Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma

Background. Despite the generally favorable prognosis of patients with papillary thyroid cancers, 10-year re- currence rates for patients with stage I to III disease is greater than 20%, with central compartment recurrences common among these recurrent sites. Methods. This study is a retrospective analysis of consecu- tive patients treated by a single surgeon over an 18-month pe- riod of time terminating in 2003. Results. Sixty-three patients underwent a comprehensive dissection of levels VI and VII for papillary thyroid carcinoma dur- ing this period. There was a female predominance of 2:1, with 48% of patients being greater than 45 years of age. The median number of lymph nodes identified was 16 (range, 3-52), with 7 (1-20) lymph nodes pathologically involved. Permanent hypo- parathyroidism was present on presentation in 13% of patients and developed in an additional 5% following surgery. Although recurrent laryngeal paralysis was present on presentation among 8 (13%) of patients, no patients experienced paralysis of documented functioning recurrent laryngeal nerves or necessi- tated tracheotomy. Postoperative thyroglobulin levels were reduced to nondetectable in 71% of the informative cases. Over 60% of patients were discharged on their first postoperative day. Conclusion. Bilateral paratracheal and superior mediastinal dissection is an oncologically safe procedure exhibiting mini- mal morbidity when performed among experienced individuals despite multiple prior surgical procedures or existing vocal cord paralysis. V C 2009 Wiley Periodicals, Inc. Head Neck 31: 1152-1163, 2009