Elective central node dissection: Comparison of open to minimally invasive video-assisted approach

Abstract

Objectives/hypothesis: Compare outcomes of concomitant primary thyroidectomy with elective central neck dissection (CND) by the standard open versus minimally invasive video-assisted (MIVA) approach.

Study design: Case series chart review, single institution, tertiary referral center.

Methods: Current Procedural Terminology code 60252 was used to identify patients undergoing CND from February 2005 through June 2012. Therapeutic CND and revision cases were excluded. The MIVA approach was performed in patients with low-risk thyroid carcinoma (cT1 or 2, cN0). Primary outcomes included nodal yield and complications, and secondary outcomes included recurrence.

Results: Of 87 eligible patients, 38 were open and 49 were MIVA. The MIVA group was more likely female (88% vs. 68%, P = .03), but groups were similar in age (46.0 vs. 48.6 mean years, P = .37) and percentage of unilateral dissection (69.4% vs. 71.0%, P = .86). The MIVA group was more often pT1 or 2 (86.9% vs. 76.4%, P = .02). Pathological node positivity was 40% overall and not significantly different between groups (43.5% vs. 35.3%, P = .46). Nodal yield was similar between groups (6.4 vs. 6.8, P = .73). Transient recurrent laryngeal nerve paralysis rates were similar (4.1% vs. 2.6%, P = .71). Transient hypoparathyroidism (postanesthesia care unit parathyroid hormone ≤15 pg/mL) was lower in the MIVA group but not statistically significant (29.2% vs. 45.2%, P = .15). No patients experienced permanent hypoparathyroidism or developed clinically detectable structural recurrence. Rates of biochemical response were similar (any thyroglobulin >1 ng/dL) (13.8% vs. 8.0%, P = .86).

Conclusions: Concomitant MIVA thyroidectomy with elective CND appears to be a safe and effective alternative to the open approach for low-risk thyroid carcinoma with similar nodal yield, complications, and recurrence.

Level of evidence: 4 Laryngoscope, 126:1715-1718, 2016.

Keywords: Thyroid; central neck; lymph nodes; neck dissection; papillary thyroid cancer; thyroid cancer.