Top

World Journal of Surgical Oncology

Published in:

01-12-2020 | Hypoparathyroidism | Research

Effects of active localization and vascular preservation of inferior parathyroid glands in central neck dissection for papillary thyroid carcinoma

Authors: Dawei Hou, Haie Xu, Bing Yuan, Jianhui Liu, Yibing Lu, Ming Liu, Zhuyin Qian

Published in: World Journal of Surgical Oncology | Issue 1/2020

Abstract

Background

The purpose of present study is to assess the effects of active localization and vascular preservation of inferior parathyroid glands in central neck dissection (CND) for papillary thyroid carcinoma (PTC).

Methods

A classification of IPGs according to their location and vascular features was developed, and, based on this classification, a CND procedure was designed, and IPGs and their vascular were actively localized and strategically preserved. A total of 197 patients with PTC who underwent a total thyroidectomy and concomitant CND were enrolled. Eighty-nine patients with traditional meticulous fascia dissection were allocated to group A, and 108 patients with active location and vascular preservation of IPGs were allocated to group B. Those with inferior parathyroid glands auto-transplantation in each group were assigned as group At (18) and group Bt (12). Variables including serum intact parathyroid hormone (PTH), total calcium, the incidence of transient, and permanent hypoparathyroidism were studied.

Results

Compared with group A, serum intact PTH (P < 0.001) and total calcium levels (P < 0.05) in group B significantly improved on the first postoperative day, and the incidence of transient hypoparathyroidism significantly dropped in group B (P < 0.001). A total of 170 patients in the two groups had complete follow-up data. The incidence of permanent hypoparathyroidism significantly decreased in group B, from 8.8% to 1.0% (P = 0.017). However, there were no significant differences in all variables between group Bt and group At.

Conclusion

Active location and vascular preservation of inferior parathyroid glands effectively protected the function of IPGs in CND for PTC.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. https://doi.org/10.3322/caac.21551.CrossRefPubMed

Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. The Lancet. 2016;388(10061):2783–95. https://doi.org/10.1016/s0140-6736(16)30172-6.CrossRef

Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Annals of surgery. 2003;237(3):399–407. https://doi.org/10.1097/01.sla.0000055273.58908.19.CrossRefPubMedPubMedCentral

Pereira JA, Jimeno J, Miquel J, Iglesias M, Munne A, Sancho JJ, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery. 2005;138(6):1095–100, discussion 100-1. https://doi.org/10.1016/j.surg.2005.09.013.CrossRefPubMed

Lang BH, Ng SH, Lau LL, Cowling BJ, Wong KP, Wan KY. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid: official journal of the American Thyroid Association. 2013;23(9):1087–98. https://doi.org/10.1089/thy.2012.0608.CrossRef

Gambardella C, Patrone R, Di Capua F, Offi C, Mauriello C, Clarizia G, et al. The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study. BMC Surg. 2019;18(Suppl 1):110. https://doi.org/10.1186/s12893-018-0433-0.CrossRefPubMed

Gambardella C, Tartaglia E, Nunziata A, Izzo G, Siciliano G, Cavallo F, et al. Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients. World J Surg Oncol. 2016;14(1):247. https://doi.org/10.1186/s12957-016-1003-5.CrossRefPubMedPubMedCentral

Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid: official journal of the American Thyroid Association. 2012;22(9):911–7. https://doi.org/10.1089/thy.2012.0011.CrossRef

Hadker N, Egan J, Sanders J, Lagast H, Clarke BL. Understanding the burden of illness associated with hypoparathyroidism reported among patients in the PARADOX study. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2014;20(7):671–9. https://doi.org/10.4158/EP13328.OR.CrossRef

10.

Buttner M, Musholt TJ, Singer S. Quality of life in patients with hypoparathyroidism receiving standard treatment: a systematic review. Endocrine. 2017;58(1):14–20. https://doi.org/10.1007/s12020-017-1377-3.CrossRefPubMed

11.

Almquist M, Ivarsson K, Nordenstrom E, Bergenfelz A. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. Br J Surg. 2018;105(10):1313–8. https://doi.org/10.1002/bjs.10843.CrossRefPubMed

12.

Barczynski M, Cichon S, Konturek A. Which criterion of intraoperative iPTH assay is the most accurate in prediction of true serum calcium levels after thyroid surgery? Langenbeck’s archives of surgery. 2007;392(6):693–8. https://doi.org/10.1007/s00423-007-0165-6.CrossRefPubMed

13.

Wang JB, Wu K, Shi LH, Sun YY, Li FB, Xie L. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma. Br J Surg. 2017;104(11):1514–22. https://doi.org/10.1002/bjs.10581.CrossRefPubMed

14.

Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid: official journal of the American Thyroid Association. 2016;26(1):1–133. https://doi.org/10.1089/thy.2015.0020.CrossRef

15.

Takami H, Ito Y, Okamoto T, Yoshida A. Therapeutic strategy for differentiated thyroid carcinoma in Japan based on a newly established guideline managed by Japanese society of thyroid surgeons and Japanese association of endocrine surgeons. World J Surg. 2011;35(1):111–21.CrossRef

16.

Takami H, Ito Y, Okamoto T, Onoda N, Noguchi H, Yoshida A. Revisiting the guidelines issued by the Japanese society of thyroid surgeons and Japan association of endocrine surgeons: a gradual move towards consensus between Japanese and western practice in the management of thyroid carcinoma. World Journal of Surgery. 2014;38(8):2002–10.CrossRef

17.

Halsted WS, Evans HM. I. The parathyroid glandules. Their blood supply and their preservation in operation upon the thyroid gland. Annals of surgery. 1907;46(4):489–506.CrossRef

18.

Zhu J, Tian W, Xu Z, Guo Z, Zhang H, Liu S, et al. Expert consensus statement on parathyroid protection in thyroidectomy. Ann Transl Med. 2015;3(16):10. https://doi.org/10.3978/j.issn.2305-5839.2015.08.20.CrossRef

19.

Wei T, Li Z, Jin J, Chen R, Gong Y, Du Z et al. Autotransplantation of inferior parathyroid glands during central neck dissection for papillary thyroid carcinoma: a retrospective cohort study. International journal of surgery (London, England). 2014;12(12):1286-90. doi:10.1016/j.ijsu.2014.11.001.

20.

Park I, Rhu J, Woo JW, Choi JH, Kim JS, Kim JH. Preserving parathyroid gland vasculature to reduce post-thyroidectomy hypocalcemia. World J Surg. 2016;40(6):1382–9. https://doi.org/10.1007/s00268-016-3423-3.CrossRefPubMed

21.

Cui Q, Li Z, Kong D, Wang K, Wu G. A prospective cohort study of novel functional types of parathyroid glands in thyroidectomy. Medicine. 2016;95(52):e5810. https://doi.org/10.1097/md.0000000000005810.CrossRefPubMedPubMedCentral

22.

Almquist M, Hallgrimsson P, Nordenstrom E, Bergenfelz A. Prediction of permanent hypoparathyroidism after total thyroidectomy. World J Surg. 2014;38(10):2613–20. https://doi.org/10.1007/s00268-014-2622-z.CrossRefPubMed

23.

Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307–20. https://doi.org/10.1002/bjs.9384.CrossRefPubMed

24.

Seo ST, Chang JW, Jin J, Lim YC, Rha KS, Koo BS. Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results. Surgery. 2015;158(6):1492–9. https://doi.org/10.1016/j.surg.2015.04.041.CrossRefPubMed

25.

Orloff LA, Wiseman SM, Bernet VJ, Fahey TJ. 3rd, Shaha AR, Shindo ML et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid: official journal of the American Thyroid Association. 2018;28(7):830–41. https://doi.org/10.1089/thy.2017.0309.CrossRef

26.

Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015;102(4):359–67. https://doi.org/10.1002/bjs.9676.CrossRefPubMed

27.

Thompson NW, Olsen WR, Hoffman GL. The continuing development of the technique of thyroidectomy. Surgery. 1973;73(6):913–27.PubMed

28.

Akerström G, Malmaeus J, Bergström R. Surgical anatomy of human parathyroid glands. Surgery. 1984;95(1):14–21.PubMed

29.

Lee DY, Cha W, Jeong WJ, Ahn SH. Preservation of the inferior thyroidal vein reduces post-thyroidectomy hypocalcemia. The Laryngoscope. 2014;124(5):1272–7. https://doi.org/10.1002/lary.24519.CrossRefPubMed

Title: Effects of active localization and vascular preservation of inferior parathyroid glands in central neck dissection for papillary thyroid carcinoma
Authors: Dawei Hou
Haie Xu
Bing Yuan
Jianhui Liu
Yibing Lu
Ming Liu
Zhuyin Qian
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Hypoparathyroidism
Neck Dissection
Thyroidectomy
Thyroidectomy
Thyroid Cancer
Thyroid Cancer
Thyroid Cancer
Published in: World Journal of Surgical Oncology / Issue 1/2020
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-020-01867-y

2024 ASCO Annual Meeting

Springer Medicine

Effects of active localization and vascular preservation of inferior parathyroid glands in central neck dissection for papillary thyroid carcinoma

Abstract

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Impairment-driven cancer rehabilitation in patients with neoplastic spinal cord compression using minimally invasive spine stabilization

Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia

Is insulin resistance a predictor for complete response in breast cancer patients who underwent neoadjuvant treatment?

MiR-489 inhibited the development of gastric cancer via regulating HDAC7 and PI3K/AKT pathway

Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma

Bladder perforation during transurethral resection of bladder tumour is not a result of a deficient structure of the bladder wall