Post-surgical complications in thyroidectomy patients with thyroid carcinoma
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v3i3.4713
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine neoplasia, with an increasing incidence worldwide. Total thyroidectomy (TT) is one of the most important pillars of treatment; however, it is not without complications. Of these, the most common are transient/permanent hypoparathyroidism, recurrent laryngeal nerve (RLN) injury, and postoperative hemorrhage. Objective: To determine the prevalence of overweight and obesity in this population and some risk factors for this type of tumor. To determine the incidence of postoperative complications after TT as the initial treatment for DTC. Materials and methods: An observational, descriptive, and retrospective study conducted at the Academic Unit of Endocrinology and Metabolism between 2011 and 2021. Quantitative variables were represented by mean and median; qualitative variables were described as absolute and relative frequencies. Results: 34% were smokers, 39% were overweight, 30% were obese, 7% had a family history of thyroid cancer, and 2% had a history of head and neck radiation. In turn, 59% of the sample presented postoperative complications (71 events in 60 patients). The most frequent complication was transient hypoparathyroidism, present in 48%, followed by permanent hypoparathyroidism (8.9%); 8% presented recurrent laryngeal nerve injury, and 3% presented bleeding; finally, only one patient had a cervical hematoma. Conclusions: The prevalence of overweight/obesity was high in more than half of the cases, and smoking was present in one-third of the patients. Postoperative complications were present in most subjects. Transient hypoparathyroidism was the most common in almost half of them, followed by permanent hypoparathyroidism and, to a lesser extent, RLN injury, surgical site bleeding, and cervical hematoma.
Keywords
thyroid cancer; postoperative complications; thyroidectomy; hypoparathyroidism
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[27] Decia M, Rivadeneira G, Mintegui G, Mendoza B. Incidencia de hipocalcemias postquirúrgicas en el Hospital de Clínicas. Rev Med Urug 2020; 36(3):293-300. Disponible en: https://dx.doi.org/10.29193/RMU.36.3.6. [ Links ]
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Disponible en: https://inis.iaea.org/records/s5m5g-s2z91. [ Links ]
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[30] Patel KN, Yip L, Lubitz CC, Grubbs EG, Miller BS, Shen W, et al. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271(3):e21-e93. Disponible en: https://dx.doi.org/10.1097/sla.0000000000003580.
[2] Pedro A. Saco, Ana I. Voogd, Pedro Valdez, Alejandro Beguerí, Gerardo Russier, María del C. Negueruela. Differentiated thyroid cancer: clinical experience in a changing scenario. Rev. Argentina de Cirugía 2020; 111(1). Disponible en: https://doi.org/10.25132/raac.v112.n2. [ Links ]
[3] Alberth Elizondo Cerdas. Histopatología del cáncer de tiroides. Rev Med de Costa Rica y Centroamerica 2014; 71(610):253-8.
[4] Hano O, Wood L, Galbán E, Abreu M. Causas, factores de riesgo y prevención cáncer de tiroides. American Cancer Society 2015; 50(2):118-32. Disponible en: https://www.cancer.org/es/cancer/tipos/cancer-de-tiroides/causas-riesgos-prevencion.html. [ Links ]
[5 Tamayo P. Update on radioactive iodine treatment of differentiated thyroid cancer. Salamanca. Rev ORL 2021; 12(4):371-80. Disponible en: https://dx.doi.org/10.14201/orl.25746.
[6] Rosa Iglesias Rosa Ana Iglesias-López, Heather Stacey Villanueva-Alvarado, Juan José, Corrales-Hernández, Ana Isabel Sánchez-Marcos, José María Recio-Córdova, María Teresa Mories-Álvarez. Post-Therapeutic Follow-up of Thyroid Carcinoma. Rev. ORL 2020; 329-39. Ediciones Universidad de Salamanca. Disponible en: https://dx.doi.org/10.14201/orl.21513.
[7] Sosa G, Ernand S. Aspectos actuales del carcinoma bien diferenciado de tiroides. Revista Cubana de Cirugía 2016; 55(1):165-70.
[8] Tuttle M. Differentiated thyroid cancer: surgical treatment. In: UpToDate. Ross D, Mulder J, eds. (Consulta: 11 noviembre 2024). Disponible in: https://www.uptodate.com/contents/differentiated-thyroid-cancer-surgical-treatment/print.
[9] Alexandra I. Stavrakis, Philip H.G. Ituarte, Clifford Y. Ko, Michael W. Yeh. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surg 2007; 142(6):887-99; discussion 887-99. Disponible en: https://dx.doi.org/10.1016/j.surg.2007.09.003.
[10] Boudourakis LD, Wang TS, Roman SA, Desai R, Sosa JA. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg 2009; 250(1):159–65. Disponible en: http://dx.doi.org/10.1097/SLA.0b013e3181a77cb3.
[11] Adam MA, Thomas S, Youngwirth L, Hyslop T, Reed SD, Scheri RP, et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 2017; 265(2):402–7. Disponible en: http://dx.doi.org/10.1097/SLA.0000000000001688. [ Links ]
[12] Rafferty MA, Goldstein DP, Rotstein L, Asa SL, Panzarella T, Gullane P, et al. Completion thyroidectomy versus total thyroidectomy: is there a difference in complication rates? An analysis of 350 patients. J Am Coll Surg 2007; 205(4):602–7. Disponible en: http://dx.doi.org/10.1016/j.jamcollsurg.2007.05.030.
[13] Calvo D, Sánchez Terradillos E, Gil-Carcedo S. Cáncer de tiroides. Técnicas quirúrgicas sobre tiroides. Libro virtual de formación en ORL 2020; 17:211-20.
[14] A. Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, Lausen I. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008;393(5):667-73. Disponible en: https://dx.doi.org/10.1007/s00423-008-0366-7.
[15] Tracy S. Wang, Melanie L. Lyden, Julie Ann Sosa. Thyroidectomy. UpToDate. Disponible en: https://sso.uptodate.com/contents/thyroidectomy/print. [Consulta: 13 noviembre 2024].
[16] Marco Bononi, Stefano Amore Bonapasta, Alessandra Vari, Massimo Scarpini, Alessandro De Cesare, Michelangelo Miccini, Massimo Meucci, Adriano Tocchi. Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting. Head Neck 2010; 32(9):1173-7. Disponible en: https://dx.doi.org/10.1002/hed.21313.
[17] Weiss A, Lee K, Brumund KT, Chang DC, Bouvet M. Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery 2014; 156(2):399-404.
Disponible en: https://dx.doi.org/10.1016/j.surg.2014.03.015. [ Links ]
[18] Zafon C, Puig-Domingo M, Biarnés J, Halperin I, Bella MR, Castells I, et al. A descriptive study of the characteristics of differentiated thyroid cancer in Catalonia during the period 1998-2012. Endocrinology y Nutrition 2015; 62(6):264-69. Disponible en: https://dx.doi.org/10.1016/j.endoen.2015.06.004.
[19] Arias NE, Guzmán-Gallego EA. Características clínicas del cáncer de tiroides en Manizales, Colombia, 2008-2015. Rev Peru Med Exp Salud Pública 2020; 37(2):287-91.
Disponible en: https://rpmesp.ins.gob.pe/index.php/rpmesp/article/view/4892/3719. [ Links ]
[20] Chala AI, Franco HI, Aguilar CD, Cardona JP. Estudio descriptivo de doce años de cáncer de tiroides, Manizales, Colombia. Rev Colomb Cir 2010; 25(4):276-89.
Disponible en: https://www.revistacirugia.org/index.php/cirugia/article/view/142.
[21] Álvarez R, Bonap S, González F, Rodríguez MJ. Segunda encuesta nacional de factores de riesgo de enfermedades no transmisibles. MSP 2013.
[22] Vidaurri Ojeda A, Gómez J, Chávez Hernández MM, Gonzáles Fondón A, Jiménez Báez MV. Thyroid cancer: Clinical characterization and consistency of diagnostic tests. Rev Salud Quintana Roo 2016; 9(33):11-17. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=103322&id2=. [ Links ]
[23] González CC, Yaniskowski ML, Wyse EP, Giovannini AA, López MB, Wior ME. Cáncer de tiroides. Estudio descriptivo retrospectivo. Med (B Aires) 2006; 66(6):526-32.
[24] Fogelfeld L, Wiviott MBT, Shore-Freedman E, Blend M, Bekerman C, Pinsky S, Schneider AB. Recurrence of thyroid nodules after surgical removal in patients irradiated in childhood for benign conditions. N Engl J Med 1989; 320(13):835-40. Disponible en: https://dx.doi.org/10.1056/NEJM198903303201304. [ Links ]
[25] Gonçalves Filho J, Kowalski LP. Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngol Head Neck Surg 2005; 132(3):490-4. Disponible en: https://dx.doi.org/10.1016/j.otohns.2004.09.028. [ Links ]
[26] Mintegui G, Ronco A, Álvarez C, Mendoza B. Incidencia de hipocalcemia e hipoparatiroidismo en cirugías de cuello. Rev Chil Endo Diab 2022; 15(3):104-9. Disponible en: https://www.revistasoched.cl/3_2022/02.html. [ Links ]
[27] Decia M, Rivadeneira G, Mintegui G, Mendoza B. Incidencia de hipocalcemias postquirúrgicas en el Hospital de Clínicas. Rev Med Urug 2020; 36(3):293-300. Disponible en: https://dx.doi.org/10.29193/RMU.36.3.6. [ Links ]
[28] Pitoia F, Califano I, Vázquez A, Faure E, Gauna A, Orlandi A, et al. Inter society consensus for the management of patients with differentiated thyroid cancer. Rev Asoc Arg Biolog Med Nucl 2014; 51(2).
Disponible en: https://inis.iaea.org/records/s5m5g-s2z91. [ Links ]
[29] Fretes D, Cardozo H, Caballero A, Fretes A, Insfrán S, Verdecchia C. Incidencia de complicaciones de la tiroidectomía total en el Servicio de Cirugía General Hospital Militar Central de las Fuerzas Armadas de la Nación. Cir Parag 2020; 44(2):25–7.
[30] Patel KN, Yip L, Lubitz CC, Grubbs EG, Miller BS, Shen W, et al. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271(3):e21-e93. Disponible en: https://dx.doi.org/10.1097/sla.0000000000003580.
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