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.
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.
Authors: Elisabeth Mamelle; Isabelle Borget; Sophie Leboulleux; Haïtham Mirghani; Carlos Suárez; Phillip K Pellitteri; Ashok R Shaha; Marc Hamoir; K Thomas Robbins; Avi Khafif; Juan P Rodrigo; Carl E Silver; Alessandra Rinaldo; Alfio Ferlito; Dana M Hartl Journal: Eur Arch Otorhinolaryngol Date: 2014-06-11 Impact factor: 2.503
Authors: Pietro Giorgio Calò; Celestino Pio Lombardi; Francesco Podda; Luca Sessa; Luigi Santini; Giovanni Conzo Journal: Updates Surg Date: 2017-04-13
Authors: Brian Hung-Hin Lang; George C C Lee; Cathy P C Ng; Kai Pun Wong; Koon Yat Wan; Chung-Yau Lo Journal: World J Surg Date: 2013-12 Impact factor: 3.352
Authors: Dana M Hartl; Elisabeth Mamelle; Isabelle Borget; Sophie Leboulleux; Haïtham Mirghani; Martin Schlumberger Journal: World J Surg Date: 2013-08 Impact factor: 3.352