Modified minimally invasive video-assisted lateral neck dissection for papillary thyroid carcinoma: a series of 130 cases

Abstract

Objective: To discuss the feasibility, safety and oncologic completeness of modified minimally invasive video-assisted lateral neck dissection (MIVALND) for papillary thyroid carcinoma. Methods: Data of 130 patients from Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical School, Zhejiang University undergoing MIVALND from January 2013 to September 2015 were reviewed retrospectively. There were 31 male and 99 female patients with the mean age of (39±11) years. The thyroidectomy and central compartment dissection were performed under a direct visual field or video-assisted (VA) approach, lateral neck dissection was performed via the VA approach. Serum thyroglobulin and thyroglobulin antibody levels were measured every 6 months after surgery. Ulrasonography was performed to assess the thyroid bed and lateral neck compartment every 6 months after surgery. The mean operation time for MIVALND, mean postoperative hospital stay, size of primary tumor, number of retrieved lymph nodes, complication rates, and postoperative serum thyroglobulin levels were analyzed retrospectively. The patients were followed up by outpatient review and until March 2016. Results: Beside 1 case was converted to open procedure, 129 (99.2%) patients successfully underwent MIVALND. The mean operative time was (74±17) min (ranging from 40 to 120 min) for MIVALND. The mean postoperative hospital stay was (4.9±2.1) days (range 2 to 14 days). The mean size of primary tumor was (1.3±0.7) cm (range 0.3 to 4.0 cm). The mean number of lymph nodes removed was 42±13 (range 15 to 79) in lateral compartment. Postoperative complications included 19 transient hypoparathyroidism, 7 transient recurrent laryngeal nerve (RLN) palsy and 3 permanent RLN palsy (tumor invasion and the RLN was resected en bloc with the tumor in 2 cases), 2 (1.5%) transient palsy of spinal accessory nerve, 1 (0.8%) transient palsy of marginal mandibular branch of the facial nerve, 1 (0.8%) seroma, and 4 (3.1%) minor chyle leak. The mean follow-up period was (19±10) months (ranged 6 to 36 months). The mean serum thyroglobulin level was 0.10 μg/L during follow-up. No evidence of local residual or recurrent disease was observed at postoperative follow-up. Conclusion: The modified MIVALND is a safe and feasible approach in selected papillary thyroid carcinoma patients.