Background: The American Thyroid Association recently changed its management guidelines for papillary thyroid cancer (PTC) to include routine central neck lymph node dissection (CLND) during thyroidectomy. We currently perform CLND during thyroidectomy only if enlarged central nodes are detected by palpation or ultrasonography; we perform CLND in the reoperative setting for recurrence in previously normal-appearing or incompletely resected nodes. Critics of this approach argue that reoperative CLND has higher complication and recurrence rates than initial CLND. We sought to test this argument, using it as our hypothesis.
Design: Retrospective review.
Setting: University hospital.
Patients: All patients undergoing CLND for PTC between January 1, 1998, and December 31, 2007.
Interventions: Thyroidectomy and CLND.
Main Outcome Measures: Complications (neck hematoma, recurrent laryngeal nerve injury, and hypoparathyroidism) and recurrence of PTC.
Results: Altogether, 295 CLNDs were performed: 189 were initial operations and 106 were reoperations. The rate of transient hypocalcemia (41.8% vs 23.6%) was significantly higher in patients undergoing initial CLND compared with those undergoing reoperative CLND. Rates of neck hematoma (1.1% vs 0.9%), transient hoarseness (4.8% vs 4.7%), permanent hoarseness (2.6% vs 1.9%), and permanent hypoparathyroidism (0.5% vs 0.9%) were not different between initial and reoperative CLND. In addition, recurrence rates in the central (11.6% vs 14.1%) and lateral (21.7% vs 17.0%) compartments were not different between the 2 groups.
Conclusions: Reoperative CLND for PTC has a lower rate of temporary hypocalcemia, the same rate of other complications, and the same rate of recurrence compared with initial CLND. Choosing to observe nonenlarged central neck lymph nodes for PTC does not result in increased complications or recurrence if reoperation is required.
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http://dx.doi.org/10.1001/archsurg.2010.9 | DOI Listing |
World J Surg Oncol
March 2023
Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Background: Management of the inferior parathyroid gland using total thyroidectomy (TT) with central lymph node dissection (CLND) is still controversial. Therefore, we evaluated the safety and effectiveness of single inferior parathyroid autotransplantation.
Methods: The clinical data of patients with papillary thyroid carcinoma (PTC) who underwent TT with bilateral CLND from January 2018 to December 2020 were collected.
Acta Endocrinol (Buchar)
January 2021
"La Sapienza" University of Rome, Faculty of Pharmacy and Medicine - Department of Surgery, Rome, Italy.
Context: Post-operative clinical and biochemical hypocalcemia is a common complication of thyroid surgery and the correlation with incidental parathyroidectomy (IP) remains controversial.
Objective: To evaluate the incidence of IP during TT, its correlation to early post-surgery hypocalcemia, and its potential risk factors.
Patients And Methods: 77 consecutive patients submitted to thyroid surgery between January 2018 and December 2019.
Br J Surg
June 2021
Departments of Endocrine and Sarcoma Surgery, Sweden.
Background: Surgery is the curative therapy for patients with medullary thyroid carcinoma (MTC). In determining the extent of surgery, the risk of complications should be considered. The aim of this study was to assess procedure-specific outcomes and risk factors for complications after surgery for MTC.
View Article and Find Full Text PDFAsian J Surg
September 2019
Department of General Surgery, Erciyes University Medical Faculty Hospital, Turkey. Electronic address:
Objective: The most common complication after thyroid surgery is hypocalcaemia and it sometimes leads to problems that are difficult to correct in patients. The present study was aimed to determine the risk factors causing the development of hypocalcaemia after thyroid surgery.
Methods: 818 adult patients were included in the study.
Int J Surg
August 2018
Baylor Scott & White Health, Texas A&M Health Science Center, 2401 South 31st Street, Temple, Texas, 76508, USA.
Background: This study compares the pathological outcomes and operative morbidity for papillary thyroid cancer (PTC) patients undergoing a primary total thyroidectomy (TT) with central lymph node dissection (CLND), to those undergoing an interval CLND following a previous thyroid operation, or for the unsuspected diagnosis of PTC.
Methods: Single-institution, retrospective review of PTC patients from 2000 to 2015 was performed. Three treatment groups were identified: primary TT/CLND, interval prophylactic CLND, and interval therapeutic CLND.
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