Central neck lymph node dissection for papillary thyroid cancer

  • Kropotov M
  • Grivachev E
  • Yakovleva L
  • et al.
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Abstract

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,295CLNDswereperformed:189were initialoperationsand106werereoperations.Therate of transienthypocalcemia( 41.8%vs23.6%)wassignificantlyhigher 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 reoperativeCLND.In addition, recurrence rates in the central(11.6%vs14.1%)andlateral(21.7%vs17.0%) compartments were not different between the 2 groups. Conclusions: ReoperativeCLNDfor PTC has a lower rate of temporary hypocalcemia, the same rate of other complications, and the same rate of recurrence compared with initialCLND.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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APA

Kropotov, M. A., Grivachev, E. A., Yakovleva, L. P., Khodos, A. V., & Tigrov, M. S. (2019). Central neck lymph node dissection for papillary thyroid cancer. Malignant Tumours, 9(2), 27–34. https://doi.org/10.18027/2224-5057-2019-9-2-27-34

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