Clinical course of incidental parathyroidectomy: Single center experience

Özden, Sabri; Erdoğan, Ahmet; Simsek, Besir; Saylam, Barış; Yildiz, Barış Doğu; Tez, Mesut

doi:10.1016/j.anl.2017.07.019

Cited by 17 publications

(18 citation statements)

References 15 publications

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“…These rates are compatible with those in the literature 22,23 and in our series. 24 Although the increase in complication after CND is a known fact, according to our study, we think the skip metastasis or performing CND with LND may not increase the rate of complications.…”

Section: Discussionmentioning

confidence: 52%

A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer

Özden

Çomçalı

Ataş

et al. 2020

The American Surgeon™

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The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary thyroid carcinoma (PTC) remain controversial. In this study, we evaluated predictive factors of skip LN metastasis in these patients. We reviewed the medical records of 68 PTC patients who underwent total thyroidectomy, central neck dissection, and lateral neck dissection at the initial operation. The relationships between skip LN metastasis and clinicopathologic factors were analyzed. After careful examination of electronic medical records of patients, 19 patients were excluded from the study. Of the remaining 49 patients, 9 (18.4%) had skip LN metastasis. Multivariate analysis showed that tumor size <1 cm was an independent risk factor for the presence of skip metastasis ( P = 0.035, odds ratio: 3.78, 95% confidence interval: 1.09–13.15). The rate of positive LN was relatively higher in micro-PTC patients than PTC patients. This finding is clinically significant and should be considered in routine clinical practice.

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Section: Discussionmentioning

confidence: 52%

A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer

Özden

Çomçalı

Ataş

et al. 2020

The American Surgeon™

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“…Among these, 62 eligible full-text articles were selected after carefully checking the titles and abstracts. ( Fig 1 ) However, we excluded 27 of the 62 articles because they contained unconvertible data (4 articles)[ 26 – 29 ], lacked hypocalcemia data for the control group (8 articles)[ 30 – 37 ], duplicated data derived from same center (6 articles), or did not give a clear definition of hypocalcemia (9 articles)[ 38 – 46 ]. Finally, 35 articles were included in the systematic review and meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Bai

Chen

2018

PLoS ONE

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IntroductionPostoperative hypocalcemia is the most common complication of thyroidectomy. Incidental parathyroidectomy (IP) was thought to be associated with postoperative hypocalcemia. However, according to previous studies, the risk factors and clinical outcomes of IP remain controversial.MethodsEligible studies were searched in databases including PubMed, Web of Science, and EMBASE from January 1990 to September 2017. Articles focusing on the relationship between IP and postoperative hypocalcemia were included. The risk of publication bias was assessed using Begg’s test and Egger’s regression asymmetry test. Pooled analysis was performed to evaluate the effect of IP on postoperative hypocalcemia and related risk factors. Sensitivity analysis was also conducted to test the stability of our results. The effects of hypocalcemia type, permanent definition, IP incidence, total thyroidectomy, and malignancy operation were also examined using a further subgroup analysis.ResultsThirty-five studies were finally included in the analysis after an exhaustive literature review. Pathology data demonstrate that incidental parathyroidectomy occurred in various locations: intrathyroidal (2.2–50.0%), intracapsular (16.7–40.0%) and extracapsular (15.7–81.1%) regions. Overall, the analysis found that malignancy (RR = 1.60, 95% CI: 1.27 to 2.02; p< 0.0001), central neck dissection (RR = 2.35, 95% CI: 1.47 to 3.75; p = 0.0004), total thyroidectomy (RR = 1.42, 95% CI: 1.20 to 1.67; p< 0.0001) and reoperation (RR = 1.81, 95% CI: 1.20 to 2.75; p = 0.005) were significant risk factors of IP in thyroid surgery. There was an obvious effect of IP on temporary/permanent (RR = 1.59, 95% CI: 1.37 to 1.84; p< 0.0001) and permanent (RD = 0.0220, 95% CI: 0.0069 to 0.0370; p = 0.0042) postoperative hypocalcemia. Sensitivity analysis showed that these results were robust. The subgroup analysis found that IP played a significant role in both biochemical and clinical hypocalcemia in thyroidectomy (p < 0.0001 and p = 0.0003, separately). The association of IP and permanent hypocalcemia using different definitions (6 months or more than 12 months) was also confirmed by the analysis. IP increased the incidence of temporary/permanent and permanent hypocalcemia for cases undergoing total thyroidectomy (40.4% vs 24.8% and 5.8% vs 1.4%, respectively). Thyroidectomy with IP was associated with more permanent hypocalcemia (RR = 3.10, 95% CI: 2.01 to 4.78; p< 0.0001) in malignant cases but was not associated with temporary/permanent hypocalcemia.ConclusionsMalignancy, central neck dissection, total thyroidectomy and reoperation were found to be significant risk factors of IP. IP increases the risk of postoperative hypocalcemia after thyroidectomy. We recommend a more meticulous intraoperative identification of parathyroid gland in thyroidectomy to reduce IP, particularly for total thyroidectomy and malignancy cases.

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“…Rates of IPE are not often well reported, especially in the pediatric population, ranging widely in the adult literature from 2.3% to 29%. 7 , 20 - 23 Multiple patient-specific and surgical aspects have been considered risk factors for IPE in the adult literature, such as pathologic diagnoses and extent of surgery (eg, paratracheal dissection), as well as surgeon experience and volume. 24 Familiarity with the anatomy of parathyroid gland location and blood supply and recognition of parathyroid tissue are of great importance in avoiding IPE.…”

Section: Discussionmentioning

confidence: 99%

Rate of Incidental Parathyroidectomy in a Pediatric Population

et al. 2021

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Objective Incidental parathyroidectomy is a relatively common occurrence in thyroid surgery, which may lead to hypoparathyroidism and postoperative hypocalcemia, but it is not well studied in children. The objectives of this study were to determine the rate of incidental parathyroidectomy, identify potential risk factors, and investigate postoperative complications in children undergoing thyroidectomy. Study Design Retrospective cohort study. Setting Patients who underwent thyroidectomy over a 10-year period at a tertiary children’s hospital. Methods Pathology reports were reviewed to determine incidental parathyroid gland tissue. Additional data collected included patient demographics, type of procedure, underlying thyroid pathology, as well as immediate and long-term postoperative clinical outcomes. Results Of 209 patients, 65 (31%) had incidental parathyroidectomy. Several variables were associated with incidental parathyroidectomy on univariable analysis. However, in the final multivariable model, only thyroidectomy with lymph node dissection was associated with increased odds of having incidental parathyroidectomy (odds ratio, 3.3; P = .04; 95% CI, 1.1-9.8). After a median follow up of 1 year, a significantly higher percentage of patients with incidental parathyroidectomy had evidence of long-term hypoparathyroidism (9/62 [15%] vs 3/144 [2%], P = .001). Conclusion Incidental parathyroidectomy was relatively common in our pediatric thyroidectomy population, which may be a result of several anatomic, clinical, and surgeon-related factors. Close attention to parathyroid preservation with meticulous surgical technique is the most practical method of preventing long-term hypoparathyroidism and hypocalcemia.

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Clinical course of incidental parathyroidectomy: Single center experience

Cited by 17 publications

References 15 publications

A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer

A Diagnostic Dilemma: Skip Metastasis in Papillary Thyroid Cancer

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Rate of Incidental Parathyroidectomy in a Pediatric Population

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