Total thyroidectomy with and without selective central compartment dissection: a comparison of complication rates

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Surgery

Background:

• Total thyroidectomy (TT) is a common procedure for thyroid disease.
• Central compartment lymph node dissection (CLND) is sometimes performed concurrently with TT.
• The safety and impact of CLND on postoperative complications require further investigation.

Purpose of the Study:

• To compare postoperative complication rates between patients undergoing TT with CLND and those undergoing TT alone.
• To evaluate the safety of elective selective CLND in the context of TT for papillary thyroid cancer.

Main Methods:

• Retrospective medical chart review at an academic tertiary center.
• Comparison of 122 patients who underwent TT with CLND versus 134 patients who underwent TT alone.
• Analysis of postoperative complications including vocal cord paralysis, hypocalcemia, seroma, hematoma, and chyle leak.

Main Results:

• No significant difference in permanent hypocalcemia or vocal cord paralysis between groups.
• Transient hypocalcemia was less frequent in the TT with CLND group (13.1%) compared to the TT alone group (25.4%).
• No hematoma or seroma occurred; one chyle leak in the CLND group resolved conservatively.

Conclusions:

• Concurrent CLND with TT does not elevate risks of hypocalcemia or vocal cord paralysis.
• Elective selective CLND is safe for papillary thyroid cancer when performed by experienced thyroid oncologic surgeons.
• CLND should be considered for higher-risk patients to potentially minimize central compartment reoperations.