World Journal of Surgery

, Volume 34, Issue 11, pp 2611–2620

Lymph Node Involvement and Surgical Approach in Parathyroid Cancer

  • Klaus-Martin Schulte
  • Nadia Talat
  • John Miell
  • Caje Moniz
  • Prakash Sinha
  • Salvador Diaz-Cano
Article

DOI: 10.1007/s00268-010-0722-y

Cite this article as:
Schulte, K., Talat, N., Miell, J. et al. World J Surg (2010) 34: 2611. doi:10.1007/s00268-010-0722-y

Abstract

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.

Conclusion

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.

Abbreviations

PTH

Parathyroid hormone

Ca

Corrected serum calcium

mM/L

Millimoles per litre

CI

Confidence interval

RR

Relative risk

OR

Odds ratio

TNM

Tumour node metastasis

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Klaus-Martin Schulte
    • 1
  • Nadia Talat
    • 1
  • John Miell
    • 4
  • Caje Moniz
    • 2
  • Prakash Sinha
    • 5
  • Salvador Diaz-Cano
    • 3
  1. 1.Department of Endocrine SurgeryKing’s College Hospital, King’s Health PartnersLondonUK
  2. 2.Department of Clinical ChemistryKing’s College Hospital, King’s Health PartnersLondonUK
  3. 3.Department of PathologyKing’s College Hospital, King’s Health PartnersLondonUK
  4. 4.Department of EndocrinologyUniversity Hospital LewishamLewishamUK
  5. 5.Department of SurgeryPrincess Royal University Hospital BromleyKentUK