Complications of neck dissection for thyroid cancer |
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Authors: | Cheah W Keat Arici Cumhur Ituarte Philip H G Siperstein Allan E Duh Quan-Yang Clark Orlo H |
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Institution: | (1) Department of Surgery, University of California, San Francisco/Mt. Zion Medical Center, 1600 Divisadero Street, San Francisco, California 94143-1674, USA, USA;(2) Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A80, Cleveland, Ohio 44195, USA, USA;(3) Department of Surgery, University of California, San Francisco/Veterans Administration Medical Center, 4150 Clement Street, 112C, San Francisco, California 94121, USA, USA |
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Abstract: | rophylactic and therapeutic neck dissections are
used to control or eliminate local nodal disease in patients with thyroid
cancer. The purpose of this study was to evaluate the results and complications
of neck dissection. From 1992 to 1999 a series of 115 consecutive neck
dissections were performed in 74 patients (32 men, 42 women; mean age 48 years)
with thyroid cancer and nodal metastases. Operations included central
compartment, lateral modified, and suprahyoid dissection with and without total
or completion thyroidectomy. Sixty-four percent of the patients had papillary,
4% follicular, and 32% medullary thyroid cancer. Complications included
transient hypocalcemia (23%) defined by a postoperative serum calcium level of
<2.0 mmol/L (8.0 mg/dl), one neck hematoma (0.9%), and one cardiac death
(0.9%). There were no permanent recurrent nerve palsies. Hypocalcemia occurred
more frequently when neck dissection was combined with total thyroidectomy than
without it (p <0.005). In this group, the
incidence of hypocalcemia was higher after central, than lateral, neck
dissection. When neck dissection was performed without thyroidectomy, there was
no difference in the rates of hypocalcemia between central, lateral, or central
with lateral neck dissection (p = NS).
Hypocalcemia did not increase with repeated neck dissectionsp = NS). Permanent hypoparathyroidism occurred in 0.9%.
There were no complications after suprahyoid dissection. The median duration of
hospitalization was 1 day. Therapeutic neck dissection or repeated neck
dissection can be performed relatively safely in patients with thyroid cancer.
Hypocalcemia occurs most frequently when neck dissection is combined with total
thyroidectomy. |
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