Lymph Node Involvement and Surgical Approach in Parathyroid Cancer

• Published in: World journal of surgery 2010-11, Vol.34 (11), p.2611-2620
• Main Authors: Schulte, Klaus-Martin, Talat, Nadia, Miell, John, Moniz, Caje, Sinha, Prakash, Diaz-Cano, Salvador
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Biological and medical sciences; Bloc Resection; Capsular Invasion; Cardiac Surgery; Central Compartment; Endocrinopathies; Female; General aspects; General Surgery; Humans; Locoregional Recurrence; Lymph Node; Lymph Node Excision; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Malignant tumors; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neck Dissection; Parathyroid Neoplasms - pathology; Parathyroid Neoplasms - surgery; Parathyroidectomy; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Retrospective Studies; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0722-y

Background The best surgical approach to parathyroid cancer is disputed. Recommendations vary and are built on incoherent evidence. High rates of recurrence and death require an in-depth review of underlying findings. Methods This retrospective study includes 11 patients with parathyroid cancer who underwent surgery with central and/or lateral neck dissection by a single surgeon between 2005 and 2010. The diagnosis was based on histopathological criteria in all patients. Patterns of lymph node and soft tissue involvement of these and formerly reported patients were analysed based on full-text review of all published cases of parathyroid cancer. Results In this series only 1 of 11 patients (9.1%) manifested lymph node metastasis. In the literature, lymph node metastases have been reported in only 6.5% of 972 published patients, or in 32.1% of the 196 in whom lymph node involvement was assessed by the authors. They were, with few exceptions, localised in the central compartment. Recurrence in soft tissue is more frequent than in locoregional lymph nodes. Conclusion Oncological en bloc clearance of the central compartment with meticulous removal of all possibly involved soft tissues, including a systematic central lymph node resection, may improve outcomes and should be included in the routine approach to the suspicious parathyroid lesion. There is no need for a prophylactic lateral neck dissection.