Morbidity comparison of Primary and Completion Total thyroidectomy for differentiated thyroid cancer in relation to the extent of Redo surgery

•There is no significant morbidity difference between primary and completion thyroidectomy.•However, extent of surgery and nodal stage significantly impact the outcome.•Neck dissection when performed with thyroid surgery leads to longer hospital stay.•Only contra-lateral redo surgery results in less hospital stay and hypocalcaemia rate.•Recurrence rate for DTC has association only with the initial nodal stage.

IntroductionTotal thyoidectomy has become the oncologic procedure of choice for differentiated thyroid cancers DTC. The aim of the present study was to evaluate the post-operative morbidity rates, in relation to the surgical extent of primary and redo-thyroid surgeries.Patients and MethodsA total of 331 adult patients who underwent thyroid gland surgery for a diagnosed DTC were included. 213 patients had a completion thyroidectomy, while 117 received a primary total thyroidectomy. Among the redo surgery group, 108 had surgery on the previously unexplored side of neck only, while 105 had repeat exploration and thyroid resection on the previously operated side as well. Length of hospital stay, post-operative hypocalcaemia, recurrent laryngeal nerve injury and tumour recurrence were used as primary outcome measures.ResultsComparing primary versus redo surgery, there was no statistically significant difference between the groups in terms of all four main outcome measures. After controlling for patient's age, T and N stage, length of follow up, and whether or not a neck node dissection was done, the opposite side only redo surgery was associated with a statistically significant shorter hospital stay and lesser risk of persistent hypocalcaemia. Performance of simultaneous neck dissections was found to be associated with longer hospital stay (P ≤ 0.01). Higher initial N stage has a higher likelihood of development of loco regional and metastatic recurrence (P < 0.05)ConclusionAnalysis of our data suggest that under uniform conditions of tumour stage, surgeon, demographics and T stage, there is no statistically significant difference in post-operative outcomes between primary or completion total thyroidectomy. However, less extensive surgery is associated with a better perioperative outcome.