American Association of Endocrine Surgeons- Annual Meeting Abstract Papers

NODAL YIELD, MORBIDITY AND RECURRENCE AFTER CENTRAL NECK DISSECTION FOR PAPILLARY THYROID CANCER.
A. Sitges-Serra, J. Pereira; J. Jimeno; J. Miquel; M. Iglesias; A. Munné; J Sancho.
Hospital del Mar. Barcelona, Spain

Background: The role of systematic central neck dissection (CND) in papillary cancer remains controversial. The present study aims at investigating the nodal yield, morbidity and nodal recurrences after conventional bilateral CND.
Methods: The surgical and pathology prospective protocols of patients undergoing total thyroidectomy and CND for papillary thyroid cancer during 1995-2003 were reviewed. The following data were recorded: evidence for macroscopic central nodal involvement, n of nodes obtained, n of metastatic nodes and n of parathyroid glands incidentally resected. These data were confronted with the MACIS score (low risk<6), lowest postoperative s-Ca, laryngeal nerve dysfunction, recurrences and permanent hypoparathyroidism. Differences between therapeutic (gross nodal involvement) and prophylactic (no apparent node involvement) CNDs were studied.
Results: 43 patients (7 M, 36 F) with a mean age of 52+17 yrs. were studied. A mean of 8.4 + 6.6 nodes were excised per patient. A 60% prevalence (26/43) of N+ was found. No differences were observed between low and high-risk patients (71 vs 53%; NS). There were 15 therapeutic and 28 prophylactic CNDs. After a mean follow-up of 5 yrs. there were no central neck recurrences but 5 patients developed jugular nodal recurrence despite treatment with I131. All these had had therapeutic CND and had, at least, 5 metastatic nodes in the specimen. No jugular recurrences were observed after prophylactic CND or in patients with CND specimens with less that 5 nodes involved. Permanent hypoparathyroidism was observed in two patients (4.6%) and transient vocal cord paralysis in three (7%). Parathyroid glands were found in 19% of the specimens and one-third of the patients received a parathyroid autotransplant. Neither the number of resected nodes nor the presence of metastatic nodes correlated with postoperative hypocalcemia or the number of incidentally resected parathyroid glands.
Conclusions: Macroscopic nodal involvement in the central neck carries a high risk (33%) of jugular recurrence. Morbidity of bilateral CND is significant and its systematic implementation in the absence of gross nodal involvement seems unwarranted.