Multidisciplinary management of surgery for thyroid dıseases: analysis of five years with the experience of Bakirkoy Dr. Sadi Konuk Education and Research Hospital
Ahmet Cem Dural1, Cevher Akarsu1, Mustafa Gökhan Ünsal1, Süleyman Büyükaşık1, Muhammet Ferhat Çelik1, Özlem Soyluk Selçukbiricik2, Hürriyet Turgut3, Süleyman Bademler1, Murat Gönenç1, Halil Alış1
1Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul
2Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Endokrinoloji Kliniği, İstanbul
3Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Patoloji Kliniği, İstanbul
Keywords: Thyroidectomy, complications of thyroidectomy, surgical sub-specialization
Abstract
Purpose: To share the experience of our clinic about the surgical approach to thyroid gland disorders, with the yields of sub-specialization trend and multidisciplinary approach in last 2 years.
Material and method: The thyroid surgery cases between January 2009 - November 2013 were retrospectively analyzed. Demographic data, fine needle aspiration biopsy cases and histopathological results, surgical procedures, laboratory outcomes and the morbidities encountered during the period were evaluated in detail. The cases operated by any general surgeon were accepted as group A, the remaining cases who were operated by surgeons who tend to be specialized in endocrine surgery were enrolled in group B.
Findings: Average age of the patient group (n=534) was 46.6 (14-81 years), and 81.6% of the cases were women. Thyroid cancer suspicion was the surgical cause for 107 cases (20%); this figure was 16.5% in group A and 24.6% in group B. Near total thyroidectomy rate for multi nodular goiter was 6% in group A. After specialization and multidisciplinary approach, recurrent laryngeal nerve dissection was applied in all cases as a routine procedure. Temporary symptomatic hypocalcemia was present in 2.6% of the cases, whereas 1.7% (n=9) cases suffered off permanent hypocalcemia. Temporary hoarseness was 2.8% and permanent hoarseness was 1.1% in whole study group. Permanent hypocalcemia and hoarseness complications were lower in group B (p=0.54 and p=0.43, respectively). Postoperative hemorrhage rate necessitating surgical intervention was 1.1% (n=6) for whole patient group, peroperative total complication rate was 1.3% (n=7). 13 cases (2.4%) were re-operated especially secondary to malignant histopathological results, in which the first surgical procedure was unilateral thyroidectomy.
Conclusion: As a yield of sub-specialization trend and multidisciplinary boards for the last 2 years, the number of thyroid cancer cases significantly increased and the case profile of our clinic has been changed. Temporary and permanent complication rates in whole patient group were congruent with the literature; whereas permanent complication rate decreased with increased operator experience.