[Surgical procedures and risk factors in therapy of benign multinodular goiter. A statistical comparison of the incidence of complications].
BACKGROUND
The best surgical approach for bilateral resections in the therapy of benign multinodular goiter is still controversial.


METHODS
The purpose of this study was to compare different modes of resection concerning differences in complication rates and risk factors influencing the outcome. 2235 thyroid resections for multinodular goiter between 1985 and 1999 were analysed.


RESULTS
When compared to bilateral subtotal resection (n = 327; 14.6%), those patients who received lobectomy and contralateral subtotal resection (n = 952; 42.6%) showed a statistically significant higher incidence of temporary hypocalcaemia (22.6% versus 15.9%) only. The "nerve at risk"-analysis demonstrated no significant difference of laryngeal nerve paralysis between the side of lobectomy and subtotal resection, respectively. In comparison to the entire patient population operations for recurrent goiters had an equal operative risk, whereas patients with goiter WHO III or an intrathoracic location had significant higher rates of temporary laryngeal nerve paralysis and hypocalcaemia.


CONCLUSIONS
Lobectomy and contralateral subtotal resection offers numerous advantages concerning intraoperative variability and definitive resection of suspicious nodules. With an adequate standardized surgical technique and identification of the laryngeal nerve, the complication rate is comparable to bilateral subtotal resection.
Steinmüller
T
T
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Charité, Campus Virchow-Klinikum, Medizinische Fakultät, Humboldt-Universität zu Berlin.
Ulrich
F
F
Rayes
N
N
Lang
M
M
Seehofer
D
D
Tullius
S G
SG
Jonas
S
S
Neuhaus
P
P
D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000601:surgery*; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012008:Recurrence; D061226:Recurrent Laryngeal Nerve Injuries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology