Revista Colombiana de Cirugía
Print version ISSN 2011-7582
ZUNIGA, Sergio and SANABRIA, Álvaro. Complications and recurrence following surgical treatment of papillary thyroid carcinoma. Experience at the Instituto Nacional de Cancerología. rev. colomb. cir. [online]. 2007, vol.22, n.3, pp. 166-174. ISSN 2011-7582.
Introduction: Papillary carcinoma of the thyroid is the most common tumor of the head and neck region. Treatment is basically surgical. Postoperative complications and recurrence are this entity´s main consequences affecting the patients´subsequent life, as survival is prolonged and it has been demonstrated that the type of operation has a minor impact on specific mortality rates. We embarked on a descriptive study focused on perioperative complications and recurrence, and also on trying to clarify the differences in rates reported in the literature. Materials and methods. The study corresponds to a historical cohort. The clinical records of all patients admitted to the National Cancer Institute (Bogotá, Colombia) with the diagnosis of papillary carcinoma of the thyroid in the period 1983-1999 were reviewed, considering demographic, clinical, treatment modalities, pathological study (extrathyroid capsular and vascular invasion, histological subtype, multifocality) variants, complications (recurrent laryngeal nerve paralysis, temporal o permanent hypocalcemia), recurrence, and survival. An univariable analysis was initially performed in order to identify risk factors for recurrent laryngeal nerve injury or the development of transient or permanent hypoparathyroidism; multivariable analysis was then performed intended to determine risk factors related to postoperative complications. Results. 673 patients were included in the study, of which 609 (90.5%) were female. According to the AMES classification, 261 (38.8%) were in the low risk group and 437 (64.9%) underwent total thyroidectomy; 342 (50.8%) developed complications: 87 (12.9%) lesion of the recurrent laryngeal nerve; 130 (19.3%) temporary or permanent hypocalcemia; 52 (7.7%) postoperative hematoma. Multivariable analysis for nerve injury showed total thyroidectomy as the single related factor, although with no statistical significance (OR 1.55, CI 95% 0.93-2.59, p=0.09). Multivariable analysis for hipocalcemia showed as related factors: tumor size > 1 cm (OR 1.85, CI 95% 1.0-3.42, p=0.05), capsular invasion (OR 1.91, CI 95% 1.21-3.0, p=0.005), multifocality (OR 1.84, CI 95% 1.21-2.82, p=0.004), multifocality (OR 1.84, CI 95% 1.21-2.82, p=0.004), thyroiditis (OR 2.32, CI 95% 1.37-3.92, p=0.002), neck dissection (OR 0.66, CI 95%, 0.43-0.99, p=0.05), and central neck dissection (OR 2.34, CI 95% 1.52-3.62, p<0.001). Discussion. This study shows comparable results of hypocalcemia incidence as reported in the literature. However, the incidence of recurrent laryngeal nerve paralysis appears quite higher than the literature reports.
Keywords : thyroid neoplasm; postoperative complications; recurrence.