Neural Monitored Revision Thyroid Cancer Surgery: Surgical Safety and Thyroglobulin Response

作者：Phelan Eimear; Kamani Dipti; Shin Jennifer; Randolph Gregory W^*

来源：Otolaryngology - Head and Neck Surgery, 2013, 149(1): 47-52.

DOI：10.1177/0194599813489662

• revision thyroid surgery
• IONM
• neural monitoring
• hypocalcemia
• recurrent laryngeal nerve injury
• hypoparathyroidism
• complications of revision surgery
• thyroid cancer recurrence
• papillary thyroid carcinoma
• thyroglobulin Tg response

Objective To evaluate the postoperative complications and to evaluate and stratify thyroglobulin (Tg) response associated with revision surgery for thyroid malignancy.
Study Design Case series with chart review.
Settings Academic, tertiary care center.
Subjects and Methods All patients with regionally recurrent thyroid carcinoma and who underwent revision thyroid surgery by the senior author (GWR) during a 5-year period were identified. All patients had pre- and postoperative laryngeal examination and underwent surgery with standardized neural monitoring. Postoperative complications and thyroglobulin (Tg) response were recorded.
Results One hundred seventeen cases meeting the criteria for revision surgery for recurrent thyroid cancer were identified. Among this group, 30% presented for their third or higher revision procedure. Preoperative permanent vocal cord palsy was present in 14% (n = 16), and 19% (n = 22) had preoperative permanent hypocalcaemia. There were no new cases of either temporary or permanent vocal cord palsy in our study group. Approximately 5% developed temporary and 3% permanent hypocalcaemia requiring medical treatment. The mean basal Tg following revision surgery was 5.6 ng/ml (range, 0.2-32.7), which represented a mean postoperative significant decline in Tg of approximately 90%. In nearly 40%, basal Tg was undetectable postoperatively. Tg response was stratified based on the number of revision surgeries, Tg decline was observed in 90% of all cases, 92% after first revision surgery, 85% after second, 34% after third, and 70% after fifth revision surgeries.
Conclusion Revision thyroid cancer surgery can be performed with low rates of complications and significant impact on Tg levels even after multiple revision surgeries.

• 出版日期2013-7