Archives of otolaryngology--head & neck surgery · 2012
Efficacy and safety of central compartment neck dissection for recurrent thyroid carcinoma.
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Shah Manish D, Harris Luke D, Nassif Ramez G, Kim Dae, Eski Spiro, Freeman Jeremy L
Аннотация
OBJECTIVE: To explore the safety and efficacy of central compartment neck dissection (CCND) in the treatment of well-differentiated thyroid carcinoma (WDTC) recurrences in the central compartment of the neck.
DESIGN: Retrospective medical chart review.
SETTING: Tertiary-care academic hospital.
PATIENTS: Eighty-two consecutively treated patients with recurrent WDTC, with a median follow-up of 28 months.
MAIN OUTCOME MEASURES: Postoperative complications, disease control posttreatment, and normalization of serum thyroglobulin (Tg) level.
RESULTS: Eighty-two patients underwent 86 central compartment procedures. Only CCND was performed in 36 patients (42%), while a lateral neck dissection was also required in the remainder. Postoperative hypoparathyroidism was temporary in 17 patients (20%) and permanent in 6 patients (7%). Postoperative intact serum parathyroid hormone level was greater than 15.0 pg/mL (to convert to nanograms per liter, multiply by 1.0) in 81% of patients, accurately predicting eucalcemia postoperatively. Unilateral recurrent laryngeal nerve injury was transient in 3 patients (2% of nerves at risk) and permanent in 3 patients (2%). Seventeen patients (21%) experienced subsequent recurrences after their CCND-2 patients (2%) had recurrence in the central neck, 8 (9%) in the lateral neck, 2 (2%) in the central and lateral neck, and 7 (8%) at distant sites. Twenty-seven patients underwent a CCND alone and were deemed appropriate for efficacy analysis. The Tg level was normalized in 15 patients (56%) in the group overall. Normalization occurred in 10 of the 20 patients (50%) who received sodium iodide I 131 ablation and in 5 of the 7 patients (71%) who did not.
CONCLUSION: Central compartment neck dissection is a safe and efficacious procedure for the management of central neck recurrences in WDTC.
DESIGN: Retrospective medical chart review.
SETTING: Tertiary-care academic hospital.
PATIENTS: Eighty-two consecutively treated patients with recurrent WDTC, with a median follow-up of 28 months.
MAIN OUTCOME MEASURES: Postoperative complications, disease control posttreatment, and normalization of serum thyroglobulin (Tg) level.
RESULTS: Eighty-two patients underwent 86 central compartment procedures. Only CCND was performed in 36 patients (42%), while a lateral neck dissection was also required in the remainder. Postoperative hypoparathyroidism was temporary in 17 patients (20%) and permanent in 6 patients (7%). Postoperative intact serum parathyroid hormone level was greater than 15.0 pg/mL (to convert to nanograms per liter, multiply by 1.0) in 81% of patients, accurately predicting eucalcemia postoperatively. Unilateral recurrent laryngeal nerve injury was transient in 3 patients (2% of nerves at risk) and permanent in 3 patients (2%). Seventeen patients (21%) experienced subsequent recurrences after their CCND-2 patients (2%) had recurrence in the central neck, 8 (9%) in the lateral neck, 2 (2%) in the central and lateral neck, and 7 (8%) at distant sites. Twenty-seven patients underwent a CCND alone and were deemed appropriate for efficacy analysis. The Tg level was normalized in 15 patients (56%) in the group overall. Normalization occurred in 10 of the 20 patients (50%) who received sodium iodide I 131 ablation and in 5 of the 7 patients (71%) who did not.
CONCLUSION: Central compartment neck dissection is a safe and efficacious procedure for the management of central neck recurrences in WDTC.