Intra- and postoperative complications in 137 cases of giant thyroid gland tumor

Abstract

The intra- and postoperative complications resulting from surgery for giant thyroid gland tumors (diameter greater than 10 cm) present serious challenges to patient recovery. Although there are a number of methods, all have limitations. In this study, we present our experience with several complications of surgical treatment of giant thyroid gland tumors to increase the awareness and aid the prevention of these complications. A total of 137 consecutive patients who underwent surgical treatment in Henan Tumor Hospital were retrospectively analyzed. Statistics pertaining to the patients' clinical factors were gathered. We found that the most common surgical complications were recurrent laryngeal nerve (RLN) injury and symptomatic hypoparathyroidism. Other complications included incision site infections, bleeding, infection and chyle fistula, the incidence of which increased significantly with increasing extent of surgery from group I (near-total thyroidectomy) to group V (total thyroidectomy plus lateral neck dissection). Low complication rates may be achieved with more accurate knowledge of the surgical anatomy, skilled surgical treatment and experience. More extensive surgery results in a greater number of complications.

Figure 1

Giant thyroid papillary carcinoma (Name, Lu XX; history, 11 years; diameter of tumor, 21 cm; weight of tumor, 4,200 g; hospital stay, 12 days; surgery time, 185 min). (A) Preoperative giant thyroid papillary carcinoma, causing dyspnea and limitation of movement. (B) Preoperative computerized tomography scan showing oppressed trachea. (C and F) Specimen of giant thyroid papillary carcinoma was solid. (D) Stitches after 8 days showing flap edema with no significant contour deformity. (E) Neck dissection was completed with internal jugular vein ligation.

Figure 2

Giant thyroid nodular goiter (Name, Cao XX; history, 8 years; diameter of tumor, 16 cm; weight of tumor, 2,800 g; hospital stay, 8 days; surgery time, 108 min). (A and B) Preoperative giant thyroid nodular goiter, causing dyspnea and limitation of movement and sleeping. (C) Stitches after 8 days. The flap was folded and drooping. (D) Preoperative computerized tomography scan showing calcified capsule wall and oppressed trachea. (E and F) Specimen of giant thyroid nodular goiter showing circumference and boundary cleared.