Complications of Neck Dissections in Papillary Thyroid Carcinoma: A Modified Procedure to Reduce Parathyroid Morbidity.
OBJECTIVE
Hypoparathyroidism is the most significant morbidity after neck dissection for thyroid cancer. Addition of lateral neck dissection (ND) to central ND combined with total thyroidectomy (TT) increases the risk of postoperative hypoparathyroidism compared to TT plus central ND. The aim of this study was to verify if a modified procedure and different access to the neck for lateral ND may improve safety.


METHODS
In 62 patients with papillary thyroid cancer (PTC) undergoing TT plus central and lateral ND between 2010 and 2013, lateral ND was performed as first step approaching the neck via extrathyroideal space. Calcium in serum and parathormone (PTH) were determined preoperatively, intraoperatively and during the follow-up.


RESULTS
Twenty patients (32%) developed postoperative hypocalcemia. Calcium levels and PTH completely recovered for 58 out of 62 patients from 3 to 6 months after surgery. After a mean of 12 months' follow-up, only four patients (6.5%) had developed permanent hypoparathyroidism. The incidence of parathyroid complication after TT plus central ND and lateral ND did not differ from postoperative hypoparathyroidim after TT plus central ND.


CONCLUSIONS
The presented surgical procedure may provide a better outcome in terms of parathyroid morbidity.
Endocrine and Metabolic Surgery Unit, Department of Surgical Sciences, Agostino Gemelli University Hospital, Sacred Heart Catholic University, Rome, Italy.
Guglielmo
G
Ardito
Endocrine and Metabolic Surgery Unit, Department of Surgical Sciences, Agostino Gemelli University Hospital, Sacred Heart Catholic University, Rome, Italy.
Luca
L
Revelli
Endocrine Surgery Unit, S. Maria University Hospital, University of Perugia, Perugia, Italy apolis74@yahoo.it.
Andrea
A
Polistena
Endocrine Surgery Unit, S. Maria University Hospital, University of Perugia, Perugia, Italy.
Roberta
R
Lucchini
Endocrine and Metabolic Surgery Unit, Department of Surgical Sciences, Agostino Gemelli University Hospital, Sacred Heart Catholic University, Rome, Italy.
Erica
E
Giustozzi
Department of Anesthesiology, Agostino Gemelli University Hospital, Sacred Heart Catholic University, Rome, Italy.
Maria Lavinia
ML
Guidi
Endocrine and Metabolic Surgery Unit, Department of Surgical Sciences, Agostino Gemelli University Hospital, Sacred Heart Catholic University, Rome, Italy.
Francesco
F
Ardito
Endocrine Surgery Unit, S. Maria University Hospital, University of Perugia, Perugia, Italy.
Nicola
N
Avenia
D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D002291:Carcinoma, Papillary / Q000601:surgery*; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000097:blood / Q000209:etiology; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D057234:Preoperative Period; D015203:Reproducibility of Results; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*
D010281:Parathyroid Hormone; D002118:Calcium
Neck dissection; complication; hypoparathyroidism; surgery