Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T20:53:26.411Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of central compartment neck dissection on hypocalcaemia incidence after total thyroidectomy for carcinoma

Published online by Cambridge University Press:  25 November 2010

I Mitra ,
J R Nichani ,
B Yap  and
J J Homer
I Mitra
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK
J R Nichani
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK
B Yap
Affiliation:
Department of Oncology, Christie Hospital, Manchester, UK
J J Homer*
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK School of Cancer and Imaging, University of Manchester, UK
*
Address for correspondence: Mr Jarrod J Homer, Consultant Head and Neck Surgeon, Department of Otolaryngology–Head and Neck Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK Fax: 44 (0)161 276 5003 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Central compartment neck dissection is increasingly performed as part of surgical management of differentiated thyroid carcinoma. However, elective central neck dissection remains controversial due to complications and lack of evidence of survival benefit.

Objective:

To investigate and compare rates of transient and permanent hypocalcaemia following total thyroidectomy alone, compared with total thyroidectomy with central neck dissection, for differentiated thyroid carcinoma.

Methods:

Retrospective study of 127 consecutive patients referred with differentiated thyroid carcinoma, 2004–2006; 78 patients had undergone total thyroidectomy (group one) and 49 total thyroidectomy with central compartment node dissection (group two). Surgery was performed in various hospitals by both otolaryngologists and endocrine surgeons.

Results:

In groups one and two, the incidence of transient hypocalcaemia was 18 per cent (14/78) and 51 per cent (25/49) (p < 0.001), and the incidence of permanent hypocalcaemia 1 per cent (one of 77) and 12 per cent (six of 49) (p < 0.01), respectively. Most patients undergoing central neck dissection had evidence of pathological level six lymphadenopathy (29/49).

Conclusion:

Total thyroidectomy combined with central neck dissection for the treatment of differentiated thyroid carcinoma is more likely to result in transient (51 per cent) and permanent (12 per cent) hypocalcaemia. Elective neck dissection should be performed selectively, with a high expectation of post-operative hypocalcaemia.

Keywords

Thyroid CarcinomaNeck DissectionSurgeryHypocalcemia
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 5 , May 2011 , pp. 497 - 501
Copyright
Copyright © JLO (1984) Limited 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the British Academic Conference in Otolaryngology, 8–10 July 2009, Liverpool, UK

References

1Ito, Y, Tomoda, C, Uruno, T, Takamura, Y, Miya, A, Kobayashi, K et al. Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg 2004:28; 498–501CrossRefGoogle ScholarPubMed
2British Thyroid Association. Guidelines for the Management of Thyroid Cancer. London: Royal College of Physicians, 2007Google Scholar
3Pacini, F, Schlumberger, M, Dralle, H, Elisei, R, Smit, JW, Wiersinga, W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006;154:787–803CrossRefGoogle ScholarPubMed
4Henry, JF, Gramatica, L, Denizot, A, Kvachenyuk, A, Puccini, M, Defechereux, T. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg 1998;383:167–9CrossRefGoogle ScholarPubMed
5Robbins, KT, Clayman, G, Levine, PA, Medina, J, Sessions, R, Shaha, A et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology–Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 2002;128:751–8CrossRefGoogle ScholarPubMed
6Mehanna, HM, Jain, A, Randeva, H, Watkinson, J, Shaha, A. Postoperative hypocalcemia – the difference a definition makes. Head Neck 2010;32:279–83CrossRefGoogle ScholarPubMed
7Abboud, B, Sargi, Z, Akkam, M, Sleilaty, F. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 2002;195:456–61CrossRefGoogle ScholarPubMed
8Ramus, NI. Hypocalcaemia after subtotal thyroidectomy for thyrotoxicosis. Br J Surg 1984;71:589–90CrossRefGoogle ScholarPubMed
9Demeester-Mirkine, N, Hooghe, L, Van Geertruyden, J, De Maertelaer, V. Hypocalcemia after thyroidectomy. Arch Surg 1992;127:854–8CrossRefGoogle ScholarPubMed
10Lindblom, P, Westerdahl, J, Bergenfelz, A. Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcemia. Surgery 2002;131:515–20CrossRefGoogle ScholarPubMed
11Roh, JL, Park, JY, Park, CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 2007;245:604–10CrossRefGoogle ScholarPubMed
12Pereira, JA, Jimeno, J, Miquel, J, Iglesias, M, Munne, A, Sancho, JJ et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 2005;138:1095–100, 100–1CrossRefGoogle ScholarPubMed
13Roh, JL, Park, JY, Park, CI. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer 2009;115:251–8CrossRefGoogle ScholarPubMed
14Litvak, J, Moldawer, MP, Forbes, AP, Henneman, PH. Hypocalcemic hypercalciuria during vitamin D and dihydrotachysterol therapy of hypoparathyroidism. J Clin Endocrinol Metab 1958;18:246–52CrossRefGoogle ScholarPubMed
15Chan, FK, Tiu, SC, Choi, KL, Choi, CH, Kong, AP, Shek, CC. Increased bone mineral density in patients with chronic hypoparathyroidism. J Clin Endocrinol Metab 2003;88:3155–9CrossRefGoogle ScholarPubMed
16Laway, BA, Goswami, R, Singh, N, Gupta, N, Seith, A. Pattern of bone mineral density in patients with sporadic idiopathic hypoparathyroidism. Clin Endocrinol (Oxf) 2006;64:405–9CrossRefGoogle ScholarPubMed
17Mazzaferri, EL, Doherty, GM, Steward, DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid 2009;19:683–9CrossRefGoogle ScholarPubMed
18Mazzaferri, EL, Young, RL, Oertel, JE, Kemmerer, WT, Page, CP. Papillary thyroid carcinoma: the impact of therapy in 576 patients. Medicine (Baltimore) 1977;56:171–96CrossRefGoogle ScholarPubMed
19Cooper, DS, Doherty, GM, Haugen, BR, Kloos, RT, Lee, SL, Mandel, SJ et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214CrossRefGoogle ScholarPubMed
20Hartl, DM, Travagli, JP. The updated American Thyroid Association Guidelines for management of thyroid nodules and differentiated thyroid cancer: a surgical perspective. Thyroid 2009;19:1149–51CrossRefGoogle ScholarPubMed
21Lim, YC, Choi, EC, Yoon, YH, Kim, EH, Koo, BS. Central lymph node metastases in unilateral papillary thyroid microcarcinoma. Br J Surg 2009;96:253–7CrossRefGoogle ScholarPubMed