Surgical treatment of differentiated thyroid cancer. Technique and morbidity of paratracheal lymphadenectomy

Background. The extent of cervical lymphadenectomy in treatment of differen tiated thyroid cancer is controversial. Technique and results of paratrache al lymphadenectomy are presented to demonstrate safety of cervical lymphade nectomy procedures. Patients and methods. 68 Patients with differentiated thyroid cancer underw ent total thyroidectomy and extended lymphadenectomy in a standardized tech nique. The pre- and paratracheal and the lateral lymphnode compartments wer e cleared. Results. Permanent pareses of recurrent laryngeal nerve or permanent hypoca lcaemias were not observed. 3 patients developed transient recurrent nerve palsy, 26 patients transient hypocalcaemia (Ca2+ >1,7 and <2,2 mmol/l). In 3 patients mild voice disturbances, probably due to superior laryngeal nerv e dysfunction were observed. In I patient shorttime tracheotomy was perform ed. 1 patients showed permanent Horner's syndrome. Conclusions. Thyroidectomy with extended lymphadenectomy achieves removal o f all cervical tumor masses without relevant morbidity. The distribution of metastatic lymph nodes underlines the necessity of extended lymphadenectom y.