Repeated (secondary) operations on thyroid (gland) (surgery)

Abstract

Aim. To compare the results of surgical treatment of patients with postoperative goiter recurrence over the past 6 years and periods of 1995-2000 and 2001-2007 and determine the effectiveness of the change in surgical tactics in the direction of radicalization of surgical intervention in primary pathology of the thyroid gland and in case of probable relapse. Materials and Methods. A retrospective analysis of medical cards of 75 patients with postoperative goiter recurrence, who were operated during the last 6 years - from 2013 to 2018, in the surgical department №3 of the regional clinical hospital, was conducted. These results were compared with the results of surgical treatment of patients with postoperative goiter recurrence from 1995 to 2000 and from 2001 to 2007. The relative number and nature of relapse, diagnosis in primary and repeated operations, the number of postoperative complications were considered. Results and Discussion. 75 (1.85%) patients with post-operative goiter relapse were operated from a total of 4042 patients operated due to thyroid gland diseases from 2013 to 2018. From which 69 patients were operated on for goiter recurrence and 6 (8.0%) - for relapsed recurrence of goiter. The results of clinical examinations and the final histological studies indicate that the recurrence does not always occur as previous disease. In 30 (40%) patients, new thyroid disease has developed. There were no relapses of Graves' disease and adenoma, but these patients developed other diseases. In most cases (2/3 of patients) nodular colloid goiter developed in leftover parenchyma. Among these 30 patients with new diseases of thyroid remains, only 3 (10%) had different forms of cancer, and 27 had benign diseases. Particular attention, in our opinion, deserve patients who had a recurrence of goiter in a leftover structurally unchanged lobe after hemithyroidectomy postponed many years ago. There were 27 such patients, all had confirmed complete removal of the lobe of the gland in the primary operation by ultrasonography and during the re-operation. After the initial operation, histological examination showed that nodular colloidal goiter prevailed in the remaining lobe, in some cases with morphological features of elevated function, and in other cases with focal thyroiditis. Among patients who initially performed hemithyroidectomy, 6 were found to have cancer, mostly papillary. After re-operation, in the remaining lobe recurrence of cancer was detected in 3 patients: 2 relapses of papillary cancer and 1 - undifferentiated. Conclusions. Among postoperative goiter recurrence in 60% of patients relapses primary disease, and 40% develop a new disease. In the structure of new thyroid remains diseases, 27 (90%) patients were diagnosed with benign diseases, and 3 (10%) had different forms of cancer. In 27 patients with postoperative goiter recurrence, which were initially performed with hemithyroidectomy, there was a relapse of the disease in the leftover unchanged lobe. In 21 (77.7%) patients, benign diseases were confirmed, and 6 (22.3%) had different forms of cancer. Surgical treatment of thyroid diseases should be adequate in terms of volume, according to the revealed pathology, performed by an experienced surgeon in a specialized department, after thorough examination of the patient. To adhere to modern standards and principles of surgical treatment of diseases of the thyroid gland, which are determined by the leading scientists and clinicians of the world. After surgical treatment of benign thyroid diseases, observation by an endocrinologist is expedient for correction of the patient's hormonal condition. After surgical treatment of malignant pathology, a consultation of the oncologist of the appropriate qualification is indicated for possible appointment of radio- or another therapy.

Keywords

• thyroid gland, re-operation, postoperative goiter recurrence