Complication after Total Thyroidectomy and Node Dissection for Thyroid Cancer

Noh, Soo Young; Ko, Byung Kyun; Kim, Yon Seon

Abstract

PURPOSE
The typical complications after thyroidectomy are bleeding, hematoma, hoarseness, hypocalcemia, chylous fistula, etc. The aim of this study was to determine the incidence and to evaluate risk factors of complication after total thyroidectomy and lymph node dissection (ND) for thyroid cancer.
METHODS
We performed a retrospective review of 623 patients with thyroid cancer and who underwent total thyroidectomy and ND and the patients were treated at our hospital from March 2007 to February 2010. The clinical features of complications were reviewed and the incidence and predisposing factors of the complication were analyzed.
RESULTS
Postoperative bleeding occurred in 0.2% of the patients. The overall incidence of transient and permanent hypocalcemia was 8.5% and 0.6%, respectively. Graves disease, a decreased number of preserved parathyroid glands and an increased number of removed central lymph nodes constituted the risk factors for postoperative hypocalcemia. On multivariate logistic regression analysis, the presence of Graves disease and a decreased number of preserved parathyroid glands were the independent risk factors for postoperative hypocalcemia. Hoarseness occurred in 1.6% of the patients. The incidence of chylous fistula after lymph node dissection in the central neck and lateral neck was 0.5% and 0.3%, respectively.
CONCLUSION
Total thyroidectomy with ND is a safe procedure because the overall incidence of postoperative complications is low. Careful surgery is required for thyroid cancer patients with Graves disease. Parathyroid gland insufficiency is the important cause of hypocalcemia after total thyroidectomy and ND. To reduce voice change, careful dissection is required around the recurrent laryngeal nerve and excessive tracheal traction should be avoided.