Journal des troubles thyroïdiens et de la thérapie
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Oncologic Results of Completion Thyroidectomy and Secondary Prophylactic Lymph Node Dissection in the Management of Differentiated Thyroid Cancer

Stephanie Mucci-Hennekine, Cecile Caillard, Eric Mirallie, Olivier Morel, Patrice Rodien and Antoine Hamy

The management of differentiated thyroid cancer consists of a total thyroidectomy and cervical lymph node dissection (LND). However, certain patients do not receive this treatment for their first surgery, with a second operation being planned for a completion thyroidectomy and LND. The present study was undertaken to evaluate the morbidity and oncologic results of this two-stage strategy. All patients treated in two surgical stages from January 1992 to June 2009 were included in this study.

A total of 140 patients were included in the analysis. None received a diagnosis of cancer before or during the first surgery. The initial treatment involved 29 total thyroidectomies and 111 lobectomies. All patients had differentiated thyroid cancer. At the second surgery, 111 lobectomies and 140 LND were performed. Morbidity included one haematoma, 30 hypoparathyroidism (six definitive), and 13 nerve palsies (six definitive), while 14 microcarcinomas were diagnosed. In total, 12 patients suffered from lymph node metastases and 24 residual diseases. After a mean follow-up of 59.8 months, four patients had metastases and three elevated thyroglobulin levels, while 133 were disease free. Completion thyroidectomy should be performed on account of the incidence of second cancers, thus allowing for radioactive iodine therapy to be performed. Secondary prophylactic LND has a significant morbidity, which calls into question its routine recommendation.