title: High rate of recurrence after lobectomy for solitary thyroid nodule.
abstract: OBJECTIVE
  To evaluate the long-term outcome of patients treated by lobectomy for solitary thyroid nodule.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  83 patients admitted with a clinical diagnosis of solitary thyroid nodule.
  
  
  METHODS
  Preoperative ultrasonography showed a solitary nodule in 32 patients and this finding was confirmed intraoperatively in 24 cases (77%). 59 patients with multinodular goitres were treated by total thyroidectomy and 24 with solitary nodule by lobectomy.
  
  
  METHODS
  Postoperative complications and freedom from nodule recurrence and/or parenchymal irregularity.
  
  
  RESULTS
  One patient after lobectomy and 3 after total thyroidectomy developed temporary recurrent laryngeal nerve injury. Postoperative temporary hypoparathyroidism occurred in 13 patients (22%) after total thyroidectomy and in no patient after lobectomy (p = 0.02). Neither permanent recurrent laryngeal nerve injury nor permanent hypoparathyroidism occurred after either procedure. Among patients who underwent lobectomy, 6 had an adenoma and 18 had a nodular hyperplasia. At 4-year follow-up, the freedom rate from any thyroid nodule recurrence or parenchymal irregularity was 44.7%, and the freedom rate from nodular recurrence was 74%. Men tended to have a 4-year freedom rate from nodular relapse poorer than women (48% vs. 87%. p = 0.07). Nodular recurrence occurred in one patient operated on for an adenoma, and all the other recurrences occurred in patients with nodular hyperplasia.
  
  
  CONCLUSIONS
  The mid-term freedom rate from thyroid nodule recurrence or parenchymal irregularity after lobectomy for solitary nodule of the thyroid is unsatisfactory. This observation calls for a better evaluation of long-term results after lobectomy for this condition and identification of risk factors predictive of recurrence. This would enable a more appropriate preoperative selection of patients undergoing lobectomy, indicating total thyroidectomy for those patients with solitary nodule at high risk of recurrence.
authors.affiliation: 3rd Department of Surgery, University La Sapienza, Rome, Italy. maurizio.marchesi@uniroma1.it
authors.forename: Maunzio
authors.initials: M
authors.lastname: Marchesi
authors.forename: Marco
authors.initials: M
authors.lastname: Biffoni
authors.forename: Cristiana
authors.initials: C
authors.lastname: Faloci
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Campana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013960:Thyroid Function Tests; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome