1Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre; 2Laboratory Diagnostics Division, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre.
Acta Clin Croat. 2020 Jun;59(Suppl 1):115-121. doi: 10.20471/acc.2020.59.s1.15.
The aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer.
A retrospective analysis of 179 patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups.
A total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLNd group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLNd group. The rate of persistent hypoparathyroidism in the TT and TT + CCLNd groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLNd group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant.
While its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies.
Our results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy.
本研究旨在比较两组接受分化型甲状腺癌治疗的患者术后甲状旁腺功能减退症的发生率。
对 2011 年 1 月至 2018 年 12 月在我院接受分化型甲状腺癌治疗的 179 例患者进行回顾性分析。仅纳入最初接受全甲状腺切除术且术前未证实中央区和侧颈部淋巴结转移的患者。将患者分为两组进行分析。一组患者接受全甲状腺切除术和选择性中央区淋巴结清扫术（TT+CCLNd 组），另一组患者仅接受全甲状腺切除术（TT 组）。比较两组患者一过性和持续性术后甲状旁腺功能减退症的发生率。
TT+CCLNd 组共 117 例（65.4%）患者接受全甲状腺切除术和选择性中央区淋巴结清扫术（TT+CCLNd 组）。62 例（34.6%）患者仅接受全甲状腺切除术（TT 组）。TT 组中 22.6%的患者发生术后甲状旁腺功能减退症，TT+CCLNd 组为 25.6%。TT 和 TT+CCLNd 组持续性甲状旁腺功能减退症的发生率分别为 3.2%和 6.0%。两组患者一过性和持续性术后甲状旁腺功能减退症的发生率差异无统计学意义。在 TT+CCLNd 组中，82.9%的患者行同侧气管旁淋巴结清扫术，17.1%的患者行双侧气管旁淋巴结清扫术。对这两组患者的术后甲状旁腺功能减退症发生率进行了分析，但无统计学意义。
虽然选择性中央区淋巴结清扫术对局部复发率的影响仍存在争议，但它可能是选择受益于辅助放射性碘治疗的患者的有效工具。另一方面，由于对甲状旁腺及其血供的无意损伤，中央区淋巴结清扫术可能会增加甲状旁腺功能减退症的风险。本研究未发现接受中央区淋巴结清扫术的患者与仅接受全甲状腺切除术的患者之间术后甲状旁腺功能减退症存在统计学差异。我们的数据与一些已发表的研究不一致。
我们的结果表明，选择性中央区淋巴结清扫术是一种安全的手术方法，当与全甲状腺切除术同时进行时，不会显著增加术后甲状旁腺功能减退症的风险。
