Surgical Complications in Papillary Thyroid Cancer Patients with Cervical Lymph Node Metastases

Minh-Chien Pham; Thang Nguyen; Hong-Phong Nguyen

doi:10.1177/11795549241233692

Surgical Complications in Papillary Thyroid Cancer Patients with Cervical Lymph Node Metastases

Clin Med Insights Oncol. 2024 Mar 12:18:11795549241233692. doi: 10.1177/11795549241233692. eCollection 2024.

Authors

Minh-Chien Pham¹, Thang Nguyen², Hong-Phong Nguyen³

Affiliations

¹ Department of Oncology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.
² Science - Technology and External Relations Office, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.
³ Department of Pathology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.

Abstract

Background: The reported complication rates of neck dissection are not specific patients with papillary thyroid cancer` with metastatic lymph nodes. This study aimed to describe the complication profile of neck dissection and the effect of concurrent lateral neck dissection on complication rates.

Methods: This single-center prospective cohort study analyzed the data of 52 patients who underwent a total thyroidectomy and therapeutic lymph node dissection between March 2021 and March 2023. The clinicopathologic characteristics of patients and surgical complications were analyzed.

Results: The transient recurrent laryngeal nerve palsy (RLNP) and hypoparathyroidism rates were 55.8% and 51.9%, respectively. The chyle leakage rate was 5.8%. Tracheostomy was performed on 1 patient (1.9%). Patients with transient RLNP had more retrieved lymph nodes than patients without RLNP (5.5 ± 2.7 vs 3.9 ± 1.5, P = .013). The rates of transient RLNP and hypoparathyroidism were higher in the total thyroidectomy with central and lateral neck dissection group than the total thyroidectomy with central neck dissection group (62.2% vs 14.3%, P = .035 and 57.8% vs 14.3%, P = .046). Multivariate analysis showed that the increased number of retrieved lymph nodes in the central compartment and the addition of lateral neck dissection were independent risk factors for transient RLNP, with odds ratio (OR) (95% confidence interval) of 0.72 (0.53-0.98) and 9.42 (1.02-87.34).

Conclusion: The rates of transient RLNP and hypoparathyroidism after lymph node dissection in patients with papillary thyroid cancer with metastatic lymph nodes were high, and a greater number of retrieved lymph nodes in the central neck and the addition of lateral neck dissection were predictors for transient RLNP. These data may be used to discuss preoperatively with patients and make surgeons more cautious and meticulous during surgery to minimize complications.

Keywords: Papillary thyroid carcinoma; complications; lymph node metastases; neck dissection; risk factors.