Assessment of the safety profile of surgical interventions on the thyroid gland
AbstractThyroid cancer is the most common cancer of the endocrine system. It is often associated with metastases in the cervical lymph nodes, so prophylactic central lymph node dissection is often performed in order to reduce the risk of postoperative tumor recurrence. However, the rationality of performing prophylactic central lymph node dissection for all patients is debatable. This is primarily due to an increase in the frequency of possible complications after surgery, such as postoperative hypoparathyroidism and laryngeal paresis.
The purpose of the study is to evaluate the safety of thyroid surgery at different volumes of intervention.
Material and methods. We performed a retrospective analysis of ionized calcium levels included data from electronic medical records of 351 patients with differentiated carcinoma and follicular tumor of the thyroid gland. 155 patients were diagnosed with follicular tumor of the thyroid gland and 196 patients – with differentiated thyroid cancer. We performed a comparative assessment of preoperative diagnosis, postoperative complications and changes in calcium and phosphorus levels depending on the type of intervention.
Results. Patients who underwent thyroidectomy were more likely to experience postoperative hypocalcemia and hyperphosphatemia compared to patients who underwent hemithyroidectomy (p<0.001). There was no difference between the groups of patients who underwent thyroidectomy or hemithyroidectomy with lymph node dissection and those who did not undergo lymph node dissection (p>0,05). This model was statistically significant while performing regression analysis [R 2=0.109; F(2, 217)=26.54; p<0.001]. Moreover, patients who underwent thyroidectomy have lower calcium levels in the postoperative period (β= -0.33; p<0.001). Laryngeal nerve paresis was detected in 2 (1.29%) patients operated on for follicular tumor of the thyroid gland and in 3 (1.53%) patients operated on for carcinoma. There was no difference in postoperative complications between the groups with and without lymph node dissection (p=0.64).
Conclusion. According to the study, postoperative hypocalcemia is more common in patients who underwent thyroidectomy. At the same time, central lymph node dissection does not increase the risk of postoperative complications. Malignant neoplasms occur in 12.9% of patients with follicular tumors of the thyroid gland. During a routine histological examination, malignant cells were absent in 14.28% of patients with cytological suspicion of a malignant process.
Keywords: thyroidectomy; hemithyroidectomy; central lymph node dissection; laryngeal paresis; hypoparathyroidism
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Dolidze D.D., Bagatelya Z.A., Covantsev S.D., Gugnin A.V., Gogolashvili D.G., Bumbu A.V., Kantarovskaya M.N. Assessment of the safety profile of surgical interventions on the thyroid gland. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2024; 13 (2): 20–7. DOI: https://doi.org/10.33029/2304-9529-2024-13-2-20-27 (in Russian)
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