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- Title
Outcomes of Central Neck Dissection for Papillary Thyroid Carcinoma in Primary Versus Revision Setting.
- Authors
Alansari, Hasan; Mathur, Nalin; Ahmadi, Husain; AlWatban, Zaki Hassan; Alamuddin, Naji; Sabra, Omar
- Abstract
Introduction: Surgery in the central compartment after previous thyroidectomy involves an increased risk of injury to critical organs, including the parathyroids and recurrent laryngeal nerve. Contrastingly, primary central neck dissection involves a relatively low operative risk. Objective: This study aimed to compare the outcomes of central neck dissection in primary versus revision settings with respect to the lymph node yield and complication rates. Methods: This single-center prospective study included patients who underwent primary or revision neck dissection surgery for histologically confirmed thyroid malignancy between January 2018 and January 2022. Results: We included 30 patients who underwent total thyroidectomy with primary central neck dissection and 29 patients who underwent central neck dissection following remote thyroidectomy with or without previous central dissection. There was no significant between-group difference in postoperative complications, including permanent hypocalcemia and recurrent laryngeal nerve injury. However, both groups showed a significant postoperative decrease in calcium levels even though calcium and parathyroid hormone levels were within reference range. Conclusion: Although many surgeons fear revision central neck dissection, it appears to have similar therapeutic outcomes and complication rates as primary neck dissection for papillary thyroid cancer. Specifically, there were no between-group differences in the lymph node yield, hypoparathyroidism, or recurrent laryngeal nerve paralysis. Patients with normocalcemia showed a significant postoperative reduction in calcium levels, suggesting subclinical parathyroid insufficiency. Key points: The incidence of papillary thyroid cancer has increased by times 3-fold from 1975 to 2009 but this could be in part attributed to early detection of the disease and more frequent use of ultrasound imaging and other modalities of detection. Central compartment neck dissection is indicated in cases that have clinically or radiologically significant metastatic lymph nodes usually from a primary thyroid tumor or in an elective setting in advanced thyroid and other high-risk tumors. In a revision setting central or lateral lymph node dissection should be considered when suspecting persistent or recurrent disease, which is defined as central neck nodes sized more than 8 mm and lateral neck nodes are sized more than 10 mm on imaging studies. Revision central neck dissection is associated with increased morbidity and lower lymph node yield however in this study there no significant difference in post-operative complications, such as permanent hypocalcemia, recurrent laryngeal nerve injury between the 2 groups. Both groups in the study showed a significantly lower calcium level on the late postoperative tests when compared to preoperative tests, despite still having calcium and PTH levels within normal levels this may be due to parathyroid insufficiency.
- Subjects
NECK dissection; RECURRENT laryngeal nerve; LARYNGEAL nerve palsy; PAPILLARY carcinoma; THYROID cancer; LARYNGEAL nerve injuries
- Publication
Indian Journal of Otolaryngology & Head & Neck Surgery, 2024, Vol 76, Issue 1, p720
- ISSN
2231-3796
- Publication type
Article
- DOI
10.1007/s12070-023-04261-8