Rationale behind thyroidectomy in total laryngectomy: analysis of endocrine insufficiency and oncological outcomes

Panda, Smriti; Kumar, Rajeev; Konkimalla, Abhilash; Thakar, Alok; Singh, Chirom Amit; Sikka, Kapil; Sharma, Suresh C.; Kakkar, Aanchal; Bhasker, Suman

doi:10.1007/s13193-019-00935-4

Cited by 12 publications

(17 citation statements)

References 20 publications

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“…Ipsilateral hemithyroidectomy in advanced hypopharyngeal and laryngeal cancer is supported by literature demonstrating superior oncological control. 12,17 Basheeth et al 6 also demonstrated a significant relationship between tumor stage (pT4) and hypocalcaemia (P = 0.05), but not with extent of thyroidectomy or pharyngectomy, while others have suggested pharyngectomy as a risk. 5 Comparatively, rates in the total and partial pharyngectomy subgroups reveal a higher permanent and transient hypocalcaemia rate for those undergoing total pharyngectomy.…”

Section: Discussionmentioning

confidence: 96%

“…Previous authors have identified various surgical risk factors for postoperative hypocalcaemia; including the extent of thyroid resection, 1,4,5,12,13 bilateral neck dissection, salvage surgery, [4][5][6] and resection of paratracheal lymph nodes. 1,14 12 Our rates of transient and permanent hypocalcaemia (13%, 10%) are supportive of preservation or autotransplantation of the parathyroid gland (Table 3). Ipsilateral hemithyroidectomy in advanced hypopharyngeal and laryngeal cancer is supported by literature demonstrating superior oncological control.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hypocalcaemia in pharyngolaryngectomy: Preservation or autotransplantation of parathyroid glands

Every

Sideris

Sarkis

et al. 2021

Laryngoscope Investig Oto

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Objective: To describe transient and permanent hypocalcaemia following partial and total pharyngolaryngectomy with parathyroid gland preservation or autotransplantation.Methods: Thirty patients underwent partial or total pharyngolaryngectomy by a single surgeon during the period 2009-2020. Intraoperative parathyroid gland preservation or autotransplantation (where the gland appeared devascularized) was routinely performed. Calcium levels performed on day 1, 3 months, and at 12 months postoperatively were collected. Rates of transient and permanent hypocalcaemia were calculated.Results: A total of 13% of patients had transient hypocalcaemia, and 10% permanent hypocalcaemia. Rates of transient and permanent hypocalcaemia in total pharyngolaryngectomy were 14% and 14%, respectively. Partial pharyngectomy hypocalcaemia rates were 13% for transient and 0% for permanent. The majority of patients underwent salvage surgery for oncological resection, often following radiotherapy (63%). Ipsilateral hemithyroidectomy was preferred to total (57% vs 7%), with high rates of concurrent neck dissection (67%) and reconstruction (87%). Conclusion:This data supports preservation or autotransplantation of parathyroid glands as a means of reducing permanent postoperative hypocalcaemia.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hypocalcaemia in pharyngolaryngectomy: Preservation or autotransplantation of parathyroid glands

Every

Sideris

Sarkis

et al. 2021

Laryngoscope Investig Oto

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“…Corrected serum calcium levels were generally used but one study used ionised calcium levels [ 29 ]. The duration for the definition of long-term PoSH was specified as 6 months in some studies [ 8 , 14 ] and 12 months in others [ 6 , 27 ]. Some studies reported rates of transient and long-term hypocalcaemia without providing a definition in the manuscript [ 11 , 13 , 15 , 16 , 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The reported rates (i.q.r.) of transient and long-term hypocalcaemia following bilateral thyroid surgery were 27% (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) and 1% (0-3) [1]. The estimated prevalence of PoSH in Europe and United States of America was 22 per 100,000 and 23 per 100,000, respectively [2].…”

Section: Introductionmentioning

confidence: 99%

Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism

Edafe

Sandler

Beasley

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Post-laryngectomy hypoparathyroidism is associated with significant short- and long-term morbidities. This systematic review aimed to determine incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism. Methods Medline, EMBASE and the Cochrane library were searched for relevant articles on hypocalcaemia and/or hypoparathyroidism after laryngectomy or pharyngectomy. Two authors independently screened titles and abstracts from the search. Data from individual studies were collated and presented (without meta-analysis). Quality assessment of included studies was undertaken. The review protocol was registered in the PROSPERO database (CRD42019133879). Results Twenty-three observational studies were included. The rates of transient and long-term hypoparathyroidism following laryngectomy with concomitant hemi- or total thyroidectomy ranged from 5.6 to 57.1% (n = 13 studies) and 0 to 12.8% (n = 5 studies), respectively. Higher transient (62.1–100%) and long-term (12.5–91.6%) rates were reported in patients who had concomitant oesophagectomy and total thyroidectomy (n = 4 studies). Other risk factors included bilateral selective lateral neck dissection, salvage laryngectomy and total pharyngectomy. There is a lack of data on prevention and management. Conclusion Hypoparathyroidism occurs in a significant number of patients after laryngectomy. Patients who underwent laryngectomy with concomitant hemithyroidectomy may still develop hypoparathyroidism. Research on prevention and treatment is lacking and needs to be encouraged.

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Extent of thyroidectomy and paratracheal lymph node dissection in total pharyngolaryngectomy for pyriform sinus cancer, and recurrence, survival, and postoperative hypoparathyroidism: A multicenter retrospective study

Ariizumi,

Hanai,

Asakage

et al. 2023

Head & Neck

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BackgroundTotal pharyngolaryngectomy (TPL) is standard treatment for hypopharyngeal cancer. However, extensive thyroidectomy and paratracheal nodal dissection (PTND) can cause hypoparathyroidism. We sought to determine the optimum extent of resection.MethodsWe analyzed the clinicopathological information of 161 pyriform sinus cancer patients undergoing TPL from 25 Japanese institutions. Rates of recurrence and risk factors for hypoparathyroidism, as well as incidence of pathological contralateral level VI nodal metastasis and stomal recurrence, were investigated.ResultsThe extent of thyroidectomy and nodal dissection were not independent risk factors for recurrence. Incidences of contralateral level VI nodal involvement and stomal recurrence were 1.8% and 1.2%, respectively. Patients undergoing hemithyroidectomy/ipsilateral PTND did not develop stomal recurrence and had the lowest incidence of hypoparathyroidism. Prognosis in patients without tracheostomy prior to hemithyroidectomy/ipsilateral PTND was comparable to that with more extensive resections.ConclusionsHemithyroidectomy/ipsilateral PTND may be sufficient for pyriform sinus cancer cases without tracheostomy.

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Rationale behind thyroidectomy in total laryngectomy: analysis of endocrine insufficiency and oncological outcomes

Cited by 12 publications

References 20 publications

Hypocalcaemia in pharyngolaryngectomy: Preservation or autotransplantation of parathyroid glands

Hypocalcaemia in pharyngolaryngectomy: Preservation or autotransplantation of parathyroid glands

Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism

Extent of thyroidectomy and paratracheal lymph node dissection in total pharyngolaryngectomy for pyriform sinus cancer, and recurrence, survival, and postoperative hypoparathyroidism: A multicenter retrospective study

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