Risk factors of accidental parathyroidectomy following thyroid surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

NI Banggao ^1,2 , FEI Yuan ¹ , WANG Bin ³ , WU Wenshuang ¹ ,  SU Anping ¹ ,  ZHU Jingqiang ¹

1. Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases, West China Hospital, Sichuan University, Chengdu 610041,P. R. China;
2. Department of Thyroid Surgery, The People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;
3. Department of Thyroid and Breast Surgery, The Third People’s Hospital, Chengdu 610000, P. R. China;

Corresponding author：

SU Anping, Email: suanpingping@126.com; ZHU Jingqiang, Email: zjq-wkys@163.com

Keywords：

accidental parathyroidectomy; thyroid surgery; risk factor

DOI：

10.7507/1007-9424.201909040

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Objective To investigate the risk factors of accidental parathyroidectomy following thyroid surgery.Methods Data of patients who accepted at least total thyroidectomy in the Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases between January 2013 and June 2016 was collected retrospectively. According to the appearance or non-appearance of parathyroid gland in the specimens after pathologic examination, the patients were divided into accidental parathyroidectomy group and non-accidental parathyroidectomy group. Clinical data was collected for comparison between the two groups. The risk factors of accidental parathyroidectomy were indentified with univariate analysis and multivariate analysis.Results A total of 983 patients, 50 patients in the accidental parathyroidectomy group and 933 patients in the non-accidental parathyroidectomy group, were included in the study. Incidence of temporary hypoparathyroidism was 66.0% (33/50) in the accidental parathyroidectomy group and 36.2% (338/933) in the non-accidental parathyroidectomy group, there was significant difference between the two groups (χ²=19.903, P<0.05). Incidence of permanent hypoparathyroidism was 2.0% (1/50) in the accidental parathyroidectomy group and 0.4% (4/933) in the non-accidental parathyroidectomy group, and there was no significant difference between the two groups (χ²=2.315, P=0.128). Univariate analysis showed that bilateral central lymph nodes dissection (P=0.004) and the number of identified parathyroid glands ≤2 (P=0.002) were risk factors of accidental parathyroidectomy. Multivariate analysis showed that bilateral central lymph nodes dissection [OR=2.553, 95% CI was (1.236, 5.277), P=0.011] and the number of identified parathyroid glands ≤2 [OR=2.819, 95% CI was (1.423, 5.581), P=0.003] were independent risk factors of accidental parathyroidectomy.Conclusions After careful consideration of the possible risks and benefits, bilateral central lymph nodes dissection should be performed rationally. Thyroid surgeons should improve the ability of identification of parathyroid gland to reduce the incidence of accidental parathyroidectomy.

Citation： NI Banggao, FEI Yuan, WANG Bin, WU Wenshuang, SU Anping, ZHU Jingqiang. Risk factors of accidental parathyroidectomy following thyroid surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(2): 152-157. doi: 10.7507/1007-9424.201909040 Copy

1.	Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
2.	Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
3.	Cheah WK, Arici C, Ituarte PH, et al. Complications of neck dissection for thyroid cancer. World J Surg, 2002, 26(8): 1013-1016.
4.	Lee YS, Kim SW, Kim SW, et al. Extent of routine central lymph node dissection with small papillary thyroid carcinoma. World J Surg, 2007, 31(10): 1954-1959.
5.	Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
6.	Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery, 2005, 138(6): 1095-1191.
7.	Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol, 2014, 12: 200.
8.	Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level Ⅵ lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6): 1000-1007.
9.	Fahad Al-Dhahri S, Al-Ghonaim YA, Sulieman Terkawi A. Accuracy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia. J Otolaryngol Head Neck Surg, 2010, 39(4): 342-348.
10.	Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg, 2000, 24(8): 891-897.
11.	Paek SH, Lee YM, Min SY, et al. Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. World J Surg, 2013, 37(1): 94-101.
12.	朱精强, 苏安平. 甲状腺结节手术治疗的合理选择. 中国实用外科杂志, 2015, 35(6): 635-639.
13.	苏安平, 王彬, 朱精强. 甲状腺乳头状癌行甲状腺全切及双侧中央区淋巴结清扫术后甲状旁腺功能低下的危险因素分析. 中华内分泌外科杂志, 2017, 11(4): 283-288.
14.	朱精强. 分化型甲状腺癌颈淋巴结清扫的相关问题. 中国普外基础与临床杂志, 2012, 19(8): 809-813.
15.	Zhou HY, He JC, McHenry CR. Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res, 2016, 205(1): 70-75.
16.	Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid, 2018, 28(7): 830-841.
17.	Christakis I, Zacharopoulou P, Galanopoulos G, et al. Inadvertent parathyroidectomy risk factors in 1,373 thyroidectomies-male gender and presence of lymphadenopathy, but not size of gland, independently increase the risk. Gland Surg, 2017, 6(6): 666-674.
18.	Sippel RS, Ozgül O, Hartig GK, et al. Risks and consequences of incidental parathyroidectomy during thyroid resection. ANZ J Surg, 2007, 77(1-2): 33-36.
19.	Hone RW, Tikka T, Kaleva AI, et al. Analysis of the incidence and factors predictive of inadvertent parathyroidectomy during thyroid surgery. J Laryngol Otol, 2016, 130(7): 669-673.
20.	中国医师协会外科医师分会甲状腺外科医师委员会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国研究型医院学会, 等. 甲状腺围手术期甲状旁腺功能保护指南 (2018 版). 中国实用外科杂志, 2018, 38(10): 1108-1113.
21.	Wang JB, Wu K, Shi LH, et al. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma. Br J Surg, 2017, 104(11): 1514-1522.
22.	Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope, 2009, 119(6): 1135-1139.
23.	朱精强, 雷建勇, 姜可. 甲状腺微小乳头状癌淋巴结转移特点及处理策略. 中国普外基础与临床杂志, 2016, 23(10): 1160-1165.
24.	So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery, 2012, 151(2): 192-198.
25.	Wang TS, Cheung K, Farrokhyar F, et al. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol, 2013, 20(11): 3477-3483.
26.	中国抗癌协会甲状腺癌专业委员会. 甲状腺微小乳头状癌诊断与治疗中国专家共识 (2016 版). 中国肿瘤临床, 2016, 43(10): 405-411.
27.	朱精强, 汪洵理, 魏涛, 等. 纳米碳甲状旁腺负显影辨认保护技术在甲状腺癌手术中的应用. 中国普外基础与临床杂志, 2013, 20(9): 992-994.
28.	Li Y, Jian WH, Guo ZM, et al. A Meta-analysis of carbon nanoparticles for identifying lymph nodes and protecting parathyroid glands during surgery. Otolaryngol Head Neck Surg, 2015, 152(6): 1007-1016.

1. Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
2. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
3. Cheah WK, Arici C, Ituarte PH, et al. Complications of neck dissection for thyroid cancer. World J Surg, 2002, 26(8): 1013-1016.
4. Lee YS, Kim SW, Kim SW, et al. Extent of routine central lymph node dissection with small papillary thyroid carcinoma. World J Surg, 2007, 31(10): 1954-1959.
5. Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
6. Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery, 2005, 138(6): 1095-1191.
7. Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol, 2014, 12: 200.
8. Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level Ⅵ lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6): 1000-1007.
9. Fahad Al-Dhahri S, Al-Ghonaim YA, Sulieman Terkawi A. Accuracy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia. J Otolaryngol Head Neck Surg, 2010, 39(4): 342-348.
10. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg, 2000, 24(8): 891-897.
11. Paek SH, Lee YM, Min SY, et al. Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. World J Surg, 2013, 37(1): 94-101.
12. 朱精强, 苏安平. 甲状腺结节手术治疗的合理选择. 中国实用外科杂志, 2015, 35(6): 635-639.
13. 苏安平, 王彬, 朱精强. 甲状腺乳头状癌行甲状腺全切及双侧中央区淋巴结清扫术后甲状旁腺功能低下的危险因素分析. 中华内分泌外科杂志, 2017, 11(4): 283-288.
14. 朱精强. 分化型甲状腺癌颈淋巴结清扫的相关问题. 中国普外基础与临床杂志, 2012, 19(8): 809-813.
15. Zhou HY, He JC, McHenry CR. Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res, 2016, 205(1): 70-75.
16. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid, 2018, 28(7): 830-841.
17. Christakis I, Zacharopoulou P, Galanopoulos G, et al. Inadvertent parathyroidectomy risk factors in 1,373 thyroidectomies-male gender and presence of lymphadenopathy, but not size of gland, independently increase the risk. Gland Surg, 2017, 6(6): 666-674.
18. Sippel RS, Ozgül O, Hartig GK, et al. Risks and consequences of incidental parathyroidectomy during thyroid resection. ANZ J Surg, 2007, 77(1-2): 33-36.
19. Hone RW, Tikka T, Kaleva AI, et al. Analysis of the incidence and factors predictive of inadvertent parathyroidectomy during thyroid surgery. J Laryngol Otol, 2016, 130(7): 669-673.
20. 中国医师协会外科医师分会甲状腺外科医师委员会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国研究型医院学会, 等. 甲状腺围手术期甲状旁腺功能保护指南 (2018 版). 中国实用外科杂志, 2018, 38(10): 1108-1113.
21. Wang JB, Wu K, Shi LH, et al. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma. Br J Surg, 2017, 104(11): 1514-1522.
22. Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope, 2009, 119(6): 1135-1139.
23. 朱精强, 雷建勇, 姜可. 甲状腺微小乳头状癌淋巴结转移特点及处理策略. 中国普外基础与临床杂志, 2016, 23(10): 1160-1165.
24. So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery, 2012, 151(2): 192-198.
25. Wang TS, Cheung K, Farrokhyar F, et al. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol, 2013, 20(11): 3477-3483.
26. 中国抗癌协会甲状腺癌专业委员会. 甲状腺微小乳头状癌诊断与治疗中国专家共识 (2016 版). 中国肿瘤临床, 2016, 43(10): 405-411.
27. 朱精强, 汪洵理, 魏涛, 等. 纳米碳甲状旁腺负显影辨认保护技术在甲状腺癌手术中的应用. 中国普外基础与临床杂志, 2013, 20(9): 992-994.
28. Li Y, Jian WH, Guo ZM, et al. A Meta-analysis of carbon nanoparticles for identifying lymph nodes and protecting parathyroid glands during surgery. Otolaryngol Head Neck Surg, 2015, 152(6): 1007-1016.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk factors of accidental parathyroidectomy following thyroid surgery

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