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Morbidity Following Central Compartment Reoperation for Recurrent or Persistent Thyroid Cancer
Michael K. Kim, MD;
Susan H. Mandel, MD, MPH;
Zubair Baloch, MD, PhD;
Virginia A. LiVolsi, MD;
Jill E. Langer, MD;
Liesje DiDonato, BS;
Stephanie Fish, MD;
Randal S. Weber, MD
Arch Otolaryngol Head Neck Surg. 2004;130:1214-1216.
Objective To determine the incidence of recurrent laryngeal nerve injury and hypoparathyoidism, we reviewed our experience with central compartment reoperation.
Design Patients underwent preoperative ultrasonography and magnetic resonance imaging of the neck. Ultrasound-guided fine-needle aspiration biopsy was performed and demonstrated evidence of tumor in 15 patients. At the time of surgery, hook wire electrodes were placed endoscopically into 1 or both vocal cords to monitor the integrity of the recurrent laryngeal nerve.
Patients The study population comprised 20 patients who had undergone reoperative central compartment dissections between the years 1997 and 2001. There were 15 women and 5 men whose mean age was 49.4 years. All of the patients had prior total or subtotal thyroidectomy, and 4 patients had prior neck dissections. A primary thyroid cancer recurrence in the thyroid bed was present in 7 patients, and the remainder of the patients had cytological evidence of paratracheal or mediastinal metastases. A single patient had evidence of distant metastases involving the lung.
Main Outcome Measure Short- and long-term postoperative morbidity.
Results Of the 20 patients, 18 had histologic evidence of metastases to the paratracheal lymph nodes, whereas 8 patients had metastases involving the anterior mediastinal lymph nodes. The mean number of lymph nodes removed was 6.5, and the mean number of positive lymph nodes was 4.7. None of the patients with normal preoperative laryngeal function had postoperative recurrent laryngeal nerve paresis or paralysis. There were 18 patients with normal preoperative parathyroid function. Four patients developed transient postoperative hypocalcemia. All 4 patients with transient postoperative hypocalcemia are currently eucalcemic. A single patient continues to receive calcium and calcitriol supplementation 1 month following her third central compartment dissection for recurrent thyroid cancer.
Conclusions Reoperation for recurrent or persistent thyroid cancer presents a significant challenge. However, intraoperative recurrent laryngeal nerve monitoring and preservation of the vascular pedicle of the parathyroid glands has reduced the morbidity of reoperative central compartment dissections to acceptable levels. Revision surgery in the central compartment of the neck is compatible with successful eradication of recurrent thyroid cancers and acceptable morbidity.
From the Fair Grounds Medical Center, Allentown, Pa (Dr Kim); and the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine (Dr Mandel), Department of Pathology and Laboratory Medicine (Drs Baloch and LiVolsi), Ultrasound Division, Department of Radiology (Dr Langer), Department of Otorhinolaryngology: Head and Neck Surgery (Ms DiDonato and Dr Weber), and Department of Endocrinology (Dr Fish), The University of Pennsylvania Health System, Philadelphia.
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