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High rate of recurrence after lobectomy for solitary thyroid nodule
Maunzio Marchesi1, Marco Biffoni, Cristiana Faloci
13rd Department of Surgery, University La Sapienza, Rome, Italy. maurizio.marchesi@uniroma1.it
Objective:
To evaluate the long-term outcome of patients treated by lobectomy for solitary thyroid nodule.
Design:
Retrospective study.
Setting:
University hospital.
Patients:
83 patients admitted with a clinical diagnosis of solitary thyroid nodule.
Interventions:
Preoperative ultrasonography showed a solitary nodule in 32 patients and this finding was confirmed intraoperatively in 24 cases (77%). 59 patients with multinodular goitres were treated by total thyroidectomy and 24 with solitary nodule by lobectomy.
Main Outcome Measures:
Postoperative complications and freedom from nodule recurrence and/or parenchymal irregularity.
Results:
One patient after lobectomy and 3 after total thyroidectomy developed temporary recurrent laryngeal nerve injury. Postoperative temporary hypoparathyroidism occurred in 13 patients (22%) after total thyroidectomy and in no patient after lobectomy (p = 0.02). Neither permanent recurrent laryngeal nerve injury nor permanent hypoparathyroidism occurred after either procedure. Among patients who underwent lobectomy, 6 had an adenoma and 18 had a nodular hyperplasia. At 4-year follow-up, the freedom rate from any thyroid nodule recurrence or parenchymal irregularity was 44.7%, and the freedom rate from nodular recurrence was 74%. Men tended to have a 4-year freedom rate from nodular relapse poorer than women (48% vs. 87%. p = 0.07). Nodular recurrence occurred in one patient operated on for an adenoma, and all the other recurrences occurred in patients with nodular hyperplasia.
Conclusions:
The mid-term freedom rate from thyroid nodule recurrence or parenchymal irregularity after lobectomy for solitary nodule of the thyroid is unsatisfactory. This observation calls for a better evaluation of long-term results after lobectomy for this condition and identification of risk factors predictive of recurrence. This would enable a more appropriate preoperative selection of patients undergoing lobectomy, indicating total thyroidectomy for those patients with solitary nodule at high risk of recurrence.