Central neck dissection is an independent risk factor for incidental parathyroidectomy

Abstract

Objective

This study aims to determine the frequency of incidental parathyroidectomy (IP), to reveal the risk factors and to present the clinical importance of IP through the experiences of our clinic.

Materials and Methods

Patients undergoing thyroid surgery between June 2016 and May 2019 were reviewed retrospectively. Along with demographic data, surgery reports, pathology results and postoperative follow-up data were examined. Factors assumed to be associated with IP and postoperative hypocalcemia were compared between the IP group and the non-IP group.

Results

A total of 633 patients with a mean age of 48 ± 13 years were included in this study. IP was detected in 138 (21.8%) patients and parathyroid glands were localized 29.72% intrathyroidal. Postoperative hypocalcemia in the IP group was approximately 2-fold higher than the no-IP group (%15.94 to %7.27), (p < .001). Gender (p = .014), body mass index (p = .021), both preoperative and postoperative diagnosis of malignancy (p < .001) and performing central neck dissection (CND) (p < .001) were significantly associated with IP in univariate analysis. However, multivariate analysis demonstrated that CND was independently associated with IP (OR = 0.301, 95% Cl: 0.161-0.562, p < .001).

Conclusion

This study reveals that IP increases the frequency of postoperative temporary and permanent hypocalcemia in patients undergoing thyroid surgery, and CND is the only independent risk factor for IP.

Highlights of the study

• This study reveals that central neck dissection is the most important and only independent risk factor for incidental parathyroidectomy in patients undergoing thyroid surgery.

• According to our analysis, both temporary and permanent hypocalcemia, which occurs in the postoperative period, are associated with incidental parathyroidectomy.

Keywords:

• Incidental parathyroidectomy
• postoperative hypocalcemia
• thyroidectomy
• central neck lymph node dissection

Acknowledgement

Authors wish to thank all the staff of surgery, endocrinology and pathology departments in Ankara City Hospital.

Ethical approval

Local ethics board approval was obtained for this study, through registration number E-1-19-279 (date: 5 February 2020). This study was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was not obtained from the patients because of the retrospective nature of the study.

Author contributions

Conception/Design: Hakan Ataş, Barış Saylam, Mesut Tez. Provision of study materials or patients: Barış Saylam, Gökhan Akkurt. Collection and/or assembly of data: Gökhan Akkurt, Hakan Ataş. Data analysis and interpretation: Mesut Tez, Gökhan Akkurt. Manuscript writing: Hakan Ataş, Barış Saylam, Mesut Tez. Final approval of manuscript: Hakan Ataş.

Disclosure statement

The authors declare that they have no conflict of interest to disclose.