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Original Investigation
From the American Head and Neck Society
April 2017

Complications of Bilateral Neck Dissection in Thyroid Cancer From a Single High-Volume Center

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  • 2Division of Head & Neck Surgery and Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina
JAMA Otolaryngol Head Neck Surg. 2017;143(4):376-381. doi:10.1001/jamaoto.2016.3670
Key Points

Question  What is the morbidity associated with bilateral neck dissection performed for thyroid cancers?

Findings  This is a retrospective review of medical records for patients undergoing bilateral lateral neck dissections for thyroid cancers at an academic medical center. The overall rate of permanent hypoparathyroidism, defined as continued calcium supplementation at the most recent follow-up, was 37%.

Meaning  The morbidities associated with bilateral lateral neck dissections for thyroid cancers should be carefully considered against the oncologic benefit.

Abstract

Importance  The morbidity of bilateral lateral neck dissection (BLND) for thyroid cancers has not been described in detail. This study delineates the specific complications arising from BLND for thyroid cancers at a single high-volume center.

Objective  To determine the morbidity associated with BLNDs for differentiated thyroid cancers at our institution.

Design, Setting, and Participants  This was a retrospective review of medical records performed to identify patients having undergone BLNDs for thyroid cancers by a single surgeon at an academic, tertiary medical center in Toronto, Ontario, Canada, from 1988 to 2015. Patients who underwent BLND for papillary, follicular, or medullary thyroid cancers were identified through operative procedure codes and review of operative and pathology reports. The indication for this procedure was suspicious bilateral lateral compartment on imaging and clinical examination. Sixty-two patients who underwent BLND for thyroid cancers, with or without total thyroidectomy and central compartment dissection, were identified.

Main Outcomes and Measures  The main outcome measures for this study were unanticipated medical or surgical complications during the operation or in the postoperative period. Secondary measures were oncologic outcomes, including regional structural or biochemical recurrence.

Results  Of the 62 patients, 24 were male (39%), and 38 (61%) were female. Their mean age was 46 years (range, 17-80 years). The overall risk of permanent hypoparathyroidism was 37%. There was 1 case of unanticipated permanent recurrent nerve paralysis and 1 case of temporary nerve paresis. Postoperative chyle fistula occurred in 6 cases (10%). There were 3 readmissions within 30 days of surgery, 1 pulmonary embolism, and 1 perioperative mortality. Fifty percent of patients had pN0 contralateral necks despite preoperative clinical suspicion. Four patients were found to have anaplastic thyroid cancers intraoperatively. Five patients (8%) developed nodal recurrence in the neck. Four patients died of their disease within available follow-up (mean, 3.2 years).

Conclusions and Relevance  Bilateral lateral neck dissection for thyroid cancers confers a significant amount of morbidity, including a significant rate of hypoparathyroidism. Knowledge of the complications of this procedure, especially in the setting of questionable survival benefit, may assist in preoperative decision-making and patient counseling.

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