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PubMed2006

[One stage thyroidectomy and bilateral neck dissection for well-differentiated thyroid carcinoma].

OBJECTIVE: To investigate the indications, safety and difficulties of one stage thyroidectomy and bilateral neck lymph node dissection for well-differentiated thyroid carcinoma. METHODS: A retrospective review was carried out in 36 well-differentiated thyroid carcinoma patients so treated from 1990 to 2004. Various incisions including H, L and modified Kocher types were selected according to the location of primary tumor and status of cervical lymph node metastasis. Either total thyroidectomy or sub-total thyroidectomy combined with bilateral neck lymph node dissection according to the principles of modified radical neck lymph node dissection: preserving the internal jugular vein, spinal accessory nerve and sternocleidomastoid muscles. RESULTS: There was no operative death in this group. Postoperative complications included: 2 wound bleeding, 3 recurrent laryngeal nerve resection due to tumor involvement, 1 recurrent laryngeal nerve injury, 2 unilateral internal branch of superior laryngeal nerve injury, 9 unilateral external branch of superior laryngeal nerve injury, 3 unilateral accessory nerve injury, 5 unilateral sympathetic nerve injury, 2 unilateral phrenic nerve injury, 6 chylus fistula, 13 temporary hypoparathyroidism, 2 permanent hypoparathyroidism. The dissected lymph nodes were found to be positive from 0 to 21 in each patient with a mean of 8.3. Of the 36 patients: 31 had bilateral positive lymph nodes; 3 unilateral positive; 2 bilateral negative lymph nodes. The follow up period ranged from 1 to 13 years, Three patients died of distant metastasis, 1 died of cerebral vascular accident. 7 patients lost in follow-up. Totally, 25 patients are still alive, 3 patients had local relapse and were surgically treated again. CONCLUSION: The procedure of one-stage thyroidectomy and bilateral neck lymph node dissection for well-differentiated thyroid carcinoma is safe, as it is mandatory that at least one unilateral internal jugular vein should be preserved; one unilateral recurrent laryngeal nerves and accessory nerves should not be injured. Well-differentiated thyroid carcinoma patients whose bilateral cervical lymph nodes are clinically suspected to be positive (obviously enlarged, hard, purplish grapelike lymph node) or are confirmed pathologically to be positive are indications for one-stage thyroidectomy and bilateral neck lymph node dissection. Total or sub-total thyroidectomy should be undertaken with emphasis that at least one parathyroid with blood supply should be preserved. It is of utmost importance that not only the cancer be completely resected but the function of the organs be preserved.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

The role of suprahyoid neck dissection in the management of cancer of the tongue and floor of the mouth.

Suprahyoid lymph node dissection often is used as part of the surgical treatment of cancers of the anterior two thirds of the tongue and the floor of the mouth. In recent years the use of this procedure has become less widespread, but it is still advocated by some surgeons as a sound operation in the treatment of cancer. Anatomic, roentgenographic, and pathologic evidence is presented to show that this may not be the case. The evidence points out that such neoplasms do not metastasize in an orderly or predictable pattern. These patients may have isolated metastases in any region of the neck. If the decision is made to treat the neck in these situations, the whole neck should be treated. We feel that suprahyoid neck dissection has a very limited role to play in the management of cancers of the anterior two thirds of the tongue and the floor of the mouth and should be employed only when it will be of help in developing an adequate margin around the primary lesion.

Carcinoma, Squamous Cell↗
PubMed1985

Bilateral chylothorax from radical neck dissection.

Bilateral chylothorax is a rare complication occurring after head and neck surgery, with only six cases reported. The diagnosis is not difficult if a high index of suspicion is held. Early recognition and treatment prevent the devastating metabolic effects of excessive chyle loss and reduce the respiratory restriction that can progress to fatal anoxia. Dietary management with medium-chain triglycerides is essential to successful outcome. Repeated invasive therapy should be minimized.

Adult↗