Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma

Abstract

The benefits of prophylactic central neck dissection (PCND) in patients with papillary thyroid carcinoma (PTC) have not been clearly demonstrated so far and should be weighed against the potential risks of the procedure. The aim of the study was to assess the recurrent laryngeal nerve and parathyroid risks of PCND after total thyroidectomy in patients with PTC and to compare the results with those obtained in patients who underwent total thyroidectomy only. Methods: We selected 100 patients who underwent a total thyroidectomy: 50 for nontoxic benign multinodular goiter (Group 1) and 50 for PTC (Group 2). Patients with PTC had no evidence of macroscopic lymph node invasion during surgery and underwent, in addition to the total thyroidectomy, a PCND. All of the 100 patients were operated on by two experienced endocrine surgeons. All patients had pre-and postoperative investigations of vocal cord movements. Calcemia and phosphoremia were systematically evaluated preoperatively and on day 1 and day 2 after surgery. All patients presenting a postoperative calcemia below 1.90 mmol/l were considered to present an early postoperative hypoparathyroidism and received calcium-vitamin D therapy. The hypoparathyroidism was considered permanent when calciumvitamin D therapy was still necessary 1 year after surgery. Results: None of the patients presented permanent nerve palsy. There were three cases of transient nerve palsy (6%) in Group 1 and two (4%) in Group 2. In Group 1 there was no permanent hypoparathyroidism and four cases of transient hypoparathyroidism (8%). In Group 2, seven patients presented transient hypoparathyroidism (14%) and two patients (4%) remained with definitive hypoparathyroidism. Conclusion: After total thyroidectomy for PTC, PCND does not increase recurrent laryngeal nerve morbidity but it is responsible for a high rate of hypoparathyroidism, especially in the early postoperative course. Even taking into account the possible benefits, the results make it difficult to advocate PCND as a routine procedure in all patients presenting a PTC.

Sentinel lymph node biopsy as guidance for central neck dissection in patients with papillary thyroid carcinoma

“…Our and previous reports [8][9][10][11][12][13][14][15] suggest that SLN biopsy in patients who have PTC without suspected cervical lymphadenopathy can identify occult metastases early and can avoid the morbidity associated with routine and unnecessary lymph node dissection, 34 especially in the central cervical compartment. In addition, we have tried to reduce the morbidity of central neck dissection, including postoperative hypoparathyroidism, by the routine use of oral calcium and vitamin D during the early postoperative period.…”

Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study

“…After conventional open thyroidectomy, postoperative hemorrhage rates were approximately 1-2% by meta-analysis [23], whereas the rates of transient and permanent hypocalcemia were reported to be 26.1% (range, 14.0-39.6%) and 1.2% (range, 0-4.9%), respectively [23][24][25][26][27]. Temporary and permanent vocal cord palsy rates were 3.4% (range, 1.8-7.3%) and 1.1% (range, 0-3.7%), respectively [22,25,26,28]. With endoscopic thyroidectomy, the reported rates of temporary RLN injury were 2.1%, 3.6%, and 2.8% for the axillary, anterior, and hybrid approaches, respectively [1-3, 6, 9, 10, 28-33].…”

Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection

“…[16][17][18] However, there is a high rate of transient hypocalcemia after total thyroidectomy plus CND, suggesting that symptomatic hypocalcemia should be predicted or treated early to prevent prolonged hospitalization. Risk factors for the development of hypocalcemia include reductions in serum calcium 19,20 and iPTH 21,22 concentrations after surgery, suggesting that these factors may be reliable predictors of postoperative hypocalcemia.…”