Safety of modified radical neck dissection for differentiated thyroid carcinoma.
OBJECTIVE
The management of cervical metastases from differentiated thyroid carcinoma (DTC) remains controversial. Most surgeons perform a neck dissection (ND) for clinically apparent disease. The extent of nodal dissection varies from regional to comprehensive. Morbidity from ND in the setting of DTC remains high, particularly when performed in the setting of a thyroidectomy (TT). To determine complications from ND for DTC, we retrospectively reviewed our surgical experience of modified radical neck dissection for nodal metastases.


METHODS
Retrospective chart review.


METHODS
Between 1997 and 2002, 39 consecutive patients (31 females and 8 males) underwent 44 comprehensive NDs of levels II-V for DTC. Central compartment dissection (CCD) (levels VI and VII) was also performed during 23 of these procedures. Twenty (45.5%) patients had prior treatment elsewhere. Preoperative pathology revealed papillary carcinoma in 22 patients (56.4%), tall cell variant in 11 (28.2%), and follicular variant in 6 (15.4%).


RESULTS
Ten patients (20%) underwent ND alone, whereas 6 (14%) underwent simultaneous ND and TT. Fifteen patients underwent simultaneous ND, TT, and CCD (30%). Temporary hypocalcemia occurred after 21% of NDs that were performed in the setting of either TT or CCD or both. There were no cases of permanent hypoparathyroidism. Transient regional lymph node (RLN) paresis occurred in two patients and was associated with a concomitant central compartment nodal dissection; there were no permanent RLN palsies. Transient spinal accessory nerve paresis developed after 27% of NDs performed. Two patients developed chyle leaks.


CONCLUSIONS
When ND is necessary for the treatment of thyroid malignancies, the procedure can be performed safely with acceptable morbidity.
Kupferman
Michael E
ME
Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine Philadelphia, Pennsylvania 19104, USA.
Patterson
D Michael
DM
Mandel
Susan J
SJ
LiVolsi
Virginia
V
Weber
Randal S
RS
D000293:Adolescent; D000328:Adult; D005260:Female; D049671:History, 18th Century; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011183:Postoperative Complications; D012189:Retrospective Studies; D012449:Safety; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome