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Morbidity of central neck dissection: primary surgery vs reoperation. Results of a case–control study

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Abstract

Purpose

Complication rate in reoperative central neck node surgery is one of the main arguments to favor prophylactic central neck dissection at first operation in patients with papillary thyroid carcinoma. We evaluated if reoperative central neck dissection implies an increased postoperative morbidity. Secondarily, we aimed also to verify the effectiveness of the surgical resection of reoperative central neck dissection.

Methods

Forty-one patients who underwent reoperative central neck dissection after initial thyroidectomy for papillary thyroid carcinoma between January 2008 and May 2012 were compared to 41 controls who underwent central neck dissection at initial operation.

Results

The two groups were well matched for age, sex, and pN stage (P = 0.296, 0.199, and 1.000, respectively). Three patients had distant metastases at presentation. No significant difference was found concerning mean number of removed nodes (P = 0.064). No significant difference was found between the reoperative and the control groups concerning transient hypocalcemia (17 vs 19, respectively) (P = 0.901) and transient recurrent nerve palsy (2 vs 2) (P = 0.608). Follow-up was completed in 69 out of all the included patients (85.2 %). At a mean follow-up of 33 months, two patients (2.9 %) experienced nodal recurrence.

Conclusions

Morbidity of central neck dissection is similar for primary surgery and reoperation. In high-volume centers, reoperative central neck dissection can be safely accomplished when needed, allowing to achieve locoregional control in most of patients.

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References

  1. Shan CX, Zhang W, Jiang DZ, Zheng XM, Liu S, Qui M (2011) Routine central neck dissection in differentiated thyroid carcinoma: a systematic review and meta-analysis. Laryngoscope 122:797–804

    Article  Google Scholar 

  2. Sippel RS, Chen H (2009) Controversies in the surgical management of newly diagnosed and recurrent/residual thyroid cancer. Thyroid 19:1373–1380

    Article  PubMed  Google Scholar 

  3. Shaha AR (2009) Prophylactic central compartment dissection in thyroid cancer: a new avenue of debate. Surgery 146:1224–1227

    Article  PubMed  Google Scholar 

  4. Carling T, Long WD III, Udelsman R (2010) Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer. Curr Opin Oncol 22:30–34

    Article  PubMed  Google Scholar 

  5. McHenry CR (2011) Prophylactic central compartment neck dissection for papillary thyroid cancer: the search for justification continues. Surgery 150:1058–1060

    Article  PubMed  Google Scholar 

  6. Hay ID, Thompson GB, Grant CS, Bergstralh EJ, Dvorak CE, Gorman CA, Maurer MS, McIver B, Mullan BP, Oberg AL, Powell CC, van Heerden JA, Goellner JR (2002) Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg 26:879–885

    Article  PubMed  Google Scholar 

  7. Hughes DT, Laird AM, Miller BS, Gauger PG, Doherty GM (2012) Reoperative lymph node dissection for recurrent papillary thyroid cancer and effect on serum thyroglobulin. Ann Surg Oncol 19:2951–2957

    Article  PubMed  Google Scholar 

  8. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  9. Simon D, Goretzki PE, Witte J, Röher HD (1996) Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 20:860–866

    Article  CAS  PubMed  Google Scholar 

  10. Segal K, Friedental R, Lubin E, Shvero J, Sulkes J, Feinmesser R (1995) Papillary carcinoma of the thyroid. Otolaryngol Head Neck Surg 113:356–363

    Article  CAS  PubMed  Google Scholar 

  11. Moley JF, Lairmore TC, Doherty GM, Brunt LM, DeBenedetti MK (1999) Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations. Surgery 126:673–679

    Article  CAS  PubMed  Google Scholar 

  12. Uruno T, Miyauchi A, Shimizu K, Nakano K, Takamura Y, Ito Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuka F, Kuma K (2004) Prognosis after reoperation for local recurrence of papillary thyroid carcinoma. Surg Today 34:891–895

    Article  PubMed  Google Scholar 

  13. Ondik MP, Dezfoli S, Lipinski L, Ruggiero F, Goldenberg D (2009) Secondary central compartment surgery for thyroid cancer. Laryngoscope 119:1947–1950

    Article  PubMed  Google Scholar 

  14. Kim MK, Mandel SH, Baloch Z, LiVolsi VA, Langer JE, DiDonato L, Fish S, Weber RS (2004) Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg 130:1214–1216

    Article  PubMed  Google Scholar 

  15. Alvarado R, Sywak MS, Delbridge L, Sidhu SB (2009) Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery 145:514–518

    Article  PubMed  Google Scholar 

  16. Shen WT, Ogawa L, Ruan D, Suh I, Kebebew E, Duh QY, Clark OH (2010) Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg 145:272–275

    Article  PubMed  Google Scholar 

  17. White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904

    Article  PubMed  Google Scholar 

  18. Al-Saif O, Farrar WB, Bloomston M, Porter K, Ringel MD, Kloos RT (2010) Long-term efficacy of lymph node reoperation for persistent papillary thyroid cancer. J Clin Endocrinol Metab 95:2187–2194

    Article  CAS  PubMed  Google Scholar 

  19. Schuff KG, Weber SM, Givi B, Samuels MH, Andersen PE, Cohen JI (2008) Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer. Laryngoscope 118:768–775

    Article  PubMed  Google Scholar 

  20. Yim JH, Kim WB, Kim EY, Kim TY, Ryu JS, Gong G, Hong SJ, Shong YK (2011) The outcomes of first reoperation for locoregionally recurrent/persistent papillary thyroid carcinoma in patients who initially underwent total thyroidectomy and remnant ablation. J Clin Endocrinol Metab 96:2049–2056

    Article  CAS  PubMed  Google Scholar 

  21. Tufano RP, Bishop J, Wu G (2012) Reoperative central compartment dissection for patients with recurrent/persistent papillary thyroid cancer: efficacy, safety, and the association of the BRAF mutation. Laryngoscope 122:1634–1640

    Article  CAS  PubMed  Google Scholar 

  22. American Thyroid Association Surgery Working Group; American Association of Endocrine Surgeons, American Accademy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, Randolph GW, Stack BC Jr, Steward DL, Terris DJ, Thompson GB, Tufano RP, Tuttle RM, Udelsman R (2009) Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 19:1153–1158

    Article  PubMed  Google Scholar 

  23. Stack BC, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, Sosa JA, Tufano RP, for the American Thyroid Association Surgical Affairs Committee (2012) American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 22:501–508

    Article  PubMed  Google Scholar 

  24. American Joint Committee on Cancer (2010) Thyroid. AJCC Cancer Staging Manual, 7th edn. Springer, New York, pp 87–92

    Book  Google Scholar 

  25. Raffaelli M, De Crea C, Carrozza C, D’Amato G, Zuppi C, Bellantone R, Lombardi CP (2012) Combining early postoperative parathyroid hormone and serum calcium levels allows for an efficacious selective post thyroidectomy supplementation treatment. World J Surg 36:1307–1313

    Article  PubMed  Google Scholar 

  26. Lombardi CP, Raffaelli M, De Crea C, Princi P, Castaldi P, Spaventa A, Salvatori M, Bellantone R (2007) Report on 8 years of experience with video assisted thyroidectomy for papillary thyroid carcinoma. Surgery 142:944–951

    Article  PubMed  Google Scholar 

  27. Salvatori M, Raffaelli M, Castaldi P, Treglia G, Rufini V, Perotti G, Lombardi CP, Rubello D, Ardito G, Bellantone R (2007) Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma. Eur J Surg Oncol 33:648–654

    Article  CAS  PubMed  Google Scholar 

  28. Lombardi CP, Bellantone R, De Crea C, Paladino NC, Fadda G, Salvatori M, Raffaelli M (2010) Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg 34:1214–1221

    Article  PubMed  Google Scholar 

  29. Lombardi CP, Raffaelli M, De Crea C, Sessa L, Rampulla V, Bellantone R (2012) Video-assisted versus conventional total thyroidectomy and central compartment neck dissection for papillary thyroid carcinoma. World J Surg 36:1225–1230

    Article  PubMed  Google Scholar 

  30. Raffaelli M, De Crea C, Sessa L, Giustacchini P, Revelli L, Bellantone C, Lombardi CP (2012) Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node negative papillary thyroid carcinoma. Surgery 152:957–964

    Article  PubMed  Google Scholar 

  31. Torlontano M, Crocetti U, Augello G, D’Aloiso L, Bonfitto N, Varraso A, Dicembrino F, Modoni S, Frusciante V, DiGiorgio A, Bruno R, Filetti S, Trischitta V (2006) Comparative evaluation of recombinant human thyrotropin-stimulated thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography in the follow-up of patients with papillary thyroid microcarcinoma who have not undergone radioiodine therapy. J Clin Endocrinol Metab 91:60–63

    Article  CAS  PubMed  Google Scholar 

  32. Chao TC, Jeng LB, Lin JD, Chen MF (1997) Reoperative thyroid surgery. World J Surg 21:644–647

    Article  CAS  PubMed  Google Scholar 

  33. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A, German IONM Study Group (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32:1358–1366

    Article  CAS  PubMed  Google Scholar 

  34. Agarwal A, Mishra AK, Lombardi CP, Raffaelli M (2012) Applied embryology of the thyroid and parathyroid glands. In: Randolph GW (ed) Surgery of the thyroid and parathyroid glands, 2nd edn. Elsevier Saunders, Philadelphia, pp 15–24

    Google Scholar 

  35. Raffaelli M, De Crea C, Sessa L, Giustacchini P, Bellantone R, Lombardi CP (2013) Can intraoperative frozen section influence the extension of central neck dissection in cN0 papillary thyroid carcinoma? Langenbecks Arch Surg 398:383–388

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Celestino Pio Lombardi, Marco Raffaelli, Carmela De Crea, Luca Sessa & Rocco Bellantone

  2. Istituto di Semeiotica Chirurgica, U.O. Chirurgia Endocrina e Metabolica, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168, Rome, Italy

    Marco Raffaelli

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  1. Celestino Pio Lombardi
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  2. Marco Raffaelli
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  3. Carmela De Crea
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  5. Rocco Bellantone
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Correspondence to Marco Raffaelli.

Additional information

This paper is based on a work that has been presented as oral presentation at the fifth ESES Workshop, 23–25th May 2013, Berlin (Germany).

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Lombardi, C.P., Raffaelli, M., De Crea, C. et al. Morbidity of central neck dissection: primary surgery vs reoperation. Results of a case–control study. Langenbecks Arch Surg 399, 747–753 (2014). https://doi.org/10.1007/s00423-014-1201-y

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  • DOI: https://doi.org/10.1007/s00423-014-1201-y

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