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The effect of lateral neck dissection on complication rate for total thyroidectomy
Daniel J Rocke1, Hillary Mulder2, Derek Cyr2
1Duke University Medical Center, Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Durham, NC, United States of America.
American Journal of Otolaryngology
|February 25, 2020
Summary
Total thyroidectomy complications increase with lateral neck dissection. Bilateral dissection significantly raises risks of permanent hypoparathyroidism and vocal cord paralysis, informing patient counseling.
Area of Science:
- Endocrine Surgery
- Surgical Oncology
- Head and Neck Surgery
Background:
- Total thyroidectomy is a common procedure for thyroid conditions.
- Lateral neck dissection is sometimes performed concurrently to manage lymph node metastasis.
- Understanding the complication profile associated with these combined procedures is crucial for patient care.
Purpose of the Study:
- To evaluate and compare the complication rates of total thyroidectomy alone versus total thyroidectomy with concomitant unilateral or bilateral lateral neck dissection.
- To identify specific complications such as hypoparathyroidism, vocal cord paralysis, and the need for tracheotomy.
Main Methods:
- Analysis of a large administrative database (IBM MarketScan®) from 2010-2014.
- Inclusion of patients aged 18 years or older undergoing total thyroidectomy or equivalent procedures.
- Subgroup analysis for patients who also underwent unilateral or bilateral lateral neck dissection.
Main Results:
- Total thyroidectomy alone had complication rates of 20.3% for hypoparathyroidism/hypocalcemia (4.7% permanent) and 3.3% for vocal cord paralysis (0.7% permanent).
- Concomitant unilateral lateral neck dissection increased rates to 30.5% for hypoparathyroidism/hypocalcemia (8.8% permanent) and 8.3% for vocal cord paralysis (1.9% permanent).
- Bilateral lateral neck dissection further elevated these risks to 39.6% for hypoparathyroidism/hypocalcemia (10.9% permanent) and 10.2% for vocal cord paralysis (2.1% permanent), with increased tracheotomy rates.
Conclusions:
- The addition of lateral neck dissection, particularly bilateral, significantly increases the incidence and permanence of complications following total thyroidectomy.
- These findings highlight the importance of considering the extent of neck dissection when assessing surgical risks.
- The data can aid in preoperative patient counseling regarding potential outcomes and risks.
