title: Bilateral benign multinodular goiter: What is the adequate surgical therapy? A review of literature.
abstract: BACKGROUND
  Benign multinodular goiter (BMNG) is the most common endocrine disease requiring surgery. During the last few years a more aggressive approach has become the trend for bilateral BMNG treatment.
  
  
  METHODS
  Randomized clinical trials of any size that compared bilateral subtotal resection, Dunhill procedure and total thyroidectomy for benign multinodular goiter, published between January 2000 and the end of March 2015, were reviewed.
  
  
  CONCLUSIONS
  Total thyroidectomy can be considered the most reliable approach in preventing recurrence. The Dunhill procedure is related to a higher rate of recurrence, but rarely recurrences after Dunhill procedure lead to reoperation. Total thyroidectomy avoid completion thyroidectomy for incidental carcinoma and its related risks. Recurrent laryngeal nerve (RLN) palsy becomes less common as surgical experience increases. Transient and permanent hypoparathyroidism is strictly related to the extent of neck dissection. In the risk-cost analysis we must consider the type of patient candidated to surgery and the impact of the surgical protocol we apply. When thyroid surgery is taken in consideration, specific complication rates of different procedures in each hospital must be analyzed accordingly to patient-specific risk factors and local expertise.
  
  
  CONCLUSIONS
  The Dunhill procedure seems to be a good compromise between radicality and prevention of complications, avoiding reoperation for recurrence or completion thyroidectomy for incidental thyroid carcinoma. More follow-up studies and prospective studies are necessary to better evaluate, definitively, whether to prefer total thyroidectomy or Dunhill procedure in case of benign goiter surgery.
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy. Electronic address: claudio.mauriello@live.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mauriello
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy. Electronic address: gianpaolo.marte@gmail.com.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Marte
authors.affiliation: Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University "Federico II" of Naples, Italy. Electronic address: al.canfora@gmail.com.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Canfora
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy. Electronic address: dottornapolitano@gmail.com.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Napolitano
authors.affiliation: University of Bari School of Medicine, Department of Emergency and Organs Transplantation, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Pezzolla
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy. Electronic address: claudiog86@hotmail.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gambardella
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy. Electronic address: ernestart@msn.com.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Tartaglia
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy. Electronic address: michelanz@fastwebnet.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Lanza
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy. Electronic address: giancarlo.candela@unina2.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Candela
mesh_terms: D003362:Cost-Benefit Analysis; D006044:Goiter, Nodular / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology*; D037981:Neck Dissection; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology
keywords: Benign multinodular goiter; Dunhill procedure; Goiter recurrence; Post-operative complications; Subtotal thyroidectomy; Total thyroidectomy