Lymph Node Dissection Versus No Lymph Node Dissection for Parathyroid Cancer

  • Reese W. Randle
  • David F. SchneiderEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


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.


Parathyroid cancer Central compartment lymph node dissection Lymph node metastases Parathyroidectomy Neck exploration 


  1. 1.
    Lee PK, Jarosek SL, Virnig BA, Evasovich M, Tuttle TM. Trends in the incidence and treatment of parathyroid cancer in the United States. Cancer. 2007;109(9):1736–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Hundahl SA, Fleming ID, Fremgen AM, Menck HR. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985–1995: a National Cancer Data Base Report. The American College of Surgeons Commission on cancer and the American Cancer Society. Cancer. 1999;86(3):538–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Villar-Del-Moral J, Jimenez-Garcia A, Salvador-Egea P, Martos-Martinez JM, Nuno-Vazquez-Garza JM, Serradilla-Martin M, et al. Prognostic factors and staging systems in parathyroid cancer: a multicenter cohort study. Surgery. 2014;156(5):1132–44.CrossRefPubMedGoogle Scholar
  4. 4.
    Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005;132(3):359–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Iihara M, Okamoto T, Suzuki R, Kawamata A, Nishikawa T, Kobayashi M, et al. Functional parathyroid carcinoma: long-term treatment outcome and risk factor analysis. Surgery. 2007;142(6):936–43.CrossRefPubMedGoogle Scholar
  6. 6.
    Wang CA, Gaz RD. Natural history of parathyroid carcinoma. Diagnosis, treatment, and results. Am J Surg. 1985;149(4):522–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Agarwal G, Prasad KK, Kar DK, Krishnani N, Pandey R, Mishra SK. Indian primary hyperparathyroidism patients with parathyroid carcinoma do not differ in clinicoinvestigative characteristics from those with benign parathyroid pathology. World J Surg. 2006;30(5):732–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Ippolito G, Palazzo FF, Sebag F, De MC, Henry JF. Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenoma. Br J Surg. 2007;94(5):566–70.CrossRefPubMedGoogle Scholar
  9. 9.
    Cohn K, Silverman M, Corrado J, Sedgewick C. Parathyroid carcinoma: the Lahey clinic experience. Surgery. 1985;98(6):1095–100.PubMedGoogle Scholar
  10. 10.
    Pelizzo MR, Piotto A, Bergamasco A, Rubello D, Casara D. Parathyroid carcinoma. Therapeutic strategies derived from 20 years of experience. Minerva Endocrinol. 2001;26(1):23–9.PubMedGoogle Scholar
  11. 11.
    Trigonis C, Cedermark B, Willems J, Hamberger B, Granberg PO. Parathyroid carcinoma--problems in diagnosis and treatment. Clin Oncol. 1984;10(1):11–9.PubMedGoogle Scholar
  12. 12.
    Smith JF, Coombs RR. Histological diagnosis of carcinoma of the parathyroid gland. J Clin Pathol. 1984;37(12):1370–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    McKeown PP, McGarity WC, Sewell CW. Carcinoma of the parathyroid gland: is it overdiagnosed?A report of three cases. Am J Surg. 1984;147(2):292–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Obara T, Fujimoto Y. Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg. 1991;15(6):738–44.CrossRefPubMedGoogle Scholar
  15. 15.
    Wynne AG, van HJ, Carney JA, Fitzpatrick LA. Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore). 1992;71(4):197–205.CrossRefGoogle Scholar
  16. 16.
    Lee YS, Hong SW, Jeong JJ, Nam KH, Chung WY, Chang HS, et al. Parathyroid carcinoma: a 16-year experience in a single institution. Endocr J. 2010;57(6):493–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Favia G, Lumachi F, Polistina F, D’Amico DF. Parathyroid carcinoma: sixteen new cases and suggestions for correct management. World J Surg. 1998;22(12):1225–30.CrossRefPubMedGoogle Scholar
  18. 18.
    Chandar AK, Falck-Ytter Y. Evidence based medicine: quality of evidence and evaluation systems. In: Ferguson MK, editor. Difficult decisions in thoracic surgery, difficult decisions in surgery: an evidence-based approach 1. 3rd ed. London: Springer; 2014. p. 17–33.Google Scholar
  19. 19.
    Anderson BJ, Samaan NA, Vassilopoulou-Sellin R, Ordonez NG, Hickey RC. Parathyroid carcinoma: features and difficulties in diagnosis and management. Surgery. 1983;94(6):906–15.PubMedGoogle Scholar
  20. 20.
    Busaidy NL, Jimenez C, Habra MA, Schultz PN, El-Naggar AK, Clayman GL, et al. Parathyroid carcinoma: a 22-year experience. Head Neck. 2004;26(8):716–26.CrossRefPubMedGoogle Scholar
  21. 21.
    Hakaim AG, Esselstyn CB Jr. Parathyroid carcinoma: 50-year experience at the Cleveland Clinic Foundation. Cleve Clin J Med. 1993;60(4):331–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Kebebew E, Arici C, Duh QY, Clark OH. Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg. 2001;136(8):878–85.CrossRefPubMedGoogle Scholar
  23. 23.
    Koea JB, Shaw JH. Parathyroid cancer: biology and management. Surg Oncol. 1999;8(3):155–65.CrossRefPubMedGoogle Scholar
  24. 24.
    Harari A, Waring A, Fernandez-Ranvier G, Hwang J, Suh I, Mitmaker E, et al. Parathyroid carcinoma: a 43-year outcome and survival analysis. J Clin Endocrinol Metab. 2011;96(12):3679–86.CrossRefPubMedGoogle Scholar
  25. 25.
    Hsu KT, Sippel RS, Chen H, Schneider DF. Is central lymph node dissection necessary for parathyroid carcinoma? Surgery. 2014;156(6):1336–41.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sadler C, Gow KW, Beierle EA, Doski JJ, Langer M, Nuchtern JG, et al. Parathyroid carcinoma in more than 1,000 patients: a population-level analysis. Surgery. 2014;156(6):1622–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Holmes EC, Morton DL, Ketcham AS. Parathyroid carcinoma: a collective review. Ann Surg. 1969;169(4):631–40.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Cordeiro AC, Montenegro FL, Kulcsar MA, Dellanegra LA, Tavares MR, Michaluart P Jr, et al. Parathyroid carcinoma. Am J Surg. 1998;175(1):52–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Sandelin K, Auer G, Bondeson L, Grimelius L, Farnebo LO. Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg. 1992;16(4):724–31.CrossRefPubMedGoogle Scholar
  30. 30.
    Clayman GL, Gonzalez HE, El-Naggar A, Vassilopoulou-Sellin R. Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer. 2004;100(5):900–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Talat N, Schulte KM. Clinical presentation, staging and long-term evolution of parathyroid cancer. Ann Surg Oncol. 2010;17(8):2156–74.CrossRefPubMedGoogle Scholar
  32. 32.
    Schulte KM, Talat N, Miell J, Moniz C, Sinha P, Diaz-Cano S. Lymph node involvement and surgical approach in parathyroid cancer. World J Surg. 2010;34(11):2611–20.CrossRefPubMedGoogle Scholar
  33. 33.
    Schantz A, Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer. 1973;31(3):600–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Shaha AR, Shah JP. Parathyroid carcinoma: a diagnostic and therapeutic challenge. Cancer. 1999;86(3):378–80.CrossRefPubMedGoogle Scholar
  35. 35.
    Owen RP, Silver CE, Pellitteri PK, Shaha AR, Devaney KO, Werner JA, et al. Parathyroid carcinoma: a review. Head Neck. 2011;33(3):429–36.PubMedGoogle Scholar
  36. 36.
    Fernandez-Ranvier GG, Khanafshar E, Jensen K, Zarnegar R, Lee J, Kebebew E, et al. Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis? Cancer. 2007;110(2):255–64.CrossRefPubMedGoogle Scholar
  37. 37.
    Bae JH, Choi HJ, Lee Y, Moon MK, Park YJ, Shin CS, et al. Preoperative predictive factors for parathyroid carcinoma in patients with primary hyperparathyroidism. J Korean Med Sci. 2012;27(8):890–5.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Schulte KM, Gill AJ, Barczynski M, Karakas E, Miyauchi A, Knoefel WT, et al. Classification of parathyroid cancer. Ann Surg Oncol. 2012;19(8):2620–8.CrossRefPubMedGoogle Scholar
  39. 39.
    LiVolsi VA, Hamilton R. Intraoperative assessment of parathyroid gland pathology. A common view from the surgeon and the pathologist. Am J Clin Pathol. 1994;102(3):365–73.CrossRefPubMedGoogle Scholar
  40. 40.
    Kwan WY, Chow TL, Choi CY, Lam SH. Complication rates of central compartment dissection in papillary thyroid cancer. ANZ J Surg. 2013;85(4):274–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Sadowski BM, Snyder SK, Lairmore TC. Routine bilateral central lymph node clearance for papillary thyroid cancer. Surgery. 2009;146(4):696–703.CrossRefPubMedGoogle Scholar
  42. 42.
    So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery. 2012;151(2):192–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Palestini N, Borasi A, Cestino L, Freddi M, Odasso C, Robecchi A. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbeck’s Arch Surg. 2008;393(5):693–8.CrossRefGoogle Scholar
  44. 44.
    Viola D, Materazzi G, Valerio L, Molinaro E, Agate L, Faviana P, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab. 2015;100(4):1316–24. Scholar
  45. 45.
    Alvarado R, Sywak MS, Delbridge L, Sidhu SB. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery. 2009;145(5):514–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Endocrine Surgery, Department of SurgeryUniversity of KentuckyLexingtonUSA
  2. 2.Section of Endocrine Surgery, Department of SurgeryUniversity of WisconsinMadisonUSA

Personalised recommendations