Controversies in the surgical management of thyroid follicular neoplasms. Retrospective analysis of 721 patients

INTERNATIONAL JOURNAL OF SURGERY

卷:12

Review

Conzo, Giovanni¹  Calo, Pietro Giorgio²  Gambardella, Claudio¹  Tartaglia, Ernesto¹  Mauriello, Claudio¹  Della Pietra, Cristina¹  Medas, Fabio²  Cruz, Rosa Santa²  Podda, Francesco²  Santini, Luigi¹  Troncone, Giancarlo³ 

[1] Univ Naples 2, Div Gen & Endocrine Surg 7, Dept Anesthesiol Surg & Emergency Sci, I-80132 Naples, Italy

[2] Univ Cagliari, Dept Surg Sci, I-09124 Cagliari, Italy

[3] Univ Naples Federico II, Dept Biomorphol & Funct Sci, Naples, Italy

关键词: Fine needle cytology;    Follicular neoplasm;    Hemithyroidectomy;    Total thyroidectomy;    Thyroid cancer;   

DOI  :  10.1016/j.ijsu.2014.05.013

来源: Elsevier

【 摘 要 】

The most appropriate surgical management of follicular neoplasm/suspicious for follicular neoplasm lesions, is still controversial. Analysing and comparing the experience of two units for endocrine surgery, we retrospectively evaluated 721 patients, surgically treated after a follicular neoplasm diagnosis. Total thyroidectomy was routinely performed in one Institution, while in the other one it was selectively carried out. The main criteria leading to hemythyroidectomy were a single nodule, the age <= 45 years, the absence of thyroiditis or clinical/intraoperative suspicion of malignancy. Total thyroidectomy was performed in 402/721 patients (55.7%), hemythyroidectomy in 319/721 cases (44.2%) and a completion thyroidectomy in 51/319 cases (15.9%). The overall malignancy rate was 24% (176/721 patients), respectively 16% (51/319 patients) following hemythyroidectomy, and 31% (125/402 patients) following total thyroidectomy. Definitive recurrent laryngeal nerve paralysis and permanent hypoparathyroidism were not reported in hemythyroidectomy patients in which lower mean hospitalization and costs were observed. Considering the low-risk of follicular neoplasm solitary lesions, hemythyroidectomy is still the safest standard of care with lower hospitalization and costs. In case of multiglandular disease or thyroiditis, that might be associated with a higher risk of cancer, total thyroidectomy should be recommended. Further investigation is warranted to achieve a better preoperative follicular neoplasm diagnostic accuracy in order to reduce the amount of unnecessary surgical operations with a diagnostic aim. (C) 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.

【 授权许可】

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