Neck Dissection For Papillary Carcinoma Research Articles

P-EGS19 Complete oesophageal transection during thyroidectomy; Successful management of anastomotic leak using endoluminal vacuum therapy (EVT) following failed primary repair

Abstract Background Perforation of the cervical oesophagus is an extremely rare but recognised complication of thyroidectomy. As with all oesophageal perforations management depends on timing of diagnosis in relation to the timing of injury, the size of the oesophageal wall defect, extent of extraluminal contamination, and how unwell the patient is with respect to sepsis. We report a case of complete transection of the cervical oesophagus during total thyroidectomy and its subsequent management. Methods A previously well 32-year-old female had a complete cervical oesophageal transection during total thyroidectomy and neck dissection for papillary carcinoma of thyroid. This was recognised by her ENT surgeon who repaired the oesophagus primarily. Subsequently, she developed sepsis with cellulitis of her anterior chest wall. Cross-sectional imaging demonstrated a leak at the site of the cervical oesophageal repair. Gastroscopy confirmed a 50% dehiscence of the oesophageal anastomosis. Control and management of her oesophageal leak was achieved with EVT delivered using an ad-hoc endoluminal vacuum device (EVD) constructed from open cell foam sutured around the distal end of a nasogastric tube. Results The patient was managed in the intensive care unit (ICU) with appropriate organ support and antimicrobial cover. A surgical jejunostomy was placed to facilitate enteral feeding. EVT was delivered using the ad-hoc EVD which was placed endoscopically and situated intraluminally across the anastomotic leak site. Continuous negative pressure (125 mmHg) was applied. Six EVD changes were required to heal the leak. Her total length of stay was 41 days, of which 38 days were in ICU. There were no periprocedural complications related to using the EVD or EVT, although the patient subsequently developed an oesophageal stricture which required endoscopic dilatation. Conclusions Accidental complete transection of the cervical oesophagus is extremely rare. This case highlights the importance of a multidisciplinary team approach for managing such cases. EVT is an emerging treatment option for upper gastrointestinal (UGI) leaks and is reported to be safe and effective for leaks from a wide range of causes throughout the UGI tract. Successful resolution of the oesophageal leak in this unusual case demonstrates the utility of EVT in difficult clinical situations which may otherwise pose a formidable management challenge using traditional treatment strategies.

Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma

The main drawback of central neck lymph node dissection is postoperative parathyroid failure. Little information is available concerning inadvertent resection of the parathyroid glands in this setting and its relationship to postoperative hypoparathyroidism. Our aim was to determine the prevalence of inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid cancer and its impact on short-and long-term parathyroid function. This was a prospective observational study of consecutive patients undergoing first-time total thyroidectomy with a central neck dissection for papillary carcinoma >10mm. Prevalence and risk factors for inadvertent parathyroidectomy were recorded. Serum calcium and intact parathyroid hormone concentrations were determined 24hours after operation and then periodically in patients developing postoperative hypocalcemia. All patients were followed for a minimum of one year. Whole gland (n=33) or microscopic parathyroid fragments (n=14) were identified in 47/170 (28%) operative specimens. The lower parathyroid glands were involved more often. Variables influencing inadvertent parathyroidectomy were extrathyroidal extension of the tumor and therapeutic lymphadenectomy. Neither lateral neck dissection nor the number of lymph nodes retrieved affected the rate of inadvertent parathyroid resection. Postoperative hypocalcemia and permanent hypoparathyroidism were more frequent after inadvertent parathyroidectomy (64% vs 46% and 15% vs 4%; P≤.03 each). Inadvertent parathyroidectomy during total thyroidectomy with central neck dissection for papillary thyroid carcinoma is common and involves the inferior glands more frequently in patients with extended resections and clinical N1a disease. Inadvertent resection of parathyroid glands is associated with greater rates of postoperative hypocalcemia and permanent hypoparathyroidism.

Consideration of appropriate neck dissection in papillary carcinoma

Consideration of appropriate neck dissection in papillary carcinoma

Incidental parathyroidectomy during thyroid resection: incidence, risk factors, and outcome

BACKGROUND AND OBJECTIVES:Thyroidectomy is a commonly performed procedure for thyroid problems. Inadvertent removal of the parathyroid glands is one of its recognized complications, which occurs more frequently in certain high-risk patients. The aim of this study was to identify the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery.DESIGN AND SETTING:A retrospective review of thyroid operations performed at a tertiary referral hospital between January 2004 and December 2008.METHODS:Pathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid pathology. Postoperative calcium levels were reviewed in these patients.RESULTS:During the study period, 287 thyroidectomies were performed and 47 (16.4%) patients had incidentally removed parathyroid glands. Risk factors for inadvertent parathyroid resection included total thyroidectomy (P=.0001), Hashimoto thyroiditis (P=.004), and extrathyroidal spread (P=.0003). Postoperative hypocalcemia occurred in 18 (38.3%) of the patients in whom the parathyroid gland was removed inadvertently and in 48 (20%) of the rest of the patients (P=.0123).CONCLUSION:The incidence of incidental removal of parathyroid tissue during thyroidectomy is 16.4%. Total thyroidectomy, extrathyroidal extension of the tumor, and thyroiditis were found to be the risk factors. Hypocalcemia was significantly higher among patients who had inadvertent parathyroidectomy.

Evolution in the surgical management of well‐differentiated thyroid cancer or not: To dissect or not dissect the central lymph node compartment

Journal of Surgical OncologyVolume 101, Issue 2 p. 101-102 Guest EditorialFree Access Evolution in the surgical management of well-differentiated thyroid cancer or not: To dissect or not dissect the central lymph node compartment Martha A. Zeiger MD, FACS, FACE, Corresponding Author Martha A. Zeiger MD, FACS, FACE [email protected] Department of Surgery, Endocrine Surgery Section, The Johns Hopkins University School of Medicine, Baltimore, MarylandChief, Endocrine Surgery, Professor of Surgery, Oncology, Cellular and Molecular Medicine, The Johns Hopkins University School of Medicine, Blalock 606, Baltimore, MD 21287. Fax: 410-502-1891.Search for more papers by this author Martha A. Zeiger MD, FACS, FACE, Corresponding Author Martha A. Zeiger MD, FACS, FACE [email protected] Department of Surgery, Endocrine Surgery Section, The Johns Hopkins University School of Medicine, Baltimore, MarylandChief, Endocrine Surgery, Professor of Surgery, Oncology, Cellular and Molecular Medicine, The Johns Hopkins University School of Medicine, Blalock 606, Baltimore, MD 21287. Fax: 410-502-1891.Search for more papers by this author First published: 15 January 2010 https://doi.org/10.1002/jso.21385Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 Cooper DS, Doherty GM, Haugen BR, et al.: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167– 1214. 2 Frazell EL, Foote FW, Jr.: Papillary cancer of the thyroid: A review of 25 years of experience. Cancer 1958; 11: 895– 922. 3 Crile G, Jr.: The fallacy of the conventional radical neck dissection for papillary carcinoma of the thyroid. Ann Surg 1957; 145: 317– 320. 4 Noguchi S, Murakami N: The value of lymph-node dissection in patients with differentiated thyroid cancer. Surg Clin North Am 1987; 67: 251– 261. 5 Mazzaferri EL, Young RL, Oertel JE, et al.: Papillary thyroid carcinoma: The impact of therapy in 576 patients. Medicine (Baltimore) 1977; 56: 171– 196. Citing Literature Volume101, Issue21 February 2010Pages 101-102 ReferencesRelatedInformation

Major post-operative complications of thyroid surgery: Preventable or not?

Factors responsible for major complications following thyroid surgery in 598 patients were studied. Patients with non toxic multinodular goiter involving both lobes of thyroid constituted the maximum bulk subjected to thyroidectomy. The most frequent procedure was bilateral subtotal thyroidectomy. Reactionary hemorrhage occurred in 6 patients, all following bilateral procedures and among them 5 patients developed tension hematoma with respiratory obstruction despite the presence of a drain. Temporary vocal cord palsy was observed in 7 patients whereas one patient subjected to total thyroidectomy with neck dissection for papillary carcinoma of thyroid developed permanent right vocal cord palsy. Temporary parathyroid insufficiency was seen in 51 patients and one patient developed permanent hypoparathyroidism. Incidence of parathyroid insufficiency was higher in bilateral procedures as compared to unilateral ones. There was no operation related death in this series, but complications like hemorrhage, vocal cord palsy and parathyroid insufficiency following thyroid surgery are still a deep concern.

Elective neck dissection in papillary carcinoma of the thyroid

We performed electively the jugular neck dissections for N0 44 patients with papillary carcinoma of the thyroid. On jugular neck dissection, upper, middle and lower jugular nodes and supraclavicular nodes are removed . The pathological metastatic rate was 84% all nodes and 75% in the jugular nodes. A injury of the recurrent and the accessory and a chylorrhea are recognized in three patients as operative complications . On the hand, we performed therapeutically the modified radical neck dissection for Ni 35 patients The pathological metastatic rate was low in the accessory nodes ; 6% in the upper and in the lower region. Therefore, the jugular neck dissection is a reasonable and safety method and also has complication for the patients with NO nodal status of the thyroid cancer.

Elective neck dissection in papillary carcinoma of the thyroid

Elective neck dissection in papillary carcinoma of the thyroid

Elective neck dissection in papillary carcinoma of the thyroid

Elective neck dissection in papillary carcinoma of the thyroid

The fallacy of the conventional radical neck dissection for papillary carcinoma of the thyroid.

From the Department of General Surgery, The Cleveland Clinic Foundation and The Frank E. Bunts Educational Institute, Cleveland, Ohio