Lymph node involvement and surgical approach in parathyroid cancer.
BACKGROUND
The best surgical approach to parathyroid cancer is disputed. Recommendations vary and are built on incoherent evidence. High rates of recurrence and death require an in-depth review of underlying findings.


METHODS
This retrospective study includes 11 patients with parathyroid cancer who underwent surgery with central and/or lateral neck dissection by a single surgeon between 2005 and 2010. The diagnosis was based on histopathological criteria in all patients. Patterns of lymph node and soft tissue involvement of these and formerly reported patients were analysed based on full-text review of all published cases of parathyroid cancer.


RESULTS
In this series only 1 of 11 patients (9.1%) manifested lymph node metastasis. In the literature, lymph node metastases have been reported in only 6.5% of 972 published patients, or in 32.1% of the 196 in whom lymph node involvement was assessed by the authors. They were, with few exceptions, localised in the central compartment. Recurrence in soft tissue is more frequent than in locoregional lymph nodes.


CONCLUSIONS
Oncological en bloc clearance of the central compartment with meticulous removal of all possibly involved soft tissues, including a systematic central lymph node resection, may improve outcomes and should be included in the routine approach to the suspicious parathyroid lesion. There is no need for a prophylactic lateral neck dissection.
Schulte
Klaus-Martin
KM
Department of Endocrine Surgery, King's College Hospital, King's Health Partners, Denmark Hill, London, SE5 9RS, UK. klaus-martin.schulte@nhs.net
Talat
Nadia
N
Miell
John
J
Moniz
Caje
C
Sinha
Prakash
P
Diaz-Cano
Salvador
S
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010282:Parathyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D016105:Parathyroidectomy; D012189:Retrospective Studies