Alternative surgery for low grade thyroid malignancies

Area of Science:

• Surgical Oncology
• Endocrine Surgery

Background:

• Traditional thyroidectomy requires initial localization of critical structures like the recurrent laryngeal nerve (RLN) and parathyroid glands (PTGs).
• Well-differentiated thyroid cancer (WDTC) often has low-grade malignancy, and the RLN's position can make initial identification challenging.

Purpose of the Study:

• To evaluate the safety and efficacy of total thyroidectomy for WDTC without initial identification of the RLN and PTGs.
• To assess complications and clinical outcomes of this modified surgical approach.

Main Methods:

• 33 patients with WDTC underwent total thyroidectomy along the capsule, with or without modified radical neck dissection, without pre-identifying the RLN and PTGs.
• Surgical technique involved cutting the isthmus, capsular vessels, and Berry's ligament from above, allowing identification of the RLN and PTGs during thyroid removal.

Main Results:

• Only one patient (3%) experienced transient vocal palsy.
• Six patients (18%) had incidental parathyroidectomy, leading to temporary hypocalcemia in two (6%) and permanent hypocalcemia in two (6%).
• One patient died of disease recurrence; others remained disease-free during follow-up until December 2007.

Conclusions:

• Total thyroidectomy for WDTC without initial identification of the RLN and PTGs is a feasible and safe alternative surgical method.
• This approach simplifies the procedure while maintaining acceptable oncological outcomes and managing potential complications.