The Application of Strategic Parathyroid Autotransplantation in The Central Lymph Node Re-dissection for Papillary Thyroid Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SUAn-ping ,  ZHUJing-qiang , GONGRi-xiang , LIZhi-hui , WEITao , LIUFeng , GongYan-ping , MAYu , ZOUXiu-he , LEIJian-yong

Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

ZHUJing-qiang, Email: zjq-wkys@163.com

Keywords：

Papillary thyroid carcinoma; Central lymph node re-dissection; Strategic parathyroid autotransplan-tation; Hypoparathyroidism

DOI：

10.7507/1007-9424.20160301

Video：

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Objective To evaluate whether strategic parathyroid autotransplantation can decrease the incidence of hypoparathyroidism after central lymph node re-dissection in patients with papillary thyroid carcinoma. Methods Data were retrospectively collected from the patients with papillary thyroid carcinoma, who had undergone unilateral or bilateral central lymph node re-dissection in the Department of Thyroid Surgery, West China Hospital of Sichuan University between January 2009 and October 2015. The patients were divided into transplantation group and non-transplantation group according to the history of strategic parathyroid autotransplantation in the primary surgery. Data concerning patient demographics (age, sex, comorbidities, the leval of Ca²⁺ and parathyroid hormone, previous surgical manners and complications before reoperation), surgical manners of reoperation, and postoperative factors (laboratory examination and postoperative complications) were collected. Results A total of 74 patients, 35 in the transplantation group and 39 in the non-transplantation group, were included in the study. Significantly higher levels of Ca²⁺ and parathyroid hormone were observed in the transplantation group than in the non-transplantation group on one day after surgery (P < 0.05). Recurrent laryngeal nerve injury newly occurred in 2 patients in the transplantation group and 5 patients in the non-transplantation group, respectively (5.7% vs. 12.8%, P > 0.05). Transient hypoparathyroidism was documented in 4 patients in the transplantation group and in 12 patients in the non-transplantation group. Permanent hypoparathyroidism was documented in 1 patient in the transplantation group and in 4 patients in the non-transplantation group. The incidence of hypoparathyroidism was significantly lower in the transplantation group compared with the non-transplantation group (5 vs. 16, P < 0.05). The mean number of central lymph node identified pathologically was significantly more in the transplantation group (2.1±1.3 vs. 1.4±0.7, P < 0.05). Conclusion Strategic parathyroid autotransplantation can effectively decrease the incidence of hyperparathyroidism after central lymph node re-dissection in patients with papillary thyroid carcinoma, which greatly improves the surgical safety and thoroughness.

Citation： SU An-ping, ZHU Jing-qiang, GONG Ri-xiang, LI Zhi-hui, WEI Tao, LIU Feng, Gong Yan-ping, MA Yu, ZOU Xiu-he, LEI Jian-yong. The Application of Strategic Parathyroid Autotransplantation in The Central Lymph Node Re-dissection for Papillary Thyroid Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(10): 1173-1177. doi: 10.7507/1007-9424.20160301 Copy

1.	Grebe SK, Hay ID. Thyroid cancer nodal metastases:biologic significance and therapeutic considerations. Surg Oncol Clin N Am, 1996, 5(1):43-63.
2.	Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med, 1993, 328(8):553-559.
3.	Scheumann GF, Gimm O, Wegener G, et al. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg, 1994, 18(4):559-567.
4.	Qubain SW, Nakano S, Baba M, et al. Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery, 2002, 131(3):249-256.
5.	Gimm O, Rath FW, Dralle H. Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg, 1998, 85(2):252-254.
6.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7):731-736.
7.	Onkendi EO, McKenzie TJ, Richards ML, et al. Reoperative experience with papillary thyroid cancer. World J Surg, 2014, 38(3):645-652.
8.	Kim MK, Mandel SH, Baloch Z, et al. Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg, 2004, 130(10):1214-1216.
9.	Lefevre JH, Tresallet C, Leenhardt L, et al. Reoperative surgery for thyroid disease. Langenbecks Arch Surg, 2007, 392(6):685-691.
10.	Ito Y, Kihara M, Kobayashi K, et al. Permanent hypoparathyroidism after completion total thyroidectomy as a second surgery:How do we avoid it? Endocr J, 2014, 61(4):403-408.
11.	Kim SM, Kim HK, Kim KJ, et al. Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid, 2015, 25(7):830-833.
12.	Mazzaferri EL, Kloos RT. Clinical review 128:current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab, 2001, 86(4):1447-1463.
13.	Roh JL, Park JY, Park CI. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer, 2009, 115(2):251-258.
14.	Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope, 2009, 119(6):1135-1139.
15.	龚艳萍, 龚日祥, 朱精强, 等. cN0甲状腺乳头状癌中央区淋巴结清扫策略的临床研究.中华外科杂志, 2013, 51(12):1081-1084.
16.	Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol, 2014, 12:200.
17.	Wells SA Jr, Gunnells JC, Shelburne JD, et al. Transplantation of the parathyroid glands in man:clinical indications and results. Surgery, 1975, 78(1):34-44.
18.	Senapati A, Young AE. Parathyroid autotransplantation. Br J Surg, 1990, 77(10):1171-1174.
19.	Wells SA Jr, Stirman JA Jr, Bolman RM 3rd, et al. Transplantation of the parathyroid glands. Clinical and experimental results. Surg Clin North Am, 1978, 58(2):391-402.
20.	Rothmund M, Wagner PK. Assessment of parathyroid graft function after autotransplantation of fresh and cryopreserved tissue. World J Surg, 1984, 8(4):527-533.
21.	Testini M, Rosato L, Avenia N, et al. The impact of single parathyroid gland autotransplantation during thyroid surgery on postoperative hypoparathyroidism:a multicenter study. Transplant Proc, 2007, 39(1):225-230.
22.	Ahmed N, Aurangzeb M, Muslim M, et al. Routine parathyroid autotransplantation during total thyroidectomy:a procedure with predictable outcome. J Pak Med Assoc, 2013, 63(2):190-193.
23.	Testini M, Rosato L, Avenia N, et al. The impact of single parathyroid gland autotransplantation during thyroid surgery on postoperative hypoparathyroidism:a multicenter study. Transplant Proc, 2007, 39(1):225-230.
24.	Kihara M, Yokomise H, Miyauchi A, et al. Recovery of parathyroid function after total thyroidectomy. Surg Today, 2000, 30(4):333-338.
25.	Kihara M, Miyauchi A, Kontani K, et al. Recovery of parathyroid function after total thyroidectomy:long-term follow-up study. ANZ J Surg, 2005, 75(7):532-536.

1. Grebe SK, Hay ID. Thyroid cancer nodal metastases:biologic significance and therapeutic considerations. Surg Oncol Clin N Am, 1996, 5(1):43-63.
2. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med, 1993, 328(8):553-559.
3. Scheumann GF, Gimm O, Wegener G, et al. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg, 1994, 18(4):559-567.
4. Qubain SW, Nakano S, Baba M, et al. Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery, 2002, 131(3):249-256.
5. Gimm O, Rath FW, Dralle H. Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg, 1998, 85(2):252-254.
6. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7):731-736.
7. Onkendi EO, McKenzie TJ, Richards ML, et al. Reoperative experience with papillary thyroid cancer. World J Surg, 2014, 38(3):645-652.
8. Kim MK, Mandel SH, Baloch Z, et al. Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg, 2004, 130(10):1214-1216.
9. Lefevre JH, Tresallet C, Leenhardt L, et al. Reoperative surgery for thyroid disease. Langenbecks Arch Surg, 2007, 392(6):685-691.
10. Ito Y, Kihara M, Kobayashi K, et al. Permanent hypoparathyroidism after completion total thyroidectomy as a second surgery:How do we avoid it? Endocr J, 2014, 61(4):403-408.
11. Kim SM, Kim HK, Kim KJ, et al. Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid, 2015, 25(7):830-833.
12. Mazzaferri EL, Kloos RT. Clinical review 128:current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab, 2001, 86(4):1447-1463.
13. Roh JL, Park JY, Park CI. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer, 2009, 115(2):251-258.
14. Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope, 2009, 119(6):1135-1139.
15. 龚艳萍, 龚日祥, 朱精强, 等. cN0甲状腺乳头状癌中央区淋巴结清扫策略的临床研究.中华外科杂志, 2013, 51(12):1081-1084.
16. Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol, 2014, 12:200.
17. Wells SA Jr, Gunnells JC, Shelburne JD, et al. Transplantation of the parathyroid glands in man:clinical indications and results. Surgery, 1975, 78(1):34-44.
18. Senapati A, Young AE. Parathyroid autotransplantation. Br J Surg, 1990, 77(10):1171-1174.
19. Wells SA Jr, Stirman JA Jr, Bolman RM 3rd, et al. Transplantation of the parathyroid glands. Clinical and experimental results. Surg Clin North Am, 1978, 58(2):391-402.
20. Rothmund M, Wagner PK. Assessment of parathyroid graft function after autotransplantation of fresh and cryopreserved tissue. World J Surg, 1984, 8(4):527-533.
21. Testini M, Rosato L, Avenia N, et al. The impact of single parathyroid gland autotransplantation during thyroid surgery on postoperative hypoparathyroidism:a multicenter study. Transplant Proc, 2007, 39(1):225-230.
22. Ahmed N, Aurangzeb M, Muslim M, et al. Routine parathyroid autotransplantation during total thyroidectomy:a procedure with predictable outcome. J Pak Med Assoc, 2013, 63(2):190-193.
23. Testini M, Rosato L, Avenia N, et al. The impact of single parathyroid gland autotransplantation during thyroid surgery on postoperative hypoparathyroidism:a multicenter study. Transplant Proc, 2007, 39(1):225-230.
24. Kihara M, Yokomise H, Miyauchi A, et al. Recovery of parathyroid function after total thyroidectomy. Surg Today, 2000, 30(4):333-338.
25. Kihara M, Miyauchi A, Kontani K, et al. Recovery of parathyroid function after total thyroidectomy:long-term follow-up study. ANZ J Surg, 2005, 75(7):532-536.

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The Application of Strategic Parathyroid Autotransplantation in The Central Lymph Node Re-dissection for Papillary Thyroid Carcinoma

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