Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations.
BACKGROUND
The American Thyroid Association recently changed its management guidelines for papillary thyroid cancer (PTC) to include routine central neck lymph node dissection (CLND) during thyroidectomy. We currently perform CLND during thyroidectomy only if enlarged central nodes are detected by palpation or ultrasonography; we perform CLND in the reoperative setting for recurrence in previously normal-appearing or incompletely resected nodes. Critics of this approach argue that reoperative CLND has higher complication and recurrence rates than initial CLND. We sought to test this argument, using it as our hypothesis.


METHODS
Retrospective review.


METHODS
University hospital.


METHODS
All patients undergoing CLND for PTC between January 1, 1998, and December 31, 2007.


METHODS
Thyroidectomy and CLND.


METHODS
Complications (neck hematoma, recurrent laryngeal nerve injury, and hypoparathyroidism) and recurrence of PTC.


RESULTS
Altogether, 295 CLNDs were performed: 189 were initial operations and 106 were reoperations. The rate of transient hypocalcemia (41.8% vs 23.6%) was significantly higher in patients undergoing initial CLND compared with those undergoing reoperative CLND. Rates of neck hematoma (1.1% vs 0.9%), transient hoarseness (4.8% vs 4.7%), permanent hoarseness (2.6% vs 1.9%), and permanent hypoparathyroidism (0.5% vs 0.9%) were not different between initial and reoperative CLND. In addition, recurrence rates in the central (11.6% vs 14.1%) and lateral (21.7% vs 17.0%) compartments were not different between the 2 groups.


CONCLUSIONS
Reoperative CLND for PTC has a lower rate of temporary hypocalcemia, the same rate of other complications, and the same rate of recurrence compared with initial CLND. Choosing to observe nonenlarged central neck lymph nodes for PTC does not result in increased complications or recurrence if reoperation is required.
Department of Surgery, University of California, San Francisco/Mt Zion Medical Center, 1600 Divisadero Street, San Francisco, CA 94115, USA. wen.shen@ucsfmedctr.org
Wen T
WT
Shen
Lauren
L
Ogawa
Daniel
D
Ruan
Insoo
I
Suh
Electron
E
Kebebew
Quan-Yang
QY
Duh
Orlo H
OH
Clark
D000328:Adult; D002291:Carcinoma, Papillary / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D037981:Neck Dissection / Q000009:adverse effects*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery*