Elektivna disekcija regije IV ne povećava rizik postoperativnog hipoparatireoidizma kod bolesnika liječenih zbog dobro diferenciranog karcinoma štitnjače

The aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer. Methods: A retrospective analysis of 179 patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups. Results: A total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLN d group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLN d group. The rate of persistent hypoparathyroidism in the TT and TT + CCLN d groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLN d group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant. Discussion: While its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies. Our results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy.Cilj rada je usporediti incidenciju postoperativnog hipoparatireoidizma između dvije skupine bolesnika liječenih zbog dobro diferenciranog karcinoma štitnjače. Metode: Retrospektivno smo analizirali 179 bolesnika koji su u našoj ustanovi liječeni zbog dobro diferenciranog karicnoma štitnjače u periodu od siječnja 2011 do prosinca 2018. U studiju su bili uključeni samo bolesnici kod kojih je inicijalno učinjena totalna tiroidektomija te oni koji na osnovu preoperativne obrade nisu imali potvrđene metastaze na lateralnom vratu i u regiji VI. Analizirane su dvije skupine bolesnika. U prvu skupinu su uključeni bolesnici kod kojih je u istom aktu učinjena totalna tireoidektomija i disekcija regije VI. Svi ostali bolesnici kod kojih je učinjena samo totalna tireoidektomija uključeni su u drugu skupinu. Stopa tranzitornog i trajnog hipoparatireoidizma je uspoređivana između dvije skupine. Rezultati: Kod ukupno 117 bolesnika (65,4%) učinjena je disekcija regije VI istodobno s totalnom tireoidektomijom. (TT + CCLN d skupina). Kod preostalih 62 bolesnika (34,6%) učinjena je samo totalna tireoidektomija. (TT skupina). Ukupno 22,6% bolesnika iz TT skupine je razvilo postoperativni hipoparatireoidizam usporedno s 25,6% bolesnika iz TT + CCLN d skupine. Stope trajnog hipoparatireoidizma u TT i TT + CCLN d skupinama su iznosile 3,2 i 6 %. Stopa tranzitornog kao i trajnog postoperativnog hipoparatireoidizma nije bila statistički značajna između dvije skupine. Unutar TT + CCLN d skupine, kod 82,9% bolesnika je učinjena disekcija ipsilateralnih paratrahealnih limfnih čvorova, za razliku od 17,1% bolesnika kod kojih je učinjena disekcija bilateralnih paratrahealnih čvorova. Stopa postoperativnog hipoparatireoidizma je analizirana u dvjema podskupinama i nije se pokazala statistički značajnom. Rasprava: Iako je utjecaj elektivne disekcije regije VI na lokoregionalno recidiviranje i dalje kontroverzan, ona može biti odličan alat za probir bolesnika koji mogu imati korist od adjuvantne radiojodne ablacije. S druge strane, disekcija regije VI potencijalno može povećati rizik hipoparatireoidizma zbog nenamjerne ozljede doštitnih žlijezda ili/i njihove krvne opskrbe. Naša studija nije pokazala statistički značajnu razliku u stopi postoperativnog hipoparatireoidizma između skupine bolesnika kod kojih je učinjena disekcija regije VI u usporedbi sa skupinom bolesnika kod kojih je učinjena samo totalna tireoidektomija. Naši podaci su u proturiječju s nekim ranije publiciranim studijama. Naši rezultati su pokazali da je elektivna disekcija regije VI sigurni postupak i značajno ne povećava rizik postoperativnog hipoparatireoidizma kada se izvodi istodobno s totalnom tireoidektomijom