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Rosati D, Bononi M, Ruscito P, Radici M, Cavaliere C, Minni A. Bilateral and Ipsilateral Central Neck Dissection in Total Thyroidectomy: a Long Term Comparison of Complications. Indian J Otolaryngol Head Neck Surg 2022; 74:6206-6212. [PMID: 36742527 PMCID: PMC9895597 DOI: 10.1007/s12070-021-02904-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
The role of prophylactic central compartment neck dissection (CCND) in total thyroidectomy (TT) is controversial in patients without clinically evident lymph nodes metastasis (cN0) because of association with transient and permanent hypoparathyroidism (HPT) as well as transient and permanent recurrent laryngeal nerve (RLN) injury. Instead of bilateral central neck dissection (bCCND), ipsilateral central compartment neck dissection (iCCND) has recently been proposed as a safer, alternative treatment for selected patients. The aim of this study is to characterize the morbidity that CCND (ipsilateral and bilateral) adds to TT. We enrolled 453 patients: Group A (316 patients) underwent TT alone, Group B (86 patients) underwent TT + iCCND, Group C (51 patients) underwent TT + bCCND. We compared the rates of RLN injury and HPT in three groups and data analysis showed that iCCND was associated with increased rate of transient HPT but not permanent HPT and bCCND was associated with increased rate of transient and permanent HPT, when compared with TT alone. Further studies are needed to evaluate the clear advantages of CCND (both ipsilateral and bilateral), but this should be considered in the context of an higher risk of surgical complications (especially transient and permanent hypoparathyroidism), in comparison with TT alone.
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Affiliation(s)
- Davide Rosati
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Camillo de Lellis, via John Fitzgerald Kennedy, 02100 Rieti, Italy
| | - Marco Bononi
- Department of Surgery “P. Valdoni”, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Paolo Ruscito
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Camillo de Lellis, via John Fitzgerald Kennedy, 02100 Rieti, Italy
| | - Marco Radici
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Giovanni Calibita - Fatebenefratelli, Isola Tiberina, Rome, Italy
| | - Carlo Cavaliere
- Department of Sensory Organs, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Antonio Minni
- Department of Sensory Organs, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
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Dolidze DD, Shabunin AV, Mumladze RB, Vardanyan AV, Covantsev SD, Shulutko AM, Semikov VI, Isaev KM, Kazaryan AM. A Narrative Review of Preventive Central Lymph Node Dissection in Patients With Papillary Thyroid Cancer - A Necessity or an Excess. Front Oncol 2022; 12:906695. [PMID: 35847927 PMCID: PMC9278848 DOI: 10.3389/fonc.2022.906695] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023] Open
Abstract
ObjectiveThis review article summarises the latest evidence for preventive central lymph node dissection in patients with papillary thyroid cancer taking into account the possible complications and risk of recurrence.BackgroundPapillary thyroid cancer is the most frequent histological variant of malignant neoplasms of the thyroid gland. It accounts for about 80-85% of all cases of thyroid cancer. Despite good postoperative results and an excellent survival rate in comparison with many other malignant diseases, tumor metastases to the cervical lymph nodes are frequent. Most researchers agree that the presence of obvious metastases in the lymph nodes requires careful lymph node dissection. It was suggested to perform preventive routine lymphadenectomy in all patients with malignant thyroid diseases referred to surgery.MethodsIt was performed the literature review using the “papillary thyroid cancer”, “central lymph node dissection”, “hypocalcemia”, “recurrent laryngeal nerve paresis”, “metastasis”, “cancer recurrence” along with the MESH terms. The reference list of the articles was carefully reviewed as a potential source of information. The search was based on Medline, Scopus, Google Scholar, eLibrary engines. Selected publications were analyzed and their synthesis was used to write the review and analyse the role of preventive central lymph node dissection in patients with papillary thyroid cancer.ConclusionsThe necessity of preventive central lymph node dissection in patients with differentiated papillary thyroid carcinoma is still controversial. There is much evidence that it increases the frequency of transient hypocalcemia. Due to the fact that this complication is temporary, its significance in clinical practice is debatable. It can also be assumed that an extant of surgery in the neck area is associated with an increased risk of recurrent laryngeal nerve injury. However, most studies indicate that this injury is associated more with thyroidectomy itself than with lymph node dissection. Recurrent laryngeal nerve dysfunction is also a temporary complication in the vast majority of cases. At the same time, a large amount of data shows that central lymph node dissection reduces the risk of thyroid cancer recurrence in two times.
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Affiliation(s)
- David D. Dolidze
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Department of Surgery, S.P. Botkin City Clinical Hospital, Moscow, Russia
| | - Alexey V. Shabunin
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Department of Surgery, S.P. Botkin City Clinical Hospital, Moscow, Russia
| | - Robert B. Mumladze
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Department of Surgery, S.P. Botkin City Clinical Hospital, Moscow, Russia
| | - Arshak V. Vardanyan
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Department of Surgery, S.P. Botkin City Clinical Hospital, Moscow, Russia
| | | | - Alexander M. Shulutko
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vasiliy I. Semikov
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Khalid M. Isaev
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Airazat M. Kazaryan
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway
- Department of Surgery, Fonna Hospital Trust, Odda, Norway
- Intervention Centre, Oslo University Hospital – Rikshospitalet, Oslo, Norway
- Department of Surgery №1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia
- *Correspondence: Airazat M. Kazaryan,
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Fanget F, Demarchi MS, Maillard L, Lintis A, Decaussin M, Lifante JC. Medullary thyroid cancer outcomes in patients with undetectable versus normalized postoperative calcitonin levels. Br J Surg 2021; 108:1064-1071. [PMID: 33899100 DOI: 10.1093/bjs/znab106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/27/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Calcitonin (Ct) is a sensitive diagnostic biomarker and one of the most important prognostic factors in medullary thyroid cancer (MTC). This study aimed to evaluate progression-free survival and recurrence rates of MTC associated with undetectable compared with normalized serum Ct levels after surgery. METHODS This retrospective observational study included patients operated for MTC at the Digestive and Endocrine Surgery Department of Lyon Sud Hospital Centre between 2000 and 2019. Clinical and pathological factors were correlated with postoperative Ct concentrations. Undetectable and normalized Ct concentrations were defined as below 2 pg/ml and 2-10 pg/ml respectively. RESULTS Overall, 176 patients were treated for MTC, and 127 were considered biochemically cured after surgery. Of these, 24 and 103 had normalized and undetectable Ct concentrations respectively. Patients with Ct level normalization had a 25 per cent risk of disease recurrence, compared with 3 per cent in patients with undetectable Ct levels after surgery. The presence of metastasis in two or more compartments was predictive of failure to achieve undetectable Ct concentrations after surgery and an increased risk of recurrence. CONCLUSION Among patients with biochemically cured MTC, those with undetectable or normalized Ct concentrations after surgery had different risks of recurrence. Simply assessing postoperative Ct normalization can be falsely reassuring, and long-term follow-up is needed.
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Affiliation(s)
- F Fanget
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - M S Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - L Maillard
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - A Lintis
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - M Decaussin
- Department of Pathology, Hospices Civils de Lyon, Lyon, France
| | - J C Lifante
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France.,Health Services and Performance Research Laboratory (EA 7425 HESPER), Université Claude Bernard, Lyon, France
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Wang B, Zhu CR, Liu H, Yao XM, Wu J. The Ability of Near-Infrared Autofluorescence to Protect Parathyroid Gland Function During Thyroid Surgery: A Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:714691. [PMID: 34759888 PMCID: PMC8573048 DOI: 10.3389/fendo.2021.714691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/04/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We conducted this meta-analysis to assess the ability of near-infrared autofluorescence to protect parathyroid gland function during thyroid surgery. METHOD A systematic literature search was conducted using PubMed, Embase, and the Cochrane Library electronic databases for studies published up to February 2021. The reference lists of the retrieved articles were also reviewed. Two authors independently assessed methodological quality and extracted the data. A random-effects model was used to calculate the overall pooled variable and the weighted mean deviation. Publication bias in these studies was evaluated using the Egger's and Begg's tests. RESULT Seven studies involving 1,480 patients were included in the analysis. Compared with patients in the naked eye group, the pooled relative risk of inadvertent parathyroid gland resection and parathyroid gland autotransplantation for the patients in the near-infrared autofluorescence group was 0.48 (95% CI, 0.26-0.9, p = 0.023) and 0.39 (95% CI, 0.09-1.68, p = 0.208), respectively. The pooled relative risk of hypocalcemia at 1 day postoperatively and at 6 months postoperatively for the patients in the near-infrared autofluorescence group was 0.49 (95% CI, 0.34-0.71, p < 0.001) and 0.34 (95% CI, 0.06-2.03, p = 0.238) compared with patients in the naked eye group. CONCLUSION Near-infrared autofluorescence is significantly associated with a reduced risk of inadvertent parathyroid gland resection and hypocalcemia at 1 day postoperatively.
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Affiliation(s)
- Bin Wang
- Department of Thyroid and Breast Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Chun-Rong Zhu
- College of Preclinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Hong Liu
- Department of Thyroid and Breast Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Xin-Min Yao
- Department of Thyroid and Breast Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Jian Wu
- Department of Thyroid and Breast Surgery, Chengdu Third People’s Hospital, Chengdu, China
- *Correspondence: Jian Wu,
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Stubljar B, Pastorčić Grgić M, Mayer L, Perše P, Tomičević T. Elective Central Compartment Lymph Node Dissection Does not Increase the Risk of Postoperative Hypoparathyroidism in Patients Treated for Differentiated Thyroid Cancer. Acta Clin Croat 2020; 59:115-121. [PMID: 34219893 PMCID: PMC8212604 DOI: 10.20471/acc.2020.59.s1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim The aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer. Methods A retrospective analysis of 179 patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups. Results A total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLNd group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLNd group. The rate of persistent hypoparathyroidism in the TT and TT + CCLNd groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLNd group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant. Discussion While its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies. Conclusion Our results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy.
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Affiliation(s)
| | - Marija Pastorčić Grgić
- 1Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre; 2Laboratory Diagnostics Division, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre
| | - Ljiljana Mayer
- 1Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre; 2Laboratory Diagnostics Division, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre
| | - Pavao Perše
- 1Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre; 2Laboratory Diagnostics Division, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre
| | - Tomislav Tomičević
- 1Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre; 2Laboratory Diagnostics Division, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre
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Liang J, Li Z, Fang F, Yu T, Li S. Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:1-8. [PMID: 28374865 PMCID: PMC5384304 DOI: 10.14639/0392-100x-1195] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/19/2016] [Indexed: 12/25/2022]
Abstract
Central lymph node metastases are common in patients with differentiated thyroid cancer (DTC). The management of preoperatively nodenegative (cN0) DTC is still under debate. The aim of this study was to analyse the difference in recurrence and surgical complications between thyroidectomy (TT) alone and TT combined with prophylactic central neck dissection (pCND) as initial treatments to DTC patients with cN0 and evaluate the clinic significance of pCND for these patients. PubMed, Ovid, Cochrane Library, and Web of Science databases were systematically searched using multiple search terms. Twenty-three articles with 6,823 patients were identified. The quality of evidence was assessed by Jadad quality scores and the Newcastle-Ottawa Quality assessment scale. The results showed that compared with patients who underwent TT alone, patients who underwent TT plus pCND had a significant higher rate of transient recurrent laryngeal nerve injury (p = 0.023), transient hypocalcaemia (p < 0.01) and permanent hypocalcaemia (p<0.01). There was a trend towards lower central neck recurrence rate in TT plus pCND (p < 0.01). Combined TT and pCND as initial treatment for DTC patients with cN0 may reduce the risk of recurrence, but increases the incidence of some complications. Methodologically high-quality comparative studies are needed for further evaluation.
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Affiliation(s)
- J Liang
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Dadong District, Shenyang, Liaoning Province, People's Republic of China
| | - Z Li
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Dadong District, Shenyang, Liaoning Province, People's Republic of China
| | - F Fang
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Dadong District, Shenyang, Liaoning Province, People's Republic of China
| | - T Yu
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Dadong District, Shenyang, Liaoning Province, People's Republic of China
| | - S Li
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Dadong District, Shenyang, Liaoning Province, People's Republic of China
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Calò P, Conzo G, Raffaelli M, Medas F, Gambardella C, De Crea C, Gordini L, Patrone R, Sessa L, Erdas E, Tartaglia E, Lombardi C. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study. Eur J Surg Oncol 2017; 43:126-132. [DOI: 10.1016/j.ejso.2016.09.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/18/2016] [Accepted: 09/21/2016] [Indexed: 01/11/2023] Open
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Diamantis E, Farmaki P, Savvanis S, Athanasiadis G, Troupis T, Damaskos C. Sympathetic Nerve Injury in Thyroid Cancer. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 60:135-139. [PMID: 29716678 DOI: 10.14712/18059694.2018.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The double innervation of the thyroid comes from the sympathetic and parasympathetic nervous system. Injury rates during surgery are at 30% but can be minimized by upwardly preparing the thyroid vessels at the level of thyroid capsule. Several factors have been accused of increasing the risk of injury including age and tumor size. Our aim was to investigate of there is indeed any possible correlations between these factors and a possible increase in injury rates following thyroidectomy. Seven studies were included in the meta-analysis. Statistical correlation was observed for a positive relationship between injury of the sympathetic nerve and thyroid malignancy surgery (p 2 = 74%) No statistical correlations were observed for a negative or positive relationship between injury of the sympathetic nerve and tumor size. There was also no statistically significant value observed for the correlation of the patients' age with the risk of sympathetic nerve injury (p = 0.388). Lack of significant correlation reported could be due to the small number of studies and great heterogeneity between them.
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Affiliation(s)
- Evangelos Diamantis
- Department of Anatomy, National and Kapodistrian University of Athens, Greece
| | - Paraskevi Farmaki
- Department of Anatomy, National and Kapodistrian University of Athens, Greece
| | - Spyridon Savvanis
- Department of Internal Medicine General Hospital of Athens "Elpis", Athens, Greece
| | | | - Theodoros Troupis
- Department of Anatomy, National and Kapodistrian University of Athens, Greece.
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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