title: Radioactive iodine remnant uptake after completion thyroidectomy: not such a complete cancer operation.
abstract: BACKGROUND
  Given limitations in preoperative diagnostics, thyroid lobectomy followed by completion thyroidectomy (CT) for differentiated thyroid cancer (DTC) may be required. It is unclear whether resection quality by CT differs from that by total thyroidectomy (TT). Additional surgeon or patient factors may also influence the "completeness" of resection. This study evaluated how CT and surgeon volume influence the adequacy of resection as measured by radioactive iodine (RAI) remnant uptake.
  
  
  METHODS
  A retrospective review of a prospectively collected thyroid database was queried for patients treated for DTC with TT or CT followed by RAI ablation. CT patients were matched 1:2 by age, sex, and tumor size to TT patients. Surgeon volume, time to completion, and continuity of surgeon care were reviewed.
  
  
  RESULTS
  Over 18 years, 45 patients with DTC had CT and RAI. Mean age was 48 ± 2 years, and 76 % were female, with a tumor size of 2.7 ± 0.3 cm. CT had higher remnant uptake than TT (0.07 vs. 0.04 %; p = 0.04). CT performed by a high-volume surgeon had much lower remnant uptakes (0.06 vs. 0.22 %; p = 0.04). Remnant uptake followed a stepwise decrease with involvement of a high-volume surgeon for part or all of the surgical management (p = 0.11). Multiple regression analysis found CT (p = 0.02) and surgeon volume (p = 0.04) to significantly influence uptake after controlling for other factors.
  
  
  CONCLUSIONS
  Single-stage TT provides a better resection based on smaller thyroid remnant uptakes than CT for patients with thyroid cancer. If a staged operation for cancer is necessary, surgeon volume may affect the completeness of resection.
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Madison, WI, USA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.forename: Glen
authors.initials: G
authors.lastname: Leverson
authors.forename: Tamilselvan
authors.initials: T
authors.lastname: Sivashanmugam
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000628:therapy; D002291:Carcinoma, Papillary / Q000473:pathology / Q000628:therapy; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000628:therapy*; D013965:Thyroidectomy; D047368:Tumor Burden
chemical_list: D007457:Iodine Radioisotopes