Abstract
Background: Controversy exists over the extent of surgical treatment of papillary thyroid cancer.Reoperations may carry a significant risk of surgical complications. The aim of this study is to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. Methods: A total of 196 patients with papillary thyroid cancer were retrospectively reviewed to identify extent of surgery and associated complications, between 2009 and 2018 atSouth Egypt Cancer Institute Assiut University. Results: Primary procedures included less-than-total thyroidectomy (near total thyroidectomy in 5.1%, subtotal thyroidectomy in 4.1%, thyroid lobectomy in 3.1%) and total thyroidectomy in 87.8% (18.9% of them are completion thyroidectomy). No lymph nodes dissection was done in 10.7%, Berry picking in 6.1%, central compartment neck dissection in 41.8%, central compartment neck dissection with modified ipsilateral radical neck dissection in 12.2%, central compartment neck dissection with modified bilateral radical neck dissection in 26.0%, central compartment dissection with both modified bilateral radical neck dissection and superior mediastinal lymph node dissection 3.1%. The most common surgical complication were transient hypoparathyroidism (16.7% - 45.8%) and 2.0% permanent, transient vocal cord palsy (7.3% - 16.7%), and 3.9% permanent, hematoma 1.5%, seroma 7.1% and chyle fistula in 2.6% of patients. Conclusion: Thyroid cancer surgeries are safe. The transient complication rates of hypoparathyroidism increased significantly with increasing the extent of surgery.
Highlights
Papillary thyroid carcinoma (PTC) accounts for >80% of all thyroid malignancies and is the most indolent form of the disease [1]
No lymph nodes dissection was done in 10.7%, Berry picking in 6.1%, central compartment neck dissection in 41.8%, central compartment neck dissection with modified ipsilateral radical neck dissection in 12.2%, central compartment neck dissection with modified bilateral radical neck dissection in 26.0%, central compartment dissection with both modified bilateral radical neck dissection and superior mediastinal lymph node dissection 3.1%
Extent of surgery and neck dissection: Total thyroidectomy was done in 68.9%, while near-total thyroidectomy in 5.1%, subtotal thyroidectomy in 4.1%, thyroid lobectomy in 3.1% and completion thyroidectomy in 18.9%
Summary
Papillary thyroid carcinoma (PTC) accounts for >80% of all thyroid malignancies and is the most indolent form of the disease [1]. Cervical lymph node metastasis occurs frequently in PTC (10% to 15%) with more aggressive biology and requires treatment with more aggressive regimens [2]. Controversy exists over the extent of surgical treatment of papillary thyroid cancer. The aim of this study is to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. Methods: A total of 196 patients with papillary thyroid cancer were retrospectively reviewed to identify extent of surgery and associated complications, between 2009 and 2018 at South Egypt Cancer Institute Assiut University. The most common surgical complication were transient hypoparathyroidism (16.7% - 45.8%) and 2.0% permanent, transient vocal cord palsy (7.3% - 16.7%), and 3.9% permanent, hematoma 1.5%, seroma 7.1% and chyle fistula in 2.6% of patients. The transient complication rates of hypoparathyroidism increased significantly with increasing the extent of surgery
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