Evidence map›Paper›PMID 21630080›Full record

ReviewLangenbeck's archives of surgery2011

State of the art: surgery for endemic goiter--a plea for individualizing the extent of resection instead of heading for routine total thyroidectomy.

Henning Dralle, Kerstin Lorenz, Andreas Machens

Abstract readComparative StudyReview
PubMed Publisher
In one paragraph

Review in Langenbeck's archives of surgery, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 1 pooled it
5.3field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Review
  5. Accessing the influence ofLangenbeck's archives of surgery · 2022
    Article
  6. Article
  7. Article
  8. Review
  9. [Complications of lymph node dissection in thyroid cancer].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2020
    Review
  10. Review
  11. Article
  12. Article
  13. Review
  14. Observational
  15. [Complications after thyroid gland operations in Germany : A routine data analysis of 66,902 AOK patients].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2017
    Article
  16. Article
  17. Article
  18. Review
  19. Article
  20. [Surgical assessment of complications after thyroid gland operations].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2015
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 1 country.

Henning DralleDepartment of General, Visceral and Vascular Surgery, Medical Faculty, University of Halle-Wittenberg, University Hospital, Ernst-Grube-Str. 40, 06097, Halle/Saale, Germany. henning.dralle@uk-halle.de
Kerstin Lorenz
Andreas Machens
Martin Luther University Halle-Wittenberg · DEUniversity Hospital in Halle · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDuring the past 150 years of nodular goiter surgery, the pendulum has been swinging from limited to more extensive forms of thyroidectomy and all the way back reflecting the challenges of striking a balance between surgical morbidity and disease recurrence. PURPOSE: This article aimed at providing guidance for individualizing decisions using a risk-oriented surgical approach to endemic goiter based on literature review and personal experience. DISCUSSION: The following arguments favor total thyroidectomy: (a) Endemic goiter involves the entire thyroid gland; (b) Increasing standardization and specialization supported by better visualization, surgical devices, and intraoperative parathyroid hormone assays have decreased surgical morbidity; (c) One third of goiter patients require completion thyroidectomy for incidental thyroid cancer; (d) Recurrent goiter is frequently seen on ultrasonography after subtotal thyroidectomy; (e) Thyroid hormone replacement is well tolerated and inexpensive. Important counter-arguments include: (a) Restoration of iodine sufficiency does not reverse nodular goiter nor can the growth of individual nodules be predicted; (b) To gather the annual case load necessary to achieve improved outcomes, surgeons need to "super-specialize", which may not be viable globally; (c) Many incidental cancers are detectable through high-resolution ultrasonography, fine needle aspiration cytology, and frozen section during thyroidectomy; (d) Not all recurrent goiters require reoperations; (e) Thyroid hormone replacement is not available and affordable everywhere.

conclusionThe higher surgical morbidity associated with total thyroidectomy, notably recurrent laryngeal nerve palsy and hypoparathyroidism, calls for individualizing the extent of resection for endemic goiter as a new standard of care instead of heading for routine total thyroidectomy.

Indexed as

FemaleGoiter, EndemicHumansHypothyroidismMalePostoperative ComplicationsPrecision MedicinePrognosisRisk AssessmentSecondary PreventionSeverity of Illness IndexThyroidectomyThyroid HormonesTreatment OutcomeVocal Cord ParalysisThyroid Hormones

Identifiers

PMID21630080
OpenAlexW1999600172

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.