Complication rates of central compartment dissection in papillary thyroid cancer

Kwan, Wai-Yin Wilson; Chow, Tam‐Lin; Choi, Chi‐Yee; Lam, Siu‐Ho

doi:10.1111/ans.12343

Cited by 14 publications

(10 citation statements)

References 23 publications

(57 reference statements)

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“…Among these, 62 eligible full-text articles were selected after carefully checking the titles and abstracts. ( Fig 1 ) However, we excluded 27 of the 62 articles because they contained unconvertible data (4 articles)[ 26 – 29 ], lacked hypocalcemia data for the control group (8 articles)[ 30 – 37 ], duplicated data derived from same center (6 articles), or did not give a clear definition of hypocalcemia (9 articles)[ 38 – 46 ]. Finally, 35 articles were included in the systematic review and meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Bai

Chen

2018

PLoS ONE

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IntroductionPostoperative hypocalcemia is the most common complication of thyroidectomy. Incidental parathyroidectomy (IP) was thought to be associated with postoperative hypocalcemia. However, according to previous studies, the risk factors and clinical outcomes of IP remain controversial.MethodsEligible studies were searched in databases including PubMed, Web of Science, and EMBASE from January 1990 to September 2017. Articles focusing on the relationship between IP and postoperative hypocalcemia were included. The risk of publication bias was assessed using Begg’s test and Egger’s regression asymmetry test. Pooled analysis was performed to evaluate the effect of IP on postoperative hypocalcemia and related risk factors. Sensitivity analysis was also conducted to test the stability of our results. The effects of hypocalcemia type, permanent definition, IP incidence, total thyroidectomy, and malignancy operation were also examined using a further subgroup analysis.ResultsThirty-five studies were finally included in the analysis after an exhaustive literature review. Pathology data demonstrate that incidental parathyroidectomy occurred in various locations: intrathyroidal (2.2–50.0%), intracapsular (16.7–40.0%) and extracapsular (15.7–81.1%) regions. Overall, the analysis found that malignancy (RR = 1.60, 95% CI: 1.27 to 2.02; p< 0.0001), central neck dissection (RR = 2.35, 95% CI: 1.47 to 3.75; p = 0.0004), total thyroidectomy (RR = 1.42, 95% CI: 1.20 to 1.67; p< 0.0001) and reoperation (RR = 1.81, 95% CI: 1.20 to 2.75; p = 0.005) were significant risk factors of IP in thyroid surgery. There was an obvious effect of IP on temporary/permanent (RR = 1.59, 95% CI: 1.37 to 1.84; p< 0.0001) and permanent (RD = 0.0220, 95% CI: 0.0069 to 0.0370; p = 0.0042) postoperative hypocalcemia. Sensitivity analysis showed that these results were robust. The subgroup analysis found that IP played a significant role in both biochemical and clinical hypocalcemia in thyroidectomy (p < 0.0001 and p = 0.0003, separately). The association of IP and permanent hypocalcemia using different definitions (6 months or more than 12 months) was also confirmed by the analysis. IP increased the incidence of temporary/permanent and permanent hypocalcemia for cases undergoing total thyroidectomy (40.4% vs 24.8% and 5.8% vs 1.4%, respectively). Thyroidectomy with IP was associated with more permanent hypocalcemia (RR = 3.10, 95% CI: 2.01 to 4.78; p< 0.0001) in malignant cases but was not associated with temporary/permanent hypocalcemia.ConclusionsMalignancy, central neck dissection, total thyroidectomy and reoperation were found to be significant risk factors of IP. IP increases the risk of postoperative hypocalcemia after thyroidectomy. We recommend a more meticulous intraoperative identification of parathyroid gland in thyroidectomy to reduce IP, particularly for total thyroidectomy and malignancy cases.

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Section: Resultsmentioning

confidence: 99%

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Bai

Chen

2018

PLoS ONE

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“…By contrast, gross invasion to adjacent structures by MIFTC was so rare that radical resection was not considered necessary. The central compartment lymph node was normally not dissected, as is the usual practice for papillary carcinoma at our institution, (8) due to the low risk of nodal spread for FTC. (4,9,10) After surgery with or without RAI, thyroxine suppression therapy was administered to patients, who were then followed up at the outpatient clinics once every three months during the first postoperative year and every six months for four years thereafter.…”

Section: Methodsmentioning

confidence: 99%

Hemithyroidectomy for low-risk follicular carcinoma of the thyroid: results from a regional hospital

Chow

Tam

Choi

et al. 2018

smedj

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“…The risk for such complications can be minimized with an even more meticulous preparation. Other authors have reported a similar complication rate in patients undergoing thyroidectomy in combination with CND, indicating that DLL does not necessarily increase the risk for postoperative compilations [ 42 ]. Furthermore, DLL does not cause any adverse long-term consequences or negative postoperative oncological impairments.…”

Section: Discussionmentioning

confidence: 86%

Papillary thyroid cancer: the value of bilateral diagnostic lymphadenectomy

Bhangu

Bichler

Altmeier

et al. 2022

Langenbecks Arch Surg

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Purpose Papillary thyroid carcinoma (PTC) spreads early to lymph nodes (LN). However, prophylactic central (CND) and lateral neck dissection (LND) is controversially discussed in patients with clinically negative nodes (cN0). The preoperative prediction of LN metastasis is desirable as re-operation is associated with higher morbidity and poor prognosis. The study aims to analyse possible benefits of a systemic bilateral diagnostic lateral lymphadenectomy (DLL) for intraoperative LN staging. Methods Preoperative prediction of LN metastasis by conventional ultrasound (US) was correlated with the results of DLL and intra-/postoperative complications in 118 consecutive patients with PTC (cN0) undergoing initial thyroidectomy and bilateral CND and DLL. Results Lateral LNs (pN1b) were positive in 43/118 (36.4%) patients, including skip lesions (n = 6; 14.0%). Preoperative US and intraoperative DLL suspected lateral LN metastasis in 19/236 (TP: 8.1%) and 54/236 (TP: 22.9%) sides at risk, which were confirmed by histology. Sixty-seven out of 236 (FN: 28.4%) and 32/236 (FN: 13.6%) sides at risk with negative preoperative US and intraoperative DLL lateral LN metastasis were documented. DLL was significantly superior compared to US regarding sensitivity (62.8% vs 22.1%; p < 0.002), positive predictive value (100% vs 76.0%), negative predictive value (82.4% vs 68.2%), and accuracy (86.4% vs 69.1%), but not specificity (100% vs 96.0%; p = 0.039). DLL-related complications (haematoma) occurred in 6/236 [2.5%] sides at risk, including chylous fistula in 2/118 [1.7%] patients. Conclusion DLL can be recommended for LN staging during initial surgery in patients with PTC to detect occult lateral LN metastasis not suspected by US in order to plan lateral LN dissection.

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Complication rates of central compartment dissection in papillary thyroid cancer

Abstract: Total thyroidectomy with prophylactic unilateral CCD is a safe procedure for PTC without added complication rates compared with total thyroidectomy alone. It is recommended for patients with PTC and clinically negative neck lymph nodes.

Cited by 14 publications

References 23 publications

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Hemithyroidectomy for low-risk follicular carcinoma of the thyroid: results from a regional hospital

Papillary thyroid cancer: the value of bilateral diagnostic lymphadenectomy

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