In the first 2 years of follow-up, thyroglobulin levels decreased in 42%, remained stable in 22%, and increased in 36% of the patient pool. Immediate completion thyroidectomy was defined as occurring within three months after initial lobectomy. The diagnosis of minimally invasive follicular thyroid carcinoma (MIFTC) is often made histologically after thyroid lobectomy. Thus, participants would be expected to start favoring a thyroid lobectomy over total thyroidectomy if the chance of needing a completion thyroidectomy was <30%. A total of 214 of them underwent lobectomy and isthmectomy and 81 turned out to have malignant disease in the resected lobe and they underwent completion thyroidectomy within a week to 6 months after the permanent section diagnosis of cancer. We attempted to determine whether completion thyroidectomy should be considered necessary for all patients diagnosed with MIFTC after thyroid lobectomy. Background: Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been successfully performed for thyroid cancer patients with excellent cosmetic results. Cho JS(1), Yoon JH, Park MH, Shin SH, Jegal YJ, Lee JS, Kim HK. However, there is a continuous controversy about completion thyroidectomy (CT) following lobectomy. Immediate completion thyroidectomy was performed due to missed PTC (6 cases), positivity of margin or lymphovascular invasion (5 cases), disease free but required additional radioactive iodine therapy (15 cases) and remaining central metastases (10 cases). Contralateral thyroid carcinoma was detected in 15 (46.8%) of these patients undergoing iyroideclomy. On the other end of the spectrum, another thyroid cancer group has reported completion thyroidectomy rates after lobectomy to be 14% . ANZ J Surg. Confirmation of a benign or malignant thyroid mass can only be done after removal of the affected thyroid lobe. Summary. The average patient had no preference between having a thyroid lobectomy or a total thyroidectomy if the risk of needing a completion thyroidectomy after lobectomy could be reduced to 30%. Morbidity for completion thyroidectomy includes a reported 2% to 5% risk of recurrent laryngeal nerve (RLN) injury and an 8% to 15% incidence of hypoparathyroidism. We sought to determine the effect of these guideline changes on the rate of completion thyroidectomy (CT) for low-risk DTC and factors influencing surgical decision-making. Objectives: Completion thyroidectomy (CT) is defined as the removal of the residual thyroid tissue in the case of detected ma-lignancy after lobectomy for an indeterminate or non-diagnostic biopsy. During the 6.5-year follow-up, 18 patients underwent completion thyroidectomy. The subjects of this study were a total of 324 patients who underwent thyroid lobectomy as initial surgery … When I had my lobectomy I was out next day, but the info given to me by the hospital says 2-4 day stay. Currently, neck U/S remains the mainstay modality for follow-up after thyroid lobectomy… After excluding 40 patients who underwent an immediate completion thyroidectomy, 849 were included in the analysis; 619 (72.9%) had unifocal disease and 230 (27.1%) had multifocal disease. Objectives: Completion thyroidectomy (CT) is defined as the removal of the residual thyroid tissue in the case of detected malignancy after lobectomy for an indeterminate or non-diagnostic biopsy. The presence of a multifocal tumor in the first surgical specimen significantly increased the risk of malignancy in the opposite lobe ( p < 0.001). Hello everybody, I’ve just had my date through of the 14th January for my completion thyroidectomy. Article Google Scholar 30. Factors such as tumor diameter, aggressive histology, Completion thyroidectomy (CT) is an unexpected operation after lobectomy that has an unpredictable complication rate. After which I opted for a completion thyroidectomy based on my surgeons recommendation. The necessity of completion total thyroidectomy in patients with papillary thyroid microcarcinoma (PTMC) and pathological central lymph node metastasis (pCLNM) who underwent thyroid lobectomy with central compartment neck dissection (CCND) is unclear. The oncological benefit of completion thyroidectomy (CT) following thyroid lobectomy (TL) is presumed to be similar to that of upfront total thyroidectomy(TT), from a patient's perspective the risk and inconvenience of further surgery adds significantly to … Surgeries along with RAI were in 2017 and I have been on 137 mg of levothyroxine since. Merchavy S, Marom T, Forest VI, Hier M, Mlynarek A, McHugh T, et al. 2007;77:305. Comparison of the incidence of postoperative hypocalcemia following total thyroidectomy vs completion thyroidectomy. ... (completion thyroidectomy) may be needed. Completion thyroidectomy is therefore necessary in the subset of patients undergoing lobectomy for preoperative ‘low‐risk’ DTC that is then found to contain other features on histology. According to the 2015 American Thyroid Association (ATA) guidelines, completion total thyroidectomy is necessary in cases of unclear diagnosis after lobectomy, to provide complete … Observational study of central metastases following thyroid lobectomy without a completion thyroidectomy for papillary carcinoma. Their mean age was 40.7 +/- … Lobectomy is increasingly performed for low-risk differentiated thyroid cancer (DTC) and papillary thyroid microcarcinoma (PTMC). Purpose: Thyroid lobectomy is a standard procedure for patients with papillary thyroid carcinoma (PTC) with tumor size <4 cm and clinically negative lymph nodes (LNs) and is performed more frequently than total thyroidectomy. I can say that I have not had any major changes to lifestyle or energy - just the adjustment to having to take a pill and waiting 45min - 1 hour before having coffee or breakfast in AM. This is similar to our estimate of completion thyroidectomy rates for Bethesda 2 to 5 cases including those with intermediate recurrence risk, but lower than our estimate when applying the same criteria to Bethesda 6 cases. After completion thyroidectomy, 20 (20.6%) of the 97 patients revealed additional cancer focus in the residual tissue. In this study, to determine morbidity following completion thyroidectomy, we reviewed our results of reoperative surgery among patients with thyroid cancer. Increasingly, it has been recognized that low-risk patients, … After completion thyroidectomy, ... subtotal thyroidectomy, or lobectomy) is best for the patient. Following lobectomy, the mean thyroglobulin level was 12.1 ± 14.8 ng/mL. Proponents of more conservative surgical approaches cite the need to account for differing complication rates from surgeons of all skills sets as reasons to change guidelines 2 , 3 , 7 . BACKGROUND: Although lobectomy is an alternative to total thyroidectomy (TT) for 1-4 cm papillary thyroid carcinoma (PTC) without high-risk features (HRFs) such as aggressive histology, vascular invasion, lymphovascular invasion (LVI), microscopic extrathyroidal extension, positive margin, nodal metastasis >5 mm and multifocality, these HRFs are not recognized until after surgery. Completion thyroidectomy after initial lobectomy is sometimes performed unnecessarily after a new diagnosis of well-differentiated thyroid cancer (WDTC).1,2 Typically, completion thyroidectomy is performed due to concern over recurrence or multifocal cancer and to facilitate adjuvant radioactive iodine (RAI) therapy. Sancho and colleagues compared two different surgical techniques—hemithyroidectomy vs. Dunhill procedure—for the surgical management of multinodular goiter in a multicenter and randomized study. Factors such as tumor diameter, aggressive histology, extrathyroidal spread, and positive surgical margin in papillary thyroid cancer (PTC) constitute CT indications. diagnosed with pathological CLN metastasis (pCLNM) after surgery is still controversial. Recent evidence shows that, in some centres, 30%–40% of patients may be upstaged to a higher risk category after undergoing thyroid lobectomy for thyroid cancer.6 Mitigating the risk of completion thyroidectomy likely rests with the experience and preoperative workup of a high-volume, multidisciplinary thyroid cancer team . Compared to bilateral subtotal thyroidectomy, previous unilateral thyroid lobectomy, is associated with a 5-fold decrease in complications after re-operative surgery (6,59). In the case of these biopsy results, a thyroid lobectomy is indicated. Thirty two patients underwent completion thyroidectomy after initial thyroid lobectomy for a solitary thyroid nodule that proved to be malignant on parafin histopathologic ex- amination. In a cohort study at a high-volume center, operative outcomes for patients undergoing thyroid lobectomy, total thyroidectomy, and completion thyroidectomy were compared and equivalently low complication rates were observed for all 3 procedures. Introduction. OBJECTIVE: This study aimed to investigate differences in functional outcomes of postoperative complications and hypoparathyroidism between patients who underwent completion thyroidectomy (CT) after thyroid lobectomy or total thyroidectomy (TT) as an initial treatment. Completion thyroidectomy is occasionally needed after lobectomy, but its procedure-specific risks are not well characterized. Several small retrospective studies have described the use of RAI lobe ablation after TL as a safe and effective alternative to completion thyroidectomy in DTC. 4–8 Santra and colleagues studied the long-term outcomes of RAI lobe ablation in a cohort of 364 TL patients with DTC and compared them to a group of 372 patients who underwent completion thyroidectomy and RAI remnant ablation. Just wondering how quickly people managed to get discharged. Completion thyroidectomy is sometimes necessary after thyroid lobectomy, and whether it has a higher complication rate than the primary operation due to the presence of adhesions remains controversial. Potentially, Tg could be used to guide the need for completion thyroidectomy in cases of very high levels or significant increase over time, but evidence to support such an approach is of low quality. Author information: (1)Department of Surgery, Chonnam National … subtotal lobectomy 60225 90 Total thyroidectomy 60240 90 ... with limited neck dissection 60252 90 Total or subtotal thyroidectomy with radical neck dissection 60254 90 Completion total thyroidectomy 60260 90 ... may occur after complete removal of both thyroid lobes. After completion thyroidectomy, 6 of the 67 patients (8.9%) with unifocal papillary cancer had multifocal features, and malignancy was detected in the opposite lobe in 22 of the 42 patients (52.3%). Comparison of completion thyroidectomy and primary surgery for thyroid carcinoma. It has been stated that completion thyroidectomy for thyroid malignancy should be performed either within 10 days of the primary operation or after 3 months, to reduce the incidence of complications. The 2015 American Thyroid Association (ATA) guidelines recommended that low-risk, differentiated thyroid cancers (DTC) between 1 and 4 cm may be treated with thyroid lobectomy alone. Contralateral lobe papillary thyroid carcinoma-free probability, regional recurrence-free probability, disease-specific survival, and overall survival were calculated using the Kaplan-Meier method. The current meta-analysis aimed to assess the outcomes of the initial surgical procedure versus CT performed for low/intermediate-risk thyroid carcinoma.
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