Neck Dissection For Thyroid Carcinoma Research Articles

Neck swelling 19 days after thyroidectomy: A case report of a rare chyle leak patient.

The occurrence of chyle leak after neck dissection for thyroid carcinoma is uncommon, but it usually occurs within 1-10days after surgery. We encountered a 30-year-old patient with chyle leak 19days after the operation for thyroid carcinoma. The initial symptom was swelling of the neck, which was quickly diagnosed as chyle leak by puncture. This report describes the patient's presentation and discusses the conservative management of this complication. We highlight that more attention should be given to chyle leak in high-risk patients, and stricter dietary management for these patients after surgery may avoid this complication. In addition, timely diagnosis and rapid implementation of various conservative treatment measures play an important role in patient recovery.

High rate of IIA/IIB neck groups involvement supports complete lateral neck dissection in thyroid carcinoma.

Although therapeutic lateral neck dissection (LND) may be indicated in thyroid carcinoma, the cervical lymph node groups IIA and IIB, according to Robbins classification, are often not removed. The aim of our study was to determine the relevance of complete comprehensive LND in thyroid carcinoma. We conducted a retrospective study between January 2011 and August 2018 in a university teaching hospital. Histopathological analysis of LND performed during total thyroidectomy in thyroid carcinoma was reviewed according to lymph node level. To demonstrate that neck dissection of upper groups, IIA/IIB, is necessary when therapeutic LND is indicated in thyroid carcinoma, we compared histopathological involvement in complete comprehensive LND of the upper groups IIA/IIB to the lower groups III/IV/V. A total of 30 LND (24 patients) were suitable for analysis. Analysis by neck side revealed that comprehensive LND dissection samples were negative in 3 cases, and positive in 27. In those 27 positive LND, 15 demonstrated involvement of the groups IIA/IIB, and 12 were positive for involvement of the III/IV/V groups only. The combined presence of positive IIA/IIB and positive III/IV/V was observed in 15 of the 27 neck sides. There was no positive IIA/IIB without positive involvement of III/IV/V groups. The high rate of positive cervical lymph nodes in the upper groups IIA/IIB supports complete comprehensive LND rather than selective III/IV/V LND in thyroid carcinoma surgery. However, impact on survival and whether postoperative radioactive iodine treatment may be modulated remain to be studied.

Variations and results of retroauricular robotic thyroid surgery associated or not with neck dissection.

Technological advances in the last decades allowed significant evolution in head and neck surgery toward less invasive procedures, with better esthetic and functional outcomes, without compromising oncologic soundness. Although robotic thyroid surgery has been performed for some years now and several published series reported its safety and feasibility, it remains the center of significant controversy. This study shows the results of a case series of robotic thyroid surgery, combined or not with robotic neck dissection. A retrospective cohort including 48 cases of robotic thyroid surgery with or without neck dissection, using retroauricular or combined approaches, performed in a tertiary cancer center, comprised the study. Between 2015 and 2017, we performed 2,769 thyroid surgical procedures, of which 48 (1.7%) were robot-assisted, in 46 patients [26 hemithyroidectomies, 7 total thyroidectomies, and 12 total thyroidectomies (or totalization) with selective neck dissection (SND) II-VI; and 3 neck dissections for thyroid carcinoma]. There were 43 (89.6%) women, and the median age was 35 years. The mean hospital stay was 1.9 days. In 3 (6.2%) cases, drains were not placed (hemithyroidectomies), whereas the other 45 (93.8%) cases had a mean drain stay of 4.4 days (range, 1-9 days). The console time (robotic thyroid resection and neck dissection) ranged from 11 to 200 min (mean 66.1 min; median 40 min), and the total operating room time ranged from 80 to 440 min (mean 227.9 min; median 170 min). Three (6.2%) patients had transient vocal cord paresis. Transient hypocalcemia was reported in three cases (6.2%). There were 30 carcinomas (62.5%), and the mean number of retrieved lymph nodes (LNs) (considering only cases that included robotic neck dissection) was 27.2 (range, 17-40). The mean follow-up time was 17.4 months (range, 1.4-31.9 months), and no recurrence was diagnosed. The quality outcomes and complication rates are comparable to the conventional approaches. Therefore, robotic thyroidectomy can be an option for selected patients that are motivated to avoid a visible neck scar, treated in high-volume centers. For the patients who require lateral neck dissection, the retroauricular robotic approach could be even more attractive, especially for young patients.

Operative bed recurrence of thyroid cancer: utility of a preoperative needle localization technique.

Surgical management of recurrent disease after total thyroidectomy and/or neck dissection for thyroid carcinoma remains a challenging clinical problem. Reoperation is associated with a significant increase in morbidity. Preoperative needle localization technique for non-palpable breast tumors has recently been extrapolated to head and neck surgery. We report on the use of preoperative ultrasound-guided needle localization for non-palpable recurrent operative bed disease as an intraoperative aid in resection. Patients with thyroid carcinoma were identified from a retrospective database at a tertiary care center from 2011-2014. Inclusion criteria were history of thyroidectomy and/or neck dissection, non-palpable recurrent disease in the resection bed on surveillance, and ultrasound-guided needle localization of recurrent disease before resection. Perioperative data and outcomes were analyzed. Seventeen patients were identified using the inclusion criteria listed above. Median patient age was 46 years (53% male, 47% female). A total of 23 masses in the previous operative bed were needle-localized successfully with no major long-term sequelae from this technique. The recurrent laryngeal nerve was involved with tumor in six patients. Two patients, in whom the tumor surrounded the nerve circumferentially, experienced recurrent laryngeal nerve injuries. No patients experienced postoperative hypocalcemia. With a routine surveillance and a median follow-up of 558 days, sixteen of the patients remain with no evidence of disease. Preoperative ultrasound-guided needle localization of non-palpable recurrent operative bed disease after thyroidectomy and/or neck dissection is a potentially safe method to aid in resection and cure.

Incidence of permanent hypocalcaemia after total thyroidectomy with or without central neck dissection for thyroid carcinoma: a nationwide claim study.

Permanent hypocalcaemia is the most common and serious complication after total thyroidectomy (TT). This study examined the impact of central neck dissection (CND) and institutional volume on rates of permanent hypocalcaemia by analysing data held in the nationwide claim database of South Korea. Data from patients who underwent TT due to thyroid carcinoma from 2007-2013 were obtained from the Health Insurance Review and Assessment Service database. Of these, patients prescribed more than 1000 mg of elemental calcium for more than 288 days during the first 360 days postsurgery were defined as having permanent hypocalcaemia. In total, 192 333 patients (32 988 male and 159 345 female) were eligible for analysis. Of these, 52 707 (27·4%) underwent TT alone and 139 626 (72·6%) underwent TT plus CND. The incidence of permanent hypocalcaemia was greater in the TT plus CND group than in the TT alone group (5·4% vs 4·6%, P < 0·001). The age- and sex-adjusted risk for permanent hypocalcaemia in the TT plus CND group was 1·20 (P < 0·001). CND did not raise the rates of permanent hypocalcaemia in institutes with a low volume of annual cases (<200), whereas permanent hypocalcaemia was more common in the TT plus CND group than in the TT alone group (3·5% vs 2·9%, P = 0·002) in institutes with a large volume of annual cases (≥800). TT plus CND was associated with a greater risk of permanent hypocalcaemia than TT alone. Surgeons should consider the risk of permanent hypocalcaemia when deciding whether to perform CND.

Chylothorax after neck dissection for thyroid carcinomas: report of three cases

Chylothorax is a rare complication of neck dissection. We report three cases of chylothorax after neck dissections for thyroid carcinoma and attribute this relatively high incidence to the assumption that most patients are asymptomatic. Thus, conventional chest X-ray or ultrasonography in the early postoperative period may be warranted to exclude asymptomatic chylothorax, especially if the thoracic duct is injured and ligated during the operation. We suggest that for chylothorax induced by ligation of the thoracic duct, which may be transient and resolve quickly, short-term thoracic drainage is enough.

Safety and feasibility of elective minimally invasive video‐assisted central neck dissection for thyroid carcinoma

Minimally invasive video-assisted thyroidectomy (MIVAT) is accepted as treatment for select patients with thyroid carcinoma. We report both benefits and limitations of elective central neck dissection performed with the MIVAT technique. Patients undergoing elective central neck dissection with MIVAT during November 2006 to October 2009 were studied retrospectively. Outcomes included complications and recurrence rates. In all, 28 patients were studied. There were no recurrences, with median follow-up of 14 months. Eleven patients (39%) had positive central lymph nodes for metastases. No permanent hypocalcemia resulted, although 3 patients (10.7%) experienced transient hypocalcemia on postoperative day 1 (Ca <8 mg/dL). No permanent hypoparathyroidism resulted, although 7 patients (25%) had transient hypoparathyroidism (postanesthesia care unit parathyroid hormone [PTH] <8 mg/dL) treated with short-term supplementation. Transient recurrent laryngeal nerve paresis occurred in 1 patient (3.6%). At the most recent check, 91% of patients had low/undetectable (<1 ng/mL) thyroglobulin. Elective central neck dissection performed with MIVAT is a safe and feasible procedure in our institutional experience.

後頚部に発生したデスモイド腫よう例

We report a desmoid tumor in a 75-year-old man, who presented with a tumor in the posterior neck in July 2003. The patient had a history of left lobectomy and neck dissection for thyroid carcinoma in September 2000.CT findings indicated a large strongly enhanced tumor located in the posterior neck.On T1-weighted MRI, the tumor was isointense to muscle and heterogeneously enhanced with gadolinium. The lesion also exhibited a high intensity on T2-weighted MRI.PET showed FDG accumulation in the tumor, while 201mT1 scintigraphy showed T1 uptake in the tumor, suspected the recurrence of thyroid carcinoma. The tumor was excised under general anesthesia in November 2003. At surgery, the lesion was adherent to the surrounding tissue, but there were no post-operative neurological problems.Pathological examination demonstrated multiplication of fibroblasts and abundant collagen but there were no remarkable features for example fission and necrosis, suggesting malignancy. However, the tumor showed a tendency to infiltrate by extension between individual muscle fibers.From available information, desmoid tumors of the head and neck are rare, especially in the posterior neck lesions. These lesions are fibrous neoplasms with a good prognosis but significant morbidity with the potential for locally aggressive growth invading surrounding structures. The complicated anatomy of the head and neck seems to generate a tendency toward such lesions, but they do not display any metastatic potential clinically.We have not detected any postoparative recurrence of the tumor for seven months to date.

Modified neck dissection in treatment of thyroid cancer: A safe procedure

Differentiated carcinoma of the thyroid metastasizes early and frequently to cervical lymph nodes. Radical neck dissection performed electively or therapeutically results in high cure rates. Modified neck dissection consisting of a single transverse incision, resection of the jugular chain of nodes and those in the posterior triangle of the neck with preservation of the sternomastoid muscle, the spinal accessory nerve and the submandibular salivary gland provides a cosmetic, functional result with minimal morbidity. In a series of 313 neck dissections for thyroid carcinoma, only three patients with papillary or follicular carcinoma, which was resectable, treated by thryoidectomy and modified neck dissection died of disease.

Management of metastatic neck node in thyroid carcinoma

Objective: To see the results of neck dissection in thyroid carcinoma with metastatic cervical lymphadenopathy. Methods: This study was carried out in the Department of Otolaryngology at Bangabandhu Sheikh Mujib Medical University, Dhaka, for the period of two years from July 2006 to June 2008. Carcinoma thyroid patients with neck node were included in this study. Results: Mean age of the patients were 43.5 years. Mean follow up period was 15 months. In cases where radical or modified radical neck dissections were done no recurrence were found. Recurrences were found in 13.33% cases where selective neck dissections were done. Overall recurrence in anatomical neck dissection is 7.40% only. But in berry picking recurrence rate is 66.66% cases. So in berry picking locoregional control of disease is less satisfactory than anatomical neck dissection. Conclusion: In anatomical neck dissection locoregional control of disease is significantly more satisfactory than berry picking. Key words: Thyroid carcinoma; Papillary; Follicular; Medullary; Neck node metastasis. DOI: 10.3329/bjo.v16i2.6832Bangladesh J Otorhinolaryngol 2010; 16(2): 80-85

Modified neck dissection for thyroid carcinoma

The presence of palpable cervical lymphadenopathy in patients with carcinoma of the thyroid nearly always indicates the presence of metastases to the nodes. A radical neck dissection is indicated in the surgical treatment of most of these patients who are otherwise operable (primary lesion can be removed). In our experience at least one-third of patients with carcinoma of the thyroid but without palpable cervical lymphadenopathy do have metastases to the cervical nodes. Whether or not cervical node dissections should be used for these patients is, therefore, not decisively established. However, a modified neck dissection is considered justified in the surgical treatment of many of this group of patients and better results are suggested if it is done. A modified neck dissection has been defined as a dissection which is identical to the classical radical neck dissection except for the preservation of the sternocleidomastoid muscle and the submaxillary gland area. This includes removal of the nodes adjacent to the thyroid and presupposes complete removal of the primary lesion.