Complications of neck dissections in papillary thyroid carcinoma. A modified procedure to reduce parathyroid morbidity

Abstract

Lymphatic metastasis develops in approximately 20% to 80% of patients with papillary thyroid carcinoma (PTC).

Clinically evident pathologic nodes should be treated with therapeutic neck dissection. The extent of lymph node dissection, based on predictable drainage patterns from PTC, includes central compartment dissection with nodal clearance of level VI, and modified radical dissection of the lateral compartment with removal of levels II through V. Neck dissection, though a reliably safe procedure, carries certain potential complications.The most significant morbidity following therapeutic neck dissection for PTC is hypoparathyroidism, related to parathyroid damage leading to temporary or permanent hypocalcemia. This complication occurs most often when lateral neck dissection is combined with total thyroidectomy plus central neck dissection. That increased hypoparathyroidism appears not to be associated with incidental removal of the parathyroid glands or the number of parathyroid glands preserved, but to vascular compromise in the dissected central neck, related to the extension of nodal dissection to include the central neck to lateral cervical compartment. To reduce parathyroid morbidity we have modified the surgical procedure in the management of patients with PTC and neck nodal involvement, and approach, first, the lateral compartment via extrathyroideal space and perform the nodal basins dissection according to operation popularized by O.Suarez and named “ functional neck dissection”, which is based on the facial compartments and the facial envelope in the neck.