Extended resection for thyroid disease has less operative morbidity than limited resection

Seiler, Christian A; Vorburger, Stephan A; Bürgi, Ulrich; Candinas, Daniel; Schmid, Stefan W (2007). Extended resection for thyroid disease has less operative morbidity than limited resection. World journal of surgery, 31(5), pp. 1005-13. New York, N.Y.: Springer-Verlag 10.1007/s00268-006-0054-0

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BACKGROUND: Theodor Kocher, surgeon and Nobel laureate, has influenced thyroid surgery all over the world: his treatment for multinodular goiter-subtotal thyroidectomy-has been the "Gold Standard" for more than a century. However, based on a new understanding of molecular growth mechanisms in goitrogenesis, we set out to evaluate if a more extended resection yields better results. METHODS: Four thousand three hundred and ninety-four thyroid gland operations with 5,785 "nerves at risk" were prospectively analyzed between 1972 and 2002. From 1972 to 1990, the limited Kocher resections were performed, and from 1991 to 2002 a more radical resection involving at least a hemithyroidectomy was performed. RESULTS: The incidence of postoperative nerve palsy was 3.6%; in the first study period and 0.9%; in the second (P < 0.001, Fisher's exact). Postoperative hypoparathyroidism decreased from 3.2%; in the first period to 0.64%; in the second (P < 0.01). The rate of reoperation for recurrent disease was 11.1%; from 1972 to 1990 and 8.5%; from 1991 to 2002 (P < 0.01). CONCLUSIONS: Extended resection for multinodular goiter not only significantly reduced morbidity, but also decreased the incidence of operations for recurrent disease. Our findings in a large cohort corroborate the suggestions that Kocher's approach should be replaced by a more radical resection, which actually was his original intention more than 130 years ago.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Seiler, Christian; Vorburger, Stephan; Bürgi, Ulrich; Candinas, Daniel and Schmid, Stefan

ISSN:

0364-2313

ISBN:

17429566

Publisher:

Springer-Verlag

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:57

Last Modified:

22 Oct 2019 21:48

Publisher DOI:

10.1007/s00268-006-0054-0

PubMed ID:

17429566

Web of Science ID:

000246234500016

BORIS DOI:

10.7892/boris.24221

URI:

https://boris.unibe.ch/id/eprint/24221 (FactScience: 47682)

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