An effective method to reduce lymphatic drainage post-lateral cervical lymph node dissection of differentiated thyroid cancer: a retrospective analysis

Analysis of risk factors for lymph node metastasis in 241 patients with thyroid carcinoma and establishment of a prediction model

This study aimed to identify risk factors for cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) and develop a clinical prediction model. Retrospectively, data were collected from 348 PTC patients treated at the Second Affiliated Hospital of Nanchang University between January 2019 and December 2022, with 241 patients included in the final analyses. Patients with lateral cervical LNM were categorized into a metastasis group, and those without were in a non-metastasis group. The patients were divided into a training set (n=169) and a validation set (n=72) in a 7:3 ratio. Logistic and least absolute shrinkage and selection operator (LASSO) regression models were used to identify key factors associated with lateral cervical LNM and prognosis, enabling the construction of a predictive model. The model's validity was assessed via the Hosmer-Lemeshow Test, calibration curves, ROC curves, and decision curve analysis. The metastasis group exhibited higher proportions of males, multiple lesions, bilateral involvement, tumor diameter ≥1 cm, and elevated levels of PLR, LMR, and NLR (P<0.05). Logistic regression analysis revealed that gender, multiple lesions, affected side, and tumor diameter were associated with lateral cervical LNM (P<0.05). The predictive Nomogram model, which included factors like affected side, tumor diameter, capsular invasion, central LNM, PLR, and NLR, demonstrated strong predictive accuracy and clinical utility. Thus, this study provides a practical clinical tool through an accurate Nomogram model to assess lateral cervical LNM risk in PTC patients using logistic and LASSO regression analyses.

Usefulness of preoperative ice cream consumption and novel postoperative drainage management in patients undergoing left-sided neck dissection for thyroid cancer: a nonrandomized prospective study

PURPOSE

This study investigated the effects of ice cream consumption on chyle leakage after left lateral neck dissection in patients with thyroid cancer.

METHODS

A total of 491 patients with thyroid cancer underwent left lateral neck dissection with identification of the thoracic duct following ice cream consumption. Before closing the wound, the anesthesiologist increased the intrathoracic pressure to observe chyle leakage. If chyle leakage occurred postoperatively, the drain was removed using the drain negative pressure release test.

RESULTS

Postoperative chyle leakage was observed in 18 of the 491 patients who underwent left lateral neck dissection. We treated 17 patients conservatively and 1 patient surgically. Drains were removed within five days in all patients. After the drain negative pressure release test had been performed in eight patients, the drainage volume significantly decreased from an average of 175 ml to 31 ml per day. The average number of days until the removal of the drainage tube was 3.2 days. No perioperative complications were associated with ice cream consumption.

CONCLUSIONS

In left lateral neck dissection for thyroid cancer, performing surgery following ice cream consumption does not completely prevent chyle leakage; however, early drain removal is possible because there is only mild leakage.

Chyle leak after head and neck surgeries: a comprehensive review of diagnosis and management strategies

Chyle leaks are uncommon complications after head and neck surgeries. Although uncommon, such a complication is noteworthy mention due to its perplexing diagnosis and management strategies. This scoping review aims to highlight and emphasize the diagnosis and management options proposed in the literature. A comprehensive search was performed in PubMed, Google Scholar, Cochrane Library, and Scopus databases and identified 617 articles that were reduced to 40 studies and reports after applying the eligibility criteria. Although numerous treatment options ranging from simple, conservative measures to invasive surgical procedures have been mentioned for low-output, high-output, and massive leaks, there is no concrete evidence on the best method. Thus, a combination of management options must be customized by case for optimum results.