Thyroidectomy over a quarter of a century in the Belgian Ardennes: a retrospective study of 1207 patients.
BACKGROUND
The general surgeon has been practising thyroid surgery for over 70 years and has done it well. The exposure to short-lived isotopes of iodine is a risk factor in the development of thyroid cancer. Therefore, the objective of this study was two-fold. Firstly, to reemphasize the importance of the general surgeon in thyroid surgery. Secondly, to examine the possible links between the incidence of thyroid cancer in Belgium and the radiation exposure caused by the Chernobyl cloud.


METHODS
To carry out this study we retrospectively analysed the files of 1207 patients who had undergone thyroid surgery between 1978 and 2004 in a hospital in the south of Belgium; all operations were performed by the same surgeon.


RESULTS
The study showed that surgery of the thyroid is carried out safely and effectively by the general surgeon. The study included 18 haemorrhagic complications (1.5%) of which 9 needed reintubation and further emergency surgery; 8 recurrent laryngeal nerve damage (0.66%); 73 cases of transitory symptomatic hypocalcaemia requiring the administration of oral calcium (6%) and 15 cases of postoperative infection of the surgical wound (1.24%). This level of complication proves that accurate, well-regulated procedures always carried out by the same surgeon make it possible to reduce the number of complications relating to thyroidectomy. The study also shows us that the question of the link with the Chernobyl accident remains open. Several facts may be emphasized. The annual average rate for cancer went from 1 before the nuclear plant accident of Chernobyl to 3.6 after April 1986. There was also an "increase" of thyroid surgical operations in 1999 (13 years after the accident). In this particular year there were 79, while the usual annual average is 46 surgery cases per year. Of these 79 surgical cases, there were 16 cancers (20.25%), while the percentage of cancer cases for the entire study was 6% of patients. Before 1986, of the 286 cases operated on, 8 were cancer, which represented 2.8%. After 1986, 921 patients underwent thyroid surgery and 64 cancers were found (7%). The cases of the three youngest whose thyroid cancer appeared after 1986 should also be noted. They were aged 13, 14 and 19 in April 1986 and had developed cancer 13 to 15 years after the Chernobyl accident.


CONCLUSIONS
It can be said that a meticulous surgical technique followed by an experienced surgeon who continually repeats the same procedures can reduce the number of postoperative complications in thyroid surgery and that the link between cancer of the thyroid in the Belgian population after 1986 and radiation exposure caused by the radioactive cloud released by the explosion of the Chernobyl nuclear plant is still open for debate. Nothing is certain and the numbers of thyroid cancers should continue to be documented in the coming years especially for patients aged less than 10 year old in April 1986.
Vincent
G
G
Cliniques du Sud Luxembourg, Arlon, Belgium. gaetanevincent@yahoo.fr
D000328:Adult; D017677:Age Distribution; D001530:Belgium / Q000453:epidemiology; D018276:Carcinoma, Medullary / Q000453:epidemiology / Q000601:surgery; D002291:Carcinoma, Papillary / Q000453:epidemiology / Q000601:surgery; D047852:Chernobyl Nuclear Accident; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D017678:Sex Distribution; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000601:surgery; D013965:Thyroidectomy / Q000706:statistics & numerical data*; D055815:Young Adult