[Safety-driven radical approaches in routine thyroid surgery: roles and challenges].

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroidology

Background:

• Thyroid surgery aims for effective hormone replacement and disease prevention.
• Thyroid lobectomy is frequently the preferred surgical approach.
• Challenges include inflammation, cancer, substernal extension, and recurrent disease.

Purpose of the Study:

• To establish criteria for safety-driven radicality in thyroid surgery.
• To identify appropriate surgical approaches for various thyroid conditions.
• To analyze factors influencing surgical outcomes and complications.

Main Methods:

• Retrospective analysis of 2215 thyroid surgeries performed between 2001 and 2003.
• Categorization of procedures into lobectomies, near-total resections, and sternotomies.
• Histopathological analysis of thyroid specimens, including tumor types and inflammation.

Main Results:

• Lobectomies constituted 86.1% of procedures; 12.3% were near-total resections.
• Papillary carcinoma was the most common malignancy (216 cases), with various presentations.
• Transient laryngeal nerve paresis occurred in 3.3%, permanent in 0.49%; higher incidence with recurrent disease.

Conclusions:

• Safety-driven radicality requires minimizing residual tissue while preserving nerve and parathyroid function.
• Meticulous nerve dissection, blood-free fields, and nerve cooling are crucial for minimizing complications.
• These practices are effective across diverse thyroid conditions, including cancer, hyperplasia, and recurrent disease.