Complications of Central Neck Dissection in Patients with Papillary Thyroid Carcinoma: Results of a Study on 1087 Patients and Review of the Literature

Abstract

The increased rates of transient and permanent hypoparathyroidism in our series suggest a critical review of indications for the routine use of prophylactic CND for PTC. Prophylactic CND ipsilateral to the tumor associated with total thyroidectomy may represent an effective strategy for reducing the rate of permanent hypoparathyroidism. Concomitant completion contralateral paratracheal lymph node neck dissection should be performed in presence of lymph node metastasis on intraoperative frozen-section pathology. This approach limits the use of bilateral CND to patients with intraoperative pathological findings of lymph node metastases.

Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients

“…I n s p i t e t h e l o w i n c i d e n c e o f p e r m a n e n t hypoparathyroidism (7.4%) and permanent recurrent laryngeal dysfunction (3.7%) in this study, which is comparable to other studies in the literature (White et al, 2007;Popadich et al, 2011;Giordano et al, 2012), we cannot conclude the safety of the procedure as regards those two parameters as this may need a larger sample size in a multicenter study with a multivariate analysis comparing another group of patients who didn't have a prophylactic Level VII nodal dissection.…”

“…For Giordano et al, 2012 transitional cases range from 3.6% to 5.5%, the definitive from 1% to 2.3%.…”

Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

“…Temporary hypoparathyroidism was (Tartaglia et al, 2014), 6% (Wang et al, 2013) and 9.7% (Popadich et al, 2011) but sometimes as high as 60% (Pereira et al, 2005). In this study, the permanent VCD was documented in 3.2% in group A and 6.3% in group B which was within the reported range (0-12%) in other studies (Choi et al, 2011;Hughes and Doherty, 2011;Popadich et al, 2011;Giordano et al, 2012;Wang et al, 2013;Tartaglia et al, 2014;Lee et al, 2015), while temporary VCD was reported to be 12.9% in group A and 9.4% in group B which was slightly higher than the reported range (0.4-9%) in other studies (Pereira et al, 2005;Popadich et al, 2011;Wang et al, 2013;Tartaglia et al, 2014;Lee et al, 2015).…”

Enlargement of “SHENOY Node”: A Risk Factor for Temporary Recurrent Laryngeal Nerve Paralysis after Thyroid Surgery

“…The lymph node located posterior to the RLN has a strong relation with temporary RLN paralysis, although the incidence of metastasis to this node is half of that in nodes anterior to the RLN, and is reported as 17% versus 36%, respectively [14]. Enlarged lymph node located just anterior to the entry point of RLN into cricothyroid membrane, within a radius of 5 mm, might be a potent predictor of temporary nerve paralysis, which cannot …”

“…There are several factors affecting the probability a the temporary RLN paralysis, such as large locally infiltrative extra-thyroidal disease, substernal extension of lesion, history of previous surgery or irradiation, surgery including central compartment lymph node dissection, presence of anatomical variation in nerve anatomy [2,[9][10][11][12][13]. The incidence of enlarged para-tracheal lymph node either reactive or metastatic is reported as 23% to 60% in patients with suspicious malignancy or differentiated thyroid cancer [14].…”