[Clinical recurrence of multinodular goiter after surgery. A multivariate study on the risk factors].
BACKGROUND
In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years.


METHODS
231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, chi2 test, Student's t test and a logistic regression test are applied.


RESULTS
After a mean postoperative follow-up of 152 +/- 71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 +/- 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred.


CONCLUSIONS
The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients.
Ríos Zambudio
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Servicio Cirugía General y del Aparato Digestivo I, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia. ARZRIOS@teleline.es
Rodríguez González
J M
JM
Galindo Fernández
P J
PJ
Montoya Tabares
M J
MJ
Canteras Jordana
M
M
Parrilla Paricio
P
P
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013965:Thyroidectomy