Revision in thyroid surgery
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Hellenic Journal of Surgery (2015) 87:1, 71-73
Revision in Thyroid Surgery K. Vamvakidis, C. Christoforides, G.N. Zografos
Abstract Revision in thyroid surgery remains a challenge for the surgeon and at the same time is an extremely demanding procedure in terms of anatomical knowledge and surgical skills in modern endocrine surgery. Recurrent or residual malignancy after unsuccessful ablation or nodal disease in the central or lateral compartment, symptomatic recurrence of a toxic or non-toxic multinodular goitre and recurrent thyrotoxicosis unresponsive to medical management are the main indications leading to revision surgery for thyroid pathology. Alteration of the known anatomical structures and possible complications or morbidity from previous operation(s) maximizes the difficulties and requirements from the surgeon. The proper timing, the preoperative laryngoscopy, the use of neuromonitoring, surgical techniques, and systematic neck dissection are of major importance for the success of the procedure, resulting in an efficient oncological operation with low morbidity. Key words: Reoperation; thyroid cancer; revision; recurrence
Introduction Revision in thyroid surgery poses a challenge to the surgeon because of scar tissue and anatomic changes caused by previous operation(s). We present strategies and methods for better outcomes with fewer complications.
Text-Review Revision in thyroid surgery is indicated in some benign but more often in malignant pathologies with persistent/ recurrent disease [1,2]. In cases of benign pathology, the indications are the same as for the primary operation and include suspicion of malignancy in the thyroid remnant, pressure on the trachea or hyperthyroidism that cannot be otherwise treated.[3] In cases of malignant tumours, the indication for revision is the documentation for persistent/recurrent disease. The fact that most operations are performed close to the primary operation suggests that persistent disease is more frequent than a recurrence [1,3]. The aim of reoperation in cases of well-differentiated thyroid cancer is the elimination of thyroglobulin and the absence of structural evidence of disease. A significant reduction of median Tg-levels can be achieved after reop-
K. Vamvakidis Consultant Endocrine Surgeon, Central Hospital, Athens G.N. Zografos 3rd Department of Surgery, “G.Gennimatas” General Hospital of Athens Corresponding author: K. Vamvakidis, e-mail: [email protected] Received 16 Sept 2014; Accepted 30 Oct 2014 Hellenic Journal of Surgery 87
eration but only about 20% achieve undetectable stimulated Tg, and about 70% of patients are alive with no structural evidence of disease [4]. The aim of reoperation in cases of medullary thyroid cancer is the elimination of calcitonin. Calcitonin levels over 1000 pg/ml are combined with a very rare biochemical cure (1%) while calcitonin levels below 1000 pg/ml, especially when in the first operation the number of infiltrated lymph nodes are < 5, are associated with very good results therapeutically [5]. Before p
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