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

Seiler, Christian ; Vorburger, Stephan ; Bürgi, Ulrich ; Candinas, Daniel ; Schmid, Stefan

In: World Journal of Surgery, 2007, vol. 31, no. 5, p. 1005-1013

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    Titre
    • Extended Resection for Thyroid Disease has Less Operative Morbidity than Limited Resection
    Auteur
    • Seiler, Christian. Department of Visceral and Transplantation Surgery, Inselspital, University of Bern, 3010, Bern, Switzerland
    • Vorburger, Stephan. Department of Visceral and Transplantation Surgery, Inselspital, University of Bern, 3010, Bern, Switzerland
    • Bürgi, Ulrich. Department of General Internal Medicine, Inselspital, University of Bern, 3010, Bern, Switzerland
    • Candinas, Daniel. Department of Visceral and Transplantation Surgery, Inselspital, University of Bern, 3010, Bern, Switzerland
    • Schmid, Stefan. Department of Visceral and Transplantation Surgery, Inselspital, University of Bern, 3010, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • World Journal of Surgery, 2007, vol. 31, no. 5, p. 1005-1013. Springer-Verlag
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:312074
    Summary
    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 130years ago