Outcomes of Central Neck Dissection for Papillary Thyroid Carcinoma in Primary Versus Revision Setting

Hasan Alansari; Nalin Mathur; Husain Ahmadi; Zaki Hassan AlWatban; Naji Alamuddin; Omar Sabra

doi:10.1007/s12070-023-04261-8

Outcomes of Central Neck Dissection for Papillary Thyroid Carcinoma in Primary Versus Revision Setting

Indian J Otolaryngol Head Neck Surg. 2024 Feb;76(1):720-725. doi: 10.1007/s12070-023-04261-8. Epub 2023 Oct 13.

Authors

Hasan Alansari¹, Nalin Mathur¹, Husain Ahmadi¹, Zaki Hassan AlWatban^{1

2}, Naji Alamuddin^{1

3}, Omar Sabra^{1

3}

Affiliations

¹ King Hamad University Hospital, Building 2435, Road 2835. Block 228, P.O. Box 24343, Muharraq, Kingdom of Bahrain.
² Ministry of Health Riyadh (Kingdom of Saudi Arabia), First Tower (B1) Prince Abdulrahman Bin Abdulaziz Street Riyadh, Riyadh, 12613 Saudi Arabia.
³ Royal College of Surgeons in Ireland-Bahrain, Building No. 2441, Road 2835, Busaiteen 228, P.O. Box 15503, Adliya, Kingdom of Bahrain.

PMID: 38440474
PMCID: PMC10908899 (available on 2025-02-01)
DOI: 10.1007/s12070-023-04261-8

Abstract

Introduction: Surgery in the central compartment after previous thyroidectomy involves an increased risk of injury to critical organs, including the parathyroids and recurrent laryngeal nerve. Contrastingly, primary central neck dissection involves a relatively low operative risk.

Objective: This study aimed to compare the outcomes of central neck dissection in primary versus revision settings with respect to the lymph node yield and complication rates.

Methods: This single-center prospective study included patients who underwent primary or revision neck dissection surgery for histologically confirmed thyroid malignancy between January 2018 and January 2022.

Results: We included 30 patients who underwent total thyroidectomy with primary central neck dissection and 29 patients who underwent central neck dissection following remote thyroidectomy with or without previous central dissection. There was no significant between-group difference in postoperative complications, including permanent hypocalcemia and recurrent laryngeal nerve injury. However, both groups showed a significant postoperative decrease in calcium levels even though calcium and parathyroid hormone levels were within reference range.

Conclusion: Although many surgeons fear revision central neck dissection, it appears to have similar therapeutic outcomes and complication rates as primary neck dissection for papillary thyroid cancer. Specifically, there were no between-group differences in the lymph node yield, hypoparathyroidism, or recurrent laryngeal nerve paralysis. Patients with normocalcemia showed a significant postoperative reduction in calcium levels, suggesting subclinical parathyroid insufficiency.

Keywords: Central neck dissection; Normocalcemia; Primary neck dissection; Thyroid malignancy.

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