In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden.
Abstract. Purpose of the study is to compare complication rates of bilateral subtotal (BST), near total (NTT) and total thyroidectomy (TT) in a cohort of patients undergoing surgery for benign multinodular goitre (MNG). Seven hundred and fifty patients undergoing surgery for MNG were studied with a median follow-up of 53 months (range 18-102). There was no operative mortality in this group and no patients required urgent re-exploration for haematoma. After BST 14 patients (14/170 -8.2%) developed transient hypocalcaemia and 4 patients (4/170 -2.4%) had transient and one permanent (1/170 -0.6%) recurrent laryngeal nevre (RLN) palsy. In NTT group 39 patients (39/320 -12.2%) developed transient hypocalcaemia and 2 patients (0.6%) transient voice disturbances. None of the patients in this group experienced permanent complications. However, in TT group 78 patients had (78/260 -30%) transient hypocalcaemia whereas only one patient (1/260 -0.4%) suffered permanent hypoparathyroidism and 5 patients (5/260 -1.9%) had temporary RLN injury but none of them remained permanent. There are only 2 (2/170 -1.2%) recurrences and those patients are in BST group. All of the patients in BST group required at least 100 mg of thyroxine supplementation following the operation. These results demonstrate low permanent complication rates following thyroid surgery. Although the incidence of transient hypoparathyroidism increases with the extent of the resection, permanent complication rates are similar for all three surgical procedures. Even with short follow-up, there is a risk of recurrence with BST and therefore NTT or TT may be the operation of choice for MNG.
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