Pediatric thyroidectomy in a "low volume" institution without protocolization: results and future horizons

  • Moreno Alfonso J
  • Molina Caballero A
  • Pérez Martínez A
  • et al.
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Abstract

OBJECTIVE: Pediatric thyroidectomy is an infrequent, complex surgery, with high risk of complications. Complication rates and oncological results of non-protocolized thyroidectomy in a secondary pediatric hospital were compared with those from reference institutions. MATERIALS AND METHODS: A retrospective study of patients under 15 years old undergoing thyroidectomy ± cervical lymphadenectomy by low volume pediatric surgeons (<30 cervical endocrine surgeries annually) in a pediatric hospital from January 2010 to January 2020 was carried out. RESULTS: 11 patients undergoing 12 surgeries (mean age: 9.8 years; 63% female) were analyzed. Thyroid nodules were the main surgical indication (50%), and prevalence of genetic mutations was 45%. 1 patient had transient hypocalcemia, and there were 2 cases of transient recurrent laryngeal nerve neuropraxia (16.6%). No permanent complications were noted. 66.6% of pathological reports showed malignancy. Mean hospital stay was 2.35 days (range: 1.25-5), with an overall complication rate of 25%, similar to that reported by high-volume institutions. After a mean follow-up of 4 years, tumor recurrence has not been observed in any patient. CONCLUSIONS: In our view, an experienced pediatric surgeon specialized in pediatric and neonatal general surgery - even if below the high volume threshold - acquires the skills required in pediatric thyroid surgery without an increase in morbidity and mortality. Perioperative management should be agreed and protocolized by the various specialists involved to improve results.

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Moreno Alfonso, J., Molina Caballero, A., Pérez Martínez, A., Ros Briones, R., Berrade Zubiri, S., & Goñi Orayen, C. (2022). Pediatric thyroidectomy in a “low volume” institution without protocolization: results and future horizons. Cirugía Pediátrica, 35(3), 125–130. https://doi.org/10.54847/cp.2022.03.15

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