Pediatric thyroidectomy in a "low volume" institution without protocolization: results and future horizons

Area of Science:

• Pediatric Surgery
• Endocrinology
• Oncology

Background:

• Pediatric thyroidectomy is a complex procedure with potential for significant complications.
• Assessing outcomes in secondary pediatric hospitals is crucial for understanding care accessibility and quality.

Purpose of the Study:

• To compare complication rates and oncological results of non-protocolized pediatric thyroidectomies performed in a secondary hospital with those from reference institutions.
• To evaluate the safety and efficacy of thyroid surgery performed by experienced pediatric surgeons with lower annual surgical volumes.

Main Methods:

• Retrospective analysis of 11 patients (12 surgeries) under 15 years old undergoing thyroidectomy ± cervical lymphadenectomy between 2010 and 2020.
• Surgeons were defined as low-volume if performing <30 cervical endocrine surgeries annually.
• Data collected included surgical indications, genetic mutations, complications, hospital stay, and oncological outcomes.

Main Results:

• Thyroid nodules were the primary indication (50%); 45% had genetic mutations.
• Overall complication rate was 25%, including transient hypocalcemia and recurrent laryngeal nerve neuropraxia, with no permanent complications.
• Malignancy was present in 66.6% of cases; no tumor recurrence was observed after a mean 4-year follow-up.

Conclusions:

• Experienced pediatric surgeons, even below high-volume thresholds, can achieve safe and effective pediatric thyroid surgery.
• Standardized perioperative management protocols involving multidisciplinary specialists are recommended to optimize surgical outcomes.