Advanced age does not increase morbidity after total thyroidectomy. Result of a prospective study - 14/03/19
, Claire Blanchard b , François Pattou c , Christelle Volteau d , Laurent Brunaud e , Antoine Hamy f , Marcel Dahan g , Jean-Michel Prades h , Gérard Landecy i , Henri-Pierre Dernis j , Jean-Christophe Lifante k , Fréderic Sebag l , Franck Jegoux m , Emmanuel Babin n , Alain Bizon o , Cécile Caillard b , Muriel Mathonnet a , Eric Mirallié b, ⁎ Abstract |
Background |
It is well known that total thyroidectomy is feasible on elderly patients but is linked to complications because of their underlying comorbidities. In this study we analyzed the specific risks linked to surgery, hypoparathyroidism and recurrent nerve palsy.
Methods |
materials-methods:Prospective, multicentre trial conducted at 13 hospital sites. The primary endpoint was the percentage of patients with postoperative hypocalcaemia (albumin-corrected serum calcium level <2 mmol/L at day 2). Secondary endpoints included recurrent nerve palsy rate at day 2, the percentage of patients with hypocalcaemia (serum calcium level <2 mmol/L) and recurrent nerve palsy at month 6, operating durations and postoperative pain. Patients were separated in two groups: <70 years and ≥70 years old.
Results |
In total, 1329 patients who underwent total thyroidectomy were included (median age 51.17 years [18.10; 80.90], 80% women, and hyperthyroidism in 20%, 101 ≥ 70 years old). Rates of hypocalcaemia at day 2 and month 6 were 20.02% and 1.98% respectively. Nasofibroscopy showed postoperative abnormal vocal cord motility in 9.92% cases (hypo-motility 5.76% - immobility 4.16%) and 0.95% at month 6 (hypo-motility 0.48%, immobility 0.48%). Patients ≥70 years had a lower (but non-significant) postoperative and definitive hypocalcaemia rate than patients < 70 years: 14.85% vs 20.44% at day 2 (p = 0.1773) and 0% vs 2.15% at month 6 respectively (p = 0.2557). Abnormal vocal cord motility rate was 12.00% in patients ≥70 years vs 9.75% in patients <70 years at day 2 (p = 0.4702), and 2.06% in patients ≥70 years vs 0.86% at month 6 (p = 0.2340).
Conclusions |
Total thyroidectomy in patients ≥70 years is feasible and safe. Age does not increase the morbidity.
The study is registered with ClinicalTrials.gov number NCT01551914.
Le texte complet de cet article est disponible en PDF.Highlights |
• | There was a trend of a lower hypocalcaemia rate for people ≥70 years old. |
• | There was no difference of postoperative recurrent laryngeal nerve palsy. |
• | (RLNP) rate between the 2 groups: <70 years and ≥70 years old. |
• | People older than 70 years were significantly in less pain. |
• | At month 6, there was no difference of hypocalcaemia rate between the 2 groups neither for RLNP. |
• | Age is not a risk factor of morbidity after total thyroidectomy. |
Keywords : Age, Thyroidectomy, Morbidity, Safety
Plan
Vol 217 - N° 4
P. 767-771 - avril 2019 Retour au numéro
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