Objectives: To analyze the histology results and to assess operative risk of iterative operations for thyroid surgery.
Patients and methods: A total of 249 re-operations were performed in 248 patients over a 6.5 year period. Two groups of patients were defined according to the indications for re-operation. Group 1: 80 patients; pathology examination of the surgical specimen discovered thyroid cancer. Group 2: 169 patients; recurrent nodular goitre after an initially benign disease.
Results: In group 1, 14 cancers were bilateral (17.5%) and 7 patients had cervical node metastases (8.8%). In group 2, 19 cancers were discovered (11.1%), including 5 cases with cervical node invasion (26.3%) and 4 with visceral metastases (21.1%). Twenty complications occurred in 20 patients (8%): compressive cervical hematomas (n = 3, 1.2%), recurrent nerve palsy (n = 7, 2.8%), hypoparathyroidism (n = 9, 3.6%; including 3 definitive cases, 1.2%) and mediastinitis (n = 1). These complications were significantly more frequent in patients re-operated for hyperthyroidism or those who had a past history of more than one cervicotomy.
Conclusion: The frequency of bilateral cancer justifies completing thyroidectomy after partial thyroidectomy. The rate of definitive complications after re-operations is greater than first line cervicotomy but is low enough to allow iterative surgery using rigorous procedure in selected patients.