Lymph Node Dissection Versus No Lymph Node Dissection for Parathyroid Cancer
Surgery is the primary treatment for parathyroid carcinoma, but no consensus statement exists regarding the optimal extent of the initial resection. Given the rare nature of the disease, the literature is almost entirely limited to retrospective reviews, but was used in an attempt to determine the impact a routine central neck dissection has on recurrence, survival, and complications in patients being treated for parathyroid carcinoma. Nodal metastases do seem to predict recurrence but not worse survival. However, no clear difference was observed in recurrence or survival based on whether or not a lymph node dissection was performed indicating that there is minimal value in a nodal dissection as a routine procedure in all patients. While the addition of a central neck dissection does not increase rates of vocal cord palsies or hematomas, it does carry a significant risk of permanent hypoparathyroidism. Therefore, because there is no definitive benefit in patients with parathyroid carcinoma, the added risk of a routine central node dissection is not justified for all patients.
KeywordsParathyroid cancer Central compartment lymph node dissection Lymph node metastases Parathyroidectomy Neck exploration
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