Prophylactic -First-Step- Central Neck Dissection Level 6 Does Not Increase Morbidity After Total ThyroidectomyReport as inadecuate

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Annals of Surgical Oncology

, Volume 23, Issue 12, pp 4016–4022

First Online: 08 July 2016Received: 26 March 2016DOI: 10.1245-s10434-016-5338-5

Cite this article as: Selberherr, A., Riss, P., Scheuba, C. et al. Ann Surg Oncol 2016 23: 4016. doi:10.1245-s10434-016-5338-5


BackgroundIn terms of morbidity, prophylactic central neck dissection CND; level 6 in potentially malignant thyroid disease is discussed controversially. The rates of transient and permanent hypoparathyroidism and palsy of the recurrent laryngeal nerve RLN after -first-step- FS-CND are analyzed in this study.

MethodsBilateral and unilateral FSCND, i.e., lymph node dissection along the RLN before total thyroidectomy, was performed bilaterally in 68 group 1 and unilaterally in 44 patients group 2, respectively. The rates of hypoparathyroidism and palsy of the RLN were documented prospectively and were compared to 237 patients of group 3 controls who underwent total thyroidectomy only.

ResultsFifteen of 68 patients 22 % of group 1 developed transient and one patient had permanent hypoparathyroidism. Transient unilateral palsy of the RLN was observed in ten patients 15 %; none were permanent. Transient hypoparathyroidism was monitored in 10 of 44 patients 23 % of group 2 and permanent hypoparathyroidism in 1 2 %. Six patients 14 % developed temporary palsy of the RLN; one remained permanent. Palsy was seen in 3 patients on the contralateral side of unilateral FSCND. Transient and permanent hypoparathyroidism was observed in 50 21 % and 2 1 % of 237 controls. Transient palsy of the RLN was documented in 22 9 % of 237 controls and permanent palsy of the RLN in 4 2 %.

ConclusionsIn this single-center series, the overall permanent morbidity was low 1 %. Therefore, FSCND may be recommended even prophylactically for experienced high-volume surgeons in patients with thyroid nodules suspicious for malignancy.

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Author: Andreas Selberherr - Philipp Riss - Christian Scheuba - Bruno Niederle



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