Bilateral En Bloc Resection of the Thyroid without Division of the Isthmus: A Technical Alternative to Conventional Subtotal Resection in Multinodular Goitre Die bilaterale En-bloc-Schilddrüsenresektion ohne Isthmusdurchtrennung: eine technische Alternative zur konventionellen subtotalen Resektion multinodulärer Knotenstruma

Abstract

Summary: Background: Bilateral multinodular goitre is a manifestation of unspecific proliferation of thyroid tissue often accompanied by multiple cold nodules scintigraphically. The suspicion of thyroid cancer cannot be completely excluded by the patient's history, physical examination, ultrasonography, fine needle aspiration cytology, or intraoperative frozen section. To evaluate surgically related morbidity and the incidence of occult thyroid cancer in multinodular goitres, the technique of bilateral en bloc resection has been analysed. Methods: From January 1995 to December 1998, 771 operations for benign goitre disease were evaluated in a prospective study. A primary bilateral en bloc resection for multinodular goitre was performed in 306 consecutive patients (39.7 %). Results were compared with the multicentre German Quality Assurance Study for Benign and Malignant Goitre (GQASG) in 1998. Results: Mean weight of resected specimens was 105.3 g, and mean thyroid remnant volume was 2.4 ml. The postoperative rate of transient and permanent recurrent laryngeal nerve (RLN) palsy for nerves at risk was 2.1 % and 0.8 %, respectively. There was no statistically significant difference for RLN palsy between en bloc resection and conventional bilateral resection of the control group. Transient and permanent calcium supplementation was required in 7.5 % and 3.6 %. Thyroid cancers were diagnosed histopathologically in 10 patients (3.6 %). A completion thyroidectomy was required in three patients (1.0 %) due to incidental follicular thyroid carcinoma. Conclusions: Bilateral en bloc resection of the thyroid represents an alternative technique with no increased morbidity compared to conventional resection and facilitates the application of surgical oncological principles in the case of occult thyroid malignancy.