[The extent of surgery for well-differentiated thyroid cancer related with surgical morbidity]

The extent of surgical treatment for well-differentiated thyroid cancer is based on non-oncological reasons related to morbidity and oncological reasons related to risk factors and cancer staging. We undertook this study to evaluate if the surgical extent for the treatment of well-differentiated thyroid cancer has a relationship with increased morbidity.

A cross-sectional, comparative, retrospective study was conducted in 823 thyroidectomies done over 5 years with systematized surgical technique. Subjects were grouped in two groups: G1 with differentiated thyroid cancer; G2 with benign thyroid disease. Studied variables were definitive hypocalcemia (DH), recurrent laryngeal nerve lesion (RLN) and external branch of superior laryngeal nerve lesion (EBSLN). Variables were measured 6 months after surgery and evaluation was also done as to the training of the surgeon: expert vs. surgical resident. Statistical analysis was done by central tendency measures and chi(2), with p >0.05 as significant.

We studied 766 women and 57 men with an average age of 42 years (range: 16-89 years). In G1 there were 195 cases all with total thyroidectomies (TT), 4 (2.05%) DH, 2 (1.02%) RLN, 3 (1.53%) EBSLN. In 45 cases, surgery was performed by the resident. G2 included 628 cases, 56 TT and 572 unilateral hemithyroidectomies with 7 (1.1%) DH, 9 (1.43%) RLN and 3 (0.47%) EBSLN. In 134 cases, surgery was performed by the resident. Comparing these results, no differences were documented in terms of cancer diagnosis and who performed the surgery, expert surgeon or surgical resident (p >0.05).

There is no reason to limit the extent of surgery for treatment of well-differentiated thyroid cancer, based on morbidity.