What term best describes a procedure that is less than total, often used in conjunction with 'subtotal' in endocrine surgeries?

Endocrine System Terminology: Subtotal and Less Than Total Procedures

In endocrine surgery terminology, the term "partial" best describes a procedure that is less than total, often used in conjunction with 'subtotal' in endocrine surgeries.

Understanding Endocrine Surgical Terminology

When describing the extent of endocrine surgical procedures, several terms are used to indicate how much of the gland is removed. These terms follow a hierarchy of tissue removal:

Terminology Hierarchy (Most to Least Extensive)

1. Total/Radical: Complete removal of the entire gland
2. Subtotal: Removal of most (typically >90%) of the gland, leaving a small remnant
3. Partial: Removal of a significant portion but less than subtotal
4. Limited/Segmental: Removal of a smaller, specific portion or segment of the gland

Evidence-Based Definitions

According to clinical practice guidelines, these terms have specific meanings in endocrine surgery:

• Total thyroidectomy refers to complete removal of the thyroid gland 1
• Subtotal thyroidectomy involves removing most of the gland while leaving a small remnant of functioning tissue 1
• Partial thyroidectomy includes procedures like hemithyroidectomy where a significant portion is removed 1

The K/DOQI Clinical Practice Guidelines specifically mention that "there are many variations on the procedure performed to accomplish surgical parathyroidectomy, which include subtotal or total parathyroidectomy, with or without implantation of parathyroid tissue" 1. This demonstrates how "subtotal" is used in conjunction with "total" to describe the extent of tissue removal.

Clinical Applications

Different endocrine conditions require different extents of surgical resection:

Thyroid Surgery

• Total thyroidectomy is indicated for thyroid cancer ≥1cm, multifocal disease, or familial thyroid cancer 2
• Subtotal thyroidectomy preserves some thyroid function while removing most of the gland
• Partial procedures (including hemithyroidectomy) may be acceptable for unifocal tumors <1cm with favorable characteristics 2

Parathyroid Surgery

• For secondary hyperparathyroidism, both "subtotal parathyroidectomy or total parathyroidectomy" are recognized options 1
• In persistent hyperparathyroidism after kidney transplantation, "subtotal parathyroidectomy" has been shown to induce greater reductions of PTH and calcium compared to medical management 1

Other Endocrine Surgeries

• In colonic Crohn's disease, guidelines differentiate between "segmental colectomy" and "subtotal or total colectomy" based on disease extent 1
• For recurrent chordoma, guidelines recommend "subtotal resection" when complete resection isn't feasible 1

Practical Implications

The distinction between these terms is clinically important as they determine:

1. How much functional tissue remains
2. The need for hormone replacement therapy
3. The risk of disease recurrence
4. Potential complications

For example, in thyroid surgery, a partial thyroidectomy may preserve enough thyroid function to avoid lifelong thyroid hormone replacement, while a total thyroidectomy will always require hormone supplementation.

The term "partial" is most appropriate when describing a procedure that is less than total but doesn't reach the extent of a subtotal resection, as it sits between "subtotal" and more limited procedures in the hierarchy of tissue removal.