnosis of differentiated thyroid cancer between February 2016 and January 2018 in the Department of General Surgery at our institution were included. Length of hospital stay, post-operative hypocalcaemia, recurrent laryngeal nerve injury and number of recurrences were used as primary outcome measures for comparison between the two groups. Pre-operative staging to evaluate the extent of the primary thyroid gland disease was done with ultrasound neck, CT scan and MRI Neck. Immediate follow up of for 4 – 8 weeks followed by follow up with nuclear Medicine department for 16 to 19 months was done. All the surgeries were conducted by the same surgeon-duo, and whenever necessary an experienced surgical oncologist’s expertise was used. RESULTS Among the 64 patients, 36 patients (56.25%) underwent primary total thyroidectomy (Group ‘A’); and 28 patients (43.75%), (Group ‘B’) underwent lobectomy for DTC initially followed by completion thyroidectomy. Unilateral or Bilateral selective neck dissections were performed in 16/36 (44.44%) patients of Group A and 12/28 (42.85%) of Group B patients. There were 24 (66.66%) females and 12 (33.33%) males in group A. In Group B there were 18 (64.28%) females and 10 (35.71%) males. Statistical analysis showed that the opposite side only completion thyroidectomy surgery is associated with a statistically significant shorter hospital stay and had persistent hypocalcaemia lesser than those of primary total thyroidectomy and same side completion thyroidectomy group. Higher initial N stage has a higher likelihood of development of locoregional and metastatic recurrence while T stage independently has no statistically significant impact on any of the outcomes. CONCLUSIONS There is no statistically significant difference in post-operative morbidity or oncologic outcome between the primary total Thyroidectomy and completion thyroidectomy. However, less extensive surgery or staged surgery is associated with a better peri-operative outcome.
