Impact of Lymph Node Dissection on Postoperative Complications of Total Thyroidectomy in Patients with Thyroid Carcinoma

Abstract

Background: Lymph node dissection (LND) in primary treatment of differentiated thyroid carcinoma is controversial. The aim of our retrospective study was to analyse the risk factors of post-thyroidectomy complications and to assess the morbidity of lymph node dissection, especially in the central neck compartment, since prophylactic central lymph node dissection has not been proven to bring an overall survival benefit. Methods: We performed a retrospective analysis of postoperative complications from 1547 consecutive patients with differentiated thyroid carcinoma in an academic department of endocrine surgery over a period of 10 years. Results: A total of 535 patients underwent lymph node dissection, whereas the other 1012 did not. The rate of postoperative hypoparathyroidism was higher in patients with LND (17.6% vs. 11.4%, p = 0.001). No significant difference in the rate of permanent hypoparathyroidism (2.4% vs. 1.3%, p = 0.096) was observed between these two groups. A multivariate analysis was performed. Female gender, ipsilateral and bilateral central LND (CLND), parathyroid autotransplantation, and the presence of the parathyroid gland on the resected thyroid were associated with transient hypoparathyroidism. Bilateral CLND and the presence of the parathyroid gland on specimen were associated with permanent hypoparathyroidism. The rate of transient recurrent laryngeal nerve (RLN) injury (15.3% vs. 5.4%, p < 0.001) and permanent RLN injury (6.5% vs. 0.9%, p < 0.001) were higher in the LND group. In multivariate analysis, ipsilateral and bilateral lateral LND (LLND) were the main predictive factors of transient and permanent RLN injury. Bilateral RLN injury (2.6% vs. 0.4%, p < 0.001), chyle leakage (2.4% vs. 0%, p < 0.001), other nerve injuries (2.2% vs. 0%, p < 0.001), and abscess (2.4% vs. 0.5%, p = 0.001) were higher in the patients with LND. Conclusions: The surgical technique and the extent of lymph node dissection during surgery for thyroid carcinoma increase postoperative morbidity. A wider knowledge of lymph-node-dissection-related complications associated with thyroid surgery could help surgeons to carefully evaluate the surgical and medical therapeutic options.

Epidemiology, Clinic-histopathological features and Surgical treatment of Papillary Thyroid Cancer: A Retrospective Descriptive Study in Northwestern Algeria

“…The role of prophylactic central neck dissection, particularly in elderly patients, has been contradicted in recent studies. There was no difference between TT and TT associated with prophylactic central cervical dissection in terms of recurrence rates, and there was an increase in postoperative morbidity for lymphadenectomy patients and those over 75 years of age (Baud et al, 2022;Gambardella et al, 2019). A thorough understanding of the complications associated with lymph node dissection during thyroid surgery can assist surgeons in selecting the optimal surgical approach (Baud et al, 2022).…”

Removing different number of regional lymph nodes affects survival outcomes of operable patients at stage IIA non-small cell lung cancer (according to the 8th edition staging)

“…For example, LND may damage the mediastinal nerve, blood vessel and lymphatic vessel, prolong the time of operation, increase postoperative drainage volume as well as increasing the incidence of chylothorax and injuring laryngeal recurrent nerve (33). Therefore, avoiding damage to important tissues in LND may be beneficial in reducing postoperative complications (34).…”

Prospective Cohort Study of Parathyroid Function and Quality of Life After Total Thyroidectomy for Thyroid Cancer: Robotic Surgery vs. Open Surgery

“…Episodes of transient hypoparathyroidism, permanent hypoparathyroidism 20 , postoperative on-Tg and on-TgAb 6 months after surgery 21 , temporary and permanent hoarseness 22 , and postoperative bleeding 23 were documented (Tables 1 – 3 ).…”