title: Surgical morbidity of cervical lymphadenectomy for thyroid cancer: A retrospective cohort study over 25 years.
abstract: BACKGROUND
  Prognosis of thyroid cancer is strictly related to loco-regional metastases. Cervical lymphadenectomy has a specific oncologic role but may lead to significant increase of morbidity. Aim of the study is the analysis of surgical morbidity in cervical lymphadenectomy for thyroid cancer.
  
  
  METHODS
  We retrospectively analyzed 1.765 thyroid cancers operated over a period of 25 years at S. Maria University Hospital, Terni, University of Perugia, Italy. Type of lymphadenectomy, histology and complications were analysed.
  
  
  RESULTS
  A prevalence of differentiated and medullary cancers was observed (respectively 88% and 7.2%). Central lymphadenectomy was carried out in 425 patients, lateral modified and radical lymphadenectomy respectively in 651 and 17 cases. Following central neck dissection we observed: bilateral and unilateral temporary recurrent nerves palsy respectively of 0.7% and 3.5%, unilateral permanent palsy in 1.6% of cases, temporary and permanent hypoparathyroidism respectively in 17.6% and 4.4%. After lateral neck dissection we observed: intra and post-operative haemorrhage respectively in 2% and 0.29%, respiratory distress in 0.29%, lesions of facial nerve in 0.44%, of vagus in 0.14%, of phrenic nerve in 0.14%, of hypoglossal nerve in 0.29%, of the accessory nerve, transient in 1.34% and permanent in 0.29%, permanent lesion of cervical plexus in 0.29%, salivary fistula in 0.14% and chylous fistula in 1.04% of patients. Student's t test was used to compare groups when appliable.
  
  
  CONCLUSIONS
  Central and lateral cervical lymph node dissection are associated to severe morbidity. Correct indication, surgical expertise, high volume of patients and early multidisciplinary management of complications is the key of an acceptable balance between oncologic benefits and surgical morbidity.
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: apolis74@yahoo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: massimo.monacelli@mail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Monacelli
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: robertalucchini@alice.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lucchini
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: triolaroberta@gmail.com.
authors.forename: Roberta
authors.initials: R
authors.lastname: Triola
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: c.claudia81@alice.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Conti
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: stefano_avenia@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Avenia
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: ivanbarillaro@gmail.com.
authors.forename: Ivan
authors.initials: I
authors.lastname: Barillaro
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: alessandrosanguinetti@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanguinetti
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: nicolaavenia@libero.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000209:etiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects*; D059348:Peripheral Nerve Injuries / Q000453:epidemiology / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery*; D055815:Young Adult
keywords: Complication; Lymphadenectomy; Surgery; Thyroid cancer