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26.11.2019 | Original Article

Central Compartment Nodal Bulk: A Predictor of Permanent Postoperative Hypocalcaemia

verfasst von: S. R. Priya, Chandrashekhar Dravid

Erschienen in: Indian Journal of Surgical Oncology | Ausgabe 1/2020

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Abstract

Central compartment clearance (CCC) for Papillary thyroid cancers (PTC) is one of the factors causing postoperative hypocalcaemia. We aimed to examine determinants of this major sequela. 41 patients treated for PTCs between 2014 and 2016 were studied. Surgical details, tumour and nodal characteristics, incidence of transient, temporary and permanent hypocalcaemia were noted. Central clearance was done bilaterally in 24 (58.5%) cases, ipsilaterally in 17 (41.6%). Central nodes were involved in 26 (63.4%) cases, unilaterally in 15 (36.6%), bilaterally in 11 (26.8%). Transient hypocalcaemia developed in 10 (24.4%) cases, temporary hypocalcaemia in 6 (14.6%) cases, and permanent hypocalcaemia in 2 (4.9%) cases. 17 (41%) patients were symptomatic. 9 (21.9%) patients received intravenous calcium. The only factor consistently associated with development of hypocalcaemia of all patterns, was the presence of matted central compartment nodes (p = 0.021). Matted nodes also related to a longer length of stay (p = 0.04) and requirement of intravenous calcium (p = 0.000). Extent of CCC, nodal yield, nodal positivity, perinodal extension, number of parathyroids identified, gender or pT size were not significantly associated. Symptomatic patients did not necessarily become permanently hypocalcaemic (p = 0.8). Patients requiring intravenous calcium were more likely to take oral calcium after discharge (p = 0.002). Postoperative hypocalcaemia is more likely in cases with bulky involved central nodes where extensive clearance is done. In routine CCC, even if done bilaterally, preservation of parathyroid function is possible. Permanent hypocalcaemia after CCC need not be taken as inevitable.

Popadich A, Levin O, Lee JC, Smooke-Praw S, Ro K, Fazel M, Arora A, Tolley NS, Palazzo F, Learoyd DL, Sidhu S (2011) A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery. 150(6):1048–1057. https://doi.org/10.1016/j.surg.2011.09.003 CrossRefPubMed

Moo TA, McGill J, Allendorf J, Lee J, Fahey T III, Zarnegar R (2010) Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg 34:1187–1191. https://doi.org/10.1007/s00268-010-0418-3 CrossRefPubMed

Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW (2012) Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol 19:4217–4222. https://doi.org/10.1245/s10434-012-2594-x CrossRefPubMed

Viola D, Materazzi G, Valerio L, Molinaro E, Agate L, Faviana P, Seccia V, Sensi E, Romei C, Piaggi P, Torregrossa L (2015) Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab 100(4):1316–1324. https://doi.org/10.1210/jc.2014-3825 CrossRef

Vergez S, Sarini J, Percodani J, Serrano E, Caron P (2010) Lymph node management in clinically node-negative patients with papillary thyroid carcinoma. Eur J Surg Oncol 36:777–782. https://doi.org/10.1016/j.ejso.2010.06.015 CrossRef

Roh JL, Park JY, Park C (2007) Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, postoperative levels of serum parathyroid hormone. Ann Surg 245(4):604–610. https://doi.org/10.1097/01.sla.0000250451.59685.67 CrossRefPubMedPubMedCentral

Mazzaferri EL, Doherty GM, Steward DL (2009) The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 19(7):683–689. https://doi.org/10.1089/thy.2009.1578 CrossRefPubMed

Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 133(2):180–185. https://doi.org/10.1067/msy.2003.61 CrossRefPubMed

Edafe O, Balasubramanian SP (2017) Incidence, prevalence and risk factors for post-surgical hypocalcaemia and hypoparathyroidism. Gland Surg 6(Suppl 1):S59–S68. https://doi.org/10.21037/gs.2017.09.03 CrossRef

10.

Praženica P, O’Keeffe L, Holý R (2015) Dissection and identification of parathyroid glands during thyroidectomy: association with hypocalcemia. Head Neck 37(3):393–399. https://doi.org/10.1002/hed.23613 CrossRefPubMed

11.

Hallgrimsson P, Nordenström E, Almquist M, Bergenfelz (2012) Risk factors for medically treated hypocalcemia after surgery for Graves’ disease: a Swedish multicenter study of 1,157 patients. World J Surg 36(8):1933–1942. https://doi.org/10.1007/s00268-012-1574-4 CrossRefPubMed

12.

Puzziello A, Rosato L, Innaro N, Orlando G, Avenia N, Perigli G, Calò PG, De Palma M (2014) Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine. 47(2):537–542. https://doi.org/10.1007/s12020-014-0209-y CrossRefPubMed

13.

Won JNC, YoungMin SPS (2016) Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg 34:47–52. https://doi.org/10.1016/j.ijsu.2016.08.019 CrossRef

14.

Antakia R, Edafe O, Uttley L, Balasubramanian SP (2015) Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid. 25(1):95–106. https://doi.org/10.1089/thy.2014.0101 CrossRefPubMed

15.

Roh JL, Park JY, Park CI (2009) Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer. 115(2):251–258. https://doi.org/10.1002/cncr.24027 CrossRefPubMed

16.

Abboud B, Sleilaty G, Zeineddine S, Braidy C, Aouad R, Tohme C, Noun R, Sarkis R (2008) Is therapy with calcium and vitamin D and parathyroid autotransplantation useful in total thyroidectomy for preventing hypocalcemia? Head Neck 30(9):1148–1154. https://doi.org/10.1002/hed.20836 CrossRefPubMed

17.

Kihara M, Miyauchi A, Kontani K, Yamauchi A, Yokomise H (2005) Recovery of parathyroid function after total thyroidectomy: long-term follow-up study. ANZ J Surg 75(7):532–536. https://doi.org/10.1111/j.1445-2197.2005.03435.x CrossRefPubMed

18.

Sancho JJ, Lennard TW, Paunovic I, Triponez F, Sitges-Serra A (2014) Prophylactic central neck dissection in papillary thyroid cancer: a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbeck's Arch Surg 399(2):155–163. https://doi.org/10.1007/s00423-013-1152-8 CrossRef

19.

Palestini N, Borasi A, Cestino L, Freddi M, Odasso C, Robecchi A (2008) Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbeck's Arch Surg 393(5):693–698. https://doi.org/10.1007/s00423-008-0360-0 CrossRef

20.

Son YI, Jeong HS, Baek CH, Chung MK, Ryu J, Chung JH, So YK, Jang JY, Choi J (2008) Extent of prophylactic lymph node dissection in the central neck area of the patients with papillary thyroid carcinoma: comparison of limited versus comprehensive lymph node dissection in a 2-year safety study. Ann Surg Oncol 15(7):2020–2026. https://doi.org/10.1245/s10434-008-9928-8 CrossRefPubMed

21.

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(5):514–518. https://doi.org/10.1016/j.surg.2009.01.013 CrossRefPubMed

22.

Iglesias P, Díez JJ (2017) Endocrine complications of surgical treatment of thyroid cancer: an update. Exp Clin Endocrinol Diabetes 125(08):497–505. https://doi.org/10.1055/s-0043-106441 CrossRefPubMed

23.

Filho JG, Kowalski LP (2005) Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngol Head Neck Surg 132(3):490–494. https://doi.org/10.1016/j.otohns.2004.09.028 CrossRef

24.

Thompson NV, Olsen WR, Hoffman GL (1973) The continuing development of the technique of thyroidectomy. Surgery 73:93–97

25.

Delbridge L (2003 Sep) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73(9):761–768. https://doi.org/10.1046/j.1445-2197.2003.02756.x CrossRefPubMed

26.

Bliss RD, Gauger PG, Delbridge LW (2000) Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg 24(8):891–897. https://doi.org/10.1007/s002680010173 CrossRefPubMed

27.

Pereira JA, Jimeno J, Miquel J, Iglesias M, Munné A, Sancho JJ, Sitges-Serra A (2005) Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery. 138(6):1095–1101. https://doi.org/10.1016/j.surg.2005.09.013 CrossRefPubMed

28.

Mehanna HM, Jain A, Randeva H, Watkinson J, Shaha A (2010) Postoperative hypocalcemia—the difference a definition makes. Head Neck 32(3):279–283. https://doi.org/10.1002/hed.21175 CrossRefPubMed

29.

Bourrel C, Uzzan B, Tison P, Despreaux G, Frachet B, Modigliani E, Perret GY (1993) Transient hypocalcemia after thyroidectomy. Ann Otol Rhinol Laryngol 102(7):496–501. https://doi.org/10.1177/000348949310200702 CrossRefPubMed

30.

Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V (1992) Hypocalcemia after thyroidectomy. Arch Surg 127(7):854–858. https://doi.org/10.1001/archsurg.1992.01420070118021 CrossRefPubMed

31.

Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B (2008) Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg 143(2):132–137. https://doi.org/10.1001/archsurg.2007.55 CrossRefPubMed

32.

Sturniolo G, Lo Schiavo MG, Tonante A, D’Alia C, Bonanno L (2000) Hypocalcaemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations. Int J Surg Invest 2:99–105

33.

Kakava K, Tournis S, Papadakis G, Karelas I, Stampouloglou P, Kassi E, Triantafillopoulos I, Villiotou V, Karatzas T (2016) Postsurgical hypoparathyroidism: a systematic review. in vivo 30(3):171–179

34.

Pfleiderer AG, Ahmad N, Draper MR, Vrotsou K, Smith WK (2009) The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. The Annals of The Royal College of Surgeons of England 91(2):140–146. https://doi.org/10.1308/003588409x359349 CrossRefPubMed

35.

Almquist M, Hallgrimsson P, Nordenström E, Bergenfelz A (2014) Prediction of permanent hypoparathyroidism after total thyroidectomy. World J Surg 38(10):2613–2620. https://doi.org/10.1007/s00268-014-2622-z CrossRef

36.

David M. Scott-Coombes Anders O.J. Bergenfelz. Endocrine quality registers: surgical outcome measurement. In: Surgery of the Thyroid and Parathyroid Glands, Chapter 48, 453-460. ed Randolph Gregory. Saunders/Elsevier 2013

37.

Shindo M, Stern A (2010) Total thyroidectomy with and without selective central compartment dissection: a comparison of complication rates. Archives of Otolaryngology–Head & Neck Surgery 136(6):584–587. https://doi.org/10.1001/archoto.2010.79 CrossRef

38.

Erbil Y, Barbaros U, Temel B, Turkoglu U, İşsever H, Bozbora A, Özarmağan S, Tezelman S (2009) The impact of age, vitamin D3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg 197(4):439–446. https://doi.org/10.1016/j.amjsurg.2008.01.032 CrossRefPubMed

39.

Falch C, Hornig J, Senne M, Braun M, Konigsrainer A, Kirschniak A, Muller S (2018) Factors predicting hypocalcemia after total thyroidectomy: a retrospective cohort analysis. Int J Surg 55:46–50. https://doi.org/10.1016/j.ijsu.2018.05.014 CrossRefPubMed

40.

Sonne-Holm E, Hahn CH (2017) Prolonged duration of surgery predicts postoperative hypoparathyroidism among patients undergoing total thyroidectomy in a tertiary referral centre. European Thyroid Journal 6(5):255–262. https://doi.org/10.1159/000470840 CrossRefPubMedPubMedCentral

41.

Chang YK, Lang BH (2017) To identify or not to identify parathyroid glands during total thyroidectomy. Gland surgery 6(Suppl 1):S20–S29. https://doi.org/10.21037/gs.2017.06.13 CrossRefPubMedPubMedCentral

42.

Lo CY, Lam KY (1998) Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study. Surgery. 124(6):1081–1087. https://doi.org/10.1067/msy.1998.92560 CrossRefPubMed

43.

Sitges-Serra A, Lorente-Poch L, Sancho J (2018) Parathyroid autotransplantation in thyroid surgery. Langenbeck’s Archives of Surgery [Internet]. Springer Nature 403(3):309–315. https://doi.org/10.1007/s00423-018-1654-5 CrossRef

44.

Vasileiadis I, Charitoudis G, Vasileiadis D, Kykalos S, Karatzas T (2018) Clinicopathological characteristics of incidental parathyroidectomy after total thyroidectomy: The effect on hypocalcemia. A retrospective cohort study. Int J Surg 55:167–174. https://doi.org/10.1016/j.ijsu.2018.05.737 CrossRefPubMed

45.

Sasson AR, Pingpank JF Jr, Wetherington RW, Hanlon AL, Ridge JA (2001) Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Archives of otolaryngology–head & neck surgery 127(3):304–308. https://doi.org/10.1001/archotol.127.3.304 CrossRef

46.

Yoo HS, Shin MC, Ji YB, Song CM, Lee SH, Tae K (2018) Optimal extent of prophylactic central neck dissection for papillary thyroid carcinoma: comparison of unilateral versus bilateral central neck dissection. Asian journal of surgery 41(4):363–369. https://doi.org/10.1016/j.asjsur.2017.03.002 CrossRefPubMed

47.

Pantvaidya G, Katna R, Deshmukh A, Nair D, D’Cruz A (2017) Morbidity of central compartment clearance: comparison of lesser versus complete clearance in patients with thyroid cancer. J Cancer Res Ther 13(1):102–106. https://doi.org/10.4103/0973-1482.199378 CrossRefPubMed

48.

Paek SH, Lee YM, Min SY, Kim SW, Chung KW (2013) Youn YK Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. World J Surg 37(1):94–101. https://doi.org/10.1007/s00268-012-1809-4 CrossRefPubMed

49.

Ambe PC, Brömling S, Knoefel WT, Rehders A (2014) Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients. Patient Saf Surg 8(1):45. https://doi.org/10.1186/preaccept-1910894601387288

50.

Chia SH, Weisman RA, Tieu D, Kelly C, Dillmann WH, Orloff LA (2006) Prospective study of perioperative factors predicting hypocalcemia after thyroid and parathyroid surgery. Arch Otolaryngol 132(1):41–45. https://doi.org/10.1001/archotol.132.1.41 CrossRef

51.

Karlan MS, Catz B, Dunkelman D, Uyeda RY, Gleischman S (1984) A safe technique for thyroidectomy with complete nerve dissection and parathyroid preservation. Head & neck surgery 6(6):1014–1019. https://doi.org/10.1002/hed.2890060606 CrossRef

52.

Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28(3):271–276. https://doi.org/10.1007/s00268-003-6903-1 CrossRefPubMed

53.

Tufano RP , Potenza A, Randolph GW (2012) Central neck dissection: technique. In Surgery of the Thyroid and Parathyroid Glands, 2nd ed, 373-381. ed Randolph GW. Saunders/Elsevier

54.

Park I, Rhu J, Woo JW, Choi JH, Kim JS, Kim JH (2016) Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg 40(6):1382–1389. https://doi.org/10.1007/s00268-016-3423-3 CrossRefPubMed

55.

Eismontas V, Slepavicius A, Janusonis V, Zeromskas P, Beisa V, Strupas K, Dambrauskas Z, Gulbinas A, Martinkenas A (2018) Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study. BMC Surg 18(1):55. https://doi.org/10.1186/s12893-018-0387-2 CrossRefPubMedPubMedCentral

56.

Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP (1998) Morbidity of thyroid surgery. Am J Surg 176(1):71–75. https://doi.org/10.1016/s0002-9610(98)00099-3 CrossRefPubMed

57.

Stack BC Jr, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, Pallota J, Snyder SK, Wong RJ, Randolph GW (2015) American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: postoperative hypoparathyroidism-definitions and management. Endocr Pract 21(6):674–685. https://doi.org/10.4158/ep14462.dsc CrossRefPubMed

58.

Roh JL, Park CI (2006) Intraoperative parathyroid hormone assay for management of patients undergoing total thyroidectomy. Head Neck 28(11):990–997. https://doi.org/10.1002/hed.20444 CrossRefPubMed

59.

Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24(8):971–975. https://doi.org/10.1007/s002680010160 CrossRefPubMed

60.

Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS (2015) Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res 197(2):348–353. https://doi.org/10.1016/j.jss.2015.04.059 CrossRefPubMedPubMedCentral

61.

Sanabria A, Dominguez LC, Vega V, Osorio C, Duarte D (2011) Routine postoperative administration of vitamin D and calcium after total thyroidectomy: a meta-analysis. Int J Surg 9(1):46–51. https://doi.org/10.1016/j.ijsu.2010.08.006 CrossRefPubMed

62.

Wang TS, Roman SA, Sosa JA (2012) Postoperative calcium supplementation in patients undergoing thyroidectomy. Curr Opin Oncol 24(1):22–28. https://doi.org/10.1097/cco.0b013e32834c4980 CrossRefPubMed

Titel: Central Compartment Nodal Bulk: A Predictor of Permanent Postoperative Hypocalcaemia
verfasst von: S. R. Priya
Chandrashekhar Dravid
Publikationsdatum: 26.11.2019
Verlag: Springer India
Erschienen in: Indian Journal of Surgical Oncology / Ausgabe 1/2020
Print ISSN: 0975-7651
Elektronische ISSN: 0976-6952
DOI: https://doi.org/10.1007/s13193-019-01010-8

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