Total thyroidectomy with and without selective central compartment dissection: A comparison of complication rates

Objective: To compare the postoperative complications between patients who underwent total thyroidectomy (TT) with central compartment lymph node dissection (CLND) and those who underwent only TT. Design: Retrospective medical chart review. Setting: Academic tertiary center. Patients: The CLND group consisted of 122 patients with a preoperative or an intraoperative diagnosis of papillary thyroid cancer who underwent TT with CLND. The TT group consisted of 134 patients who underwent TT without CLND for either benign disease or indeterminate nodules. Final pathologic analysis demonstrated that 61 of the patients in the TT group had malignant disease. Main Outcome Measures: Incidence of vocal cord paralysis, transient and permanent hypocalcemia, seroma, hematoma, and chyle leak. Results: One patient in each group (0.7%) had permanent hypocalcemia. The incidence of transient hypocalcemia in the CLND group was 13.1% (n=16) compared with 25.4% (n=34) in the TT group. Vocal cord paresis occurred in 5 patients in the CLND group, all with complete resolution. In the TT group, there were 4 cases of temporary paresis and 6 of complete paralysis, 5 of which resolved and 1 of which was permanent. There was no hematoma or seroma in either group. One patient in the CLND group developed a chyle leak, which resolved in 3 days with conservative management. Conclusions: Adding CLND to TT does not increase post-operative hypocalcemia or vocal cord paralysis. These results suggest that in the hands of experienced thyroid oncologic surgeons, elective selective CLND can be performed safely for papillary thyroid cancer and should be considered in higher-risk patients to potentially reduce the risk of reoperation in the central compartment.