Abstract
BackgroundIn terms of morbidity, prophylactic central neck dissection (CND; level 6) in potentially malignant thyroid disease is discussed controversially. The rates of (transient and permanent) hypoparathyroidism and palsy of the recurrent laryngeal nerve (RLN) after “first-step” (FS-)CND are analyzed in this study.MethodsBilateral and unilateral FSCND, i.e., lymph node dissection along the RLN before (total) thyroidectomy, was performed bilaterally in 68 (group 1) and unilaterally in 44 patients (group 2), respectively. The rates of hypoparathyroidism and palsy of the RLN were documented prospectively and were compared to 237 patients of group 3 (controls) who underwent (total) thyroidectomy only.ResultsFifteen of 68 patients (22 %) of group 1 developed transient and one patient had permanent hypoparathyroidism. Transient unilateral palsy of the RLN was observed in ten patients (15 %); none were permanent. Transient hypoparathyroidism was monitored in 10 of 44 patients (23 %) of group 2 and permanent hypoparathyroidism in 1 (2 %). Six patients (14 %) developed temporary palsy of the RLN; one remained permanent. Palsy was seen in 3 patients on the contralateral side of unilateral FSCND. Transient and permanent hypoparathyroidism was observed in 50 (21 %) and 2 (1 %) of 237 controls. Transient palsy of the RLN was documented in 22 (9 %) of 237 controls and permanent palsy of the RLN in 4 (2 %).ConclusionsIn this single-center series, the overall permanent morbidity was low (1 %). Therefore, FSCND may be recommended (even prophylactically) for experienced high-volume surgeons in patients with thyroid nodules suspicious for malignancy.
Highlights
In terms of morbidity, prophylactic central neck dissection (CND; level 6) in potentially malignant thyroid disease is discussed controversially
Prophylactic/therapeutic CND is recommended to avoid the complications of reoperation and to establish adequate staging to indicate further therapeutic options.[6]
Postoperative hypoparathyroidism was defined as ‘‘transient’’ if intact parathyroid hormone (iPTH) and serum calcium (sCa) normalized within 6 months
Summary
Postoperative hypoparathyroidism was defined as parathyroid hormone levels \15 pg/ml on the first postoperative day with coincident inadequately low calcium and the need for calcium and vitamin D supplementation regardless of the presence of symptoms.[11]. Irritation of the RLN was classified as transient in the presence of temporary hoarseness based on vocal cord immobility at laryngoscopy. When vocal cord immobility was observed, further follow-up to classify transient/permanent RLN palsy was applied. In group 2, ten patients (23 %) developed transient and one (2 %) permanent hypoparathyroidism. Unilateral transient palsy of the RLN was observed in ten patients (15 %) of group 1. In group 2, six patients (14 %) developed transient palsy of the RLN, one (2 %) remained permanent. In group 3, 22 of 237 patients (9 %) developed transient and 4 (2 %) permanent unilateral palsy of the RLN. Group Patients Nerves at risk Nerves at high/normal risk Nerves at high risk (=with FSCND) Nerves at normal risk (=without FSCND)
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