The Effect of Central Lymph Node Dissection Before Thyroidectomy on Incidental Parathyroidectomy in Patients with Thyroid Cancer

Abstract

Introduction: It is the fact that the incidence of thyroid cancer has been increasing recently. Thyroid cancer often tends to metastasize to the cervical lymph nodes and as a result, central region lymph node dissection increases the risk of incidental parathyroidectomy. In this study, the effect of two different surgical techniques on incidental parathyroidectomy (IP) has been investigated. Material and Method: A total of 115 patients who underwent bilateral total thyroidectomy (BTT) and cervical neck dissection (CND) for thyroid cancer at the Department of General Surgery Clinics have been included in the study. Patients were divided into two groups according to the surgical technique used. The first group consisted of patients who underwent CND after thyroidectomy. The second group consisted of patients who underwent lateral neck dissection (LND) before CND or then underwent CND after ligation and transection of the middle thyroid vein and, if necessary, the superior thyroid artery. Results: Incidental parathyroidectomy (IP) has been identified in the pathology specimen in 47.4% (54) of the patients. While IP was performed on 1 gland in 29.8% (34) of the patients in group 1, on 2 glands in 14% (16), and on 3 glands in 3.5% (4) of the patients, no IP was detected in group 2 (p < 0.001). It was observed that hypoparathyroidism did not develop in patients in the second group. However, 12.3% (14) of the patients who underwent BTT followed by CND developed transient hypoparathyroidism and 3.5% (4) of them developed permanent hypoparathyroidism. When the collected data is analyzed, it has been concluded that the tumor size and the diameter of the largest metastatic lymph node are significantly larger in men than in women (p < 0.001 and p < 0.001, respectively). Conclusion: IP is commonly encountered in thyroid surgery. It is concluded that performing CND and LND before thyroidectomy might reduce IP.

Keywords

• Thyroid carcinoma
• lymph node metastasis
• central compartment lymph node dissection
• postoperative hypoparathyroidism
• incidental parathyroidectomy

Supporting Institution

No.

Ethical Statement

The study has been conducted following the approval by the Clinical Research Ethics Committee on 21 June 2023 under decision number 3746. The study was conducted in accordance with the principles set forth in the Declaration of Helsinki.

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