Low transverse incision for lateral neck dissection in patients with papillary thyroid cancer: improved cosmesis

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Abstract

Background

Various incisions and approaches have been developed for lateral neck dissection. The purpose of this study was to compare the surgical and cosmetic outcomes of a single low transverse incision with the hockey stick incision for lateral neck dissection (LND) in patients with papillary thyroid carcinoma (PTC).

Methods

We retrospectively analyzed 97 patients with PTC who underwent therapeutic LND and total thyroidectomy by low transverse incision (62 patients) or hockey stick incision (35 patients). We compared the operative results, cosmetic outcomes, objective scar measurement, and sensory disturbance between the two groups.

Results

The number of harvested and metastatic lymph nodes, Vancouver Scar Scale scores, and sensory change were not significantly different between the two groups. The mean number of harvested lymph nodes in level II was 9.82 vs. 9.63 ( P = 0.885) (transverse incision vs. hockey stick incision, respectively) and in level V was 6.36 vs. 5.63 ( P = 0.597). However, subjective satisfaction with the scar and neck contour was higher in the low transverse incision group compared with the hockey stick incision group. Scores for scar consciousness and sensory change were not significantly different between the two groups.

Conclusions

A single low transverse incision may provide equivalent surgical outcomes and superior cosmetic outcomes compared with the hockey stick incision for LND in PTC.

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Most cited references 20

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The increasing incidence of thyroid cancer: the influence of access to care.

Luc G T Morris, Andrew G Sikora, Tor Tosteson … (2013)

The rapidly rising incidence of papillary thyroid cancer may be due to overdiagnosis of a reservoir of subclinical disease. To conclude that overdiagnosis is occurring, evidence for an association between access to health care and the incidence of cancer is necessary. We used Surveillance, Epidemiology, and End Results (SEER) data to examine U.S. papillary thyroid cancer incidence trends in Medicare-age and non-Medicare-age cohorts over three decades. We performed an ecologic analysis across 497 U.S. counties, examining the association of nine county-level socioeconomic markers of health care access and the incidence of papillary thyroid cancer. Papillary thyroid cancer incidence is rising most rapidly in Americans over age 65 years (annual percentage change, 8.8%), who have broad health insurance coverage through Medicare. Among those under 65, in whom health insurance coverage is not universal, the rate of increase has been slower (annual percentage change, 6.4%). Over three decades, the mortality rate from thyroid cancer has not changed. Across U.S. counties, incidence ranged widely, from 0 to 29.7 per 100,000. County papillary thyroid cancer incidence was significantly correlated with all nine sociodemographic markers of health care access: it was positively correlated with rates of college education, white-collar employment, and family income; and negatively correlated with the percentage of residents who were uninsured, in poverty, unemployed, of nonwhite ethnicity, non-English speaking, and lacking high school education. Markers for higher levels of health care access, both sociodemographic and age-based, are associated with higher papillary thyroid cancer incidence rates. More papillary thyroid cancers are diagnosed among populations with wider access to healthcare. Despite the threefold increase in incidence over three decades, the mortality rate remains unchanged. Together with the large subclinical reservoir of occult papillary thyroid cancers, these data provide supportive evidence for the widespread overdiagnosis of this entity.

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Overview of Surgical Scar Prevention and Management

Daegu Son, Aram Harijan (2014)

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities. Graphical Abstract

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Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis.

Rita W Y Chung, Kee-Seok Nam, S Lee … (2010)

Since the introduction of endoscopic techniques in thyroid surgery, several trials of endoscopic lateral neck dissection have been conducted with the aim of avoiding a long cervical scar, but these endoscopic procedures require more effort than open surgery, mainly because of the relatively nonsophisticated instruments used. However, the recent introduction of surgical robotic systems has simplified the operations and increased the precision of endoscopic techniques. We have described our initial experience with robot-assisted modified radical neck dissection (MRND) in thyroid cancer using the da Vinci S system. From October 2007 to October 2009, 33 patients with thyroid cancer with lateral neck lymph node (LN) metastases underwent robot-assisted thyroidectomy and additional robotic MRND using a gasless, transaxillary approach. Clinicopathologic data were analyzed retrospectively. Mean patient age was 37 ± 9 years and the gender ratio (male to female) was 7:26. The mean operating time was 281 ± 41 minutes and mean postoperative hospital stay was 5.4 ± 1.6 days. The mean tumor size was 1.1 ± 0.5 cm and 20 cases (61%) had papillary thyroid microcarcinoma. The mean number of retrieved LNs was 6.1 ± 4.4 in the central neck compartment and 27.7 ± 11.0 in the lateral compartment. No serious postoperative complications, such as Horner's syndrome or major nerve injury, occurred. Robot-assisted MRND is technically feasible, safe, and produces excellent cosmetic results. Based on our initial experience, robot-assisted MRND should be viewed as an acceptable alternative method in patients with low-risk, well-differentiated thyroid cancer with lateral neck node metastasis. Copyright © 2010 Mosby, Inc. All rights reserved.

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Author and article information

Contributors

Chang Myeon Song: songabcd@hanmail.net

Yong Bae Ji: jyb20000@hanmail.net

In Sik Kim: gift0102@naver.com

Ji Young Lee: blue-milgaroo@hanmail.net

Dong Sun Kim: dongsun@hanyang.ac.kr

Kyung Tae: +82-2-2290-8585 , kytae@hanyang.ac.kr

Journal

Journal ID (nlm-ta): World J Surg Oncol

Journal ID (iso-abbrev): World J Surg Oncol

Title: World Journal of Surgical Oncology

Publisher: BioMed Central (London )

ISSN (Electronic): 1477-7819

Publication date (Electronic): 4 May 2017

Publication date PMC-release: 4 May 2017

Publication date Collection: 2017

Volume: 15

Electronic Location Identifier: 97

Affiliations

[1 ]ISNI 0000 0001 1364 9317, GRID grid.49606.3d, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, , Hanyang University, ; 222 Wangsimni-ro, Seongdong-gu, Seoul 04763 South Korea

[2 ]ISNI 0000 0001 1364 9317, GRID grid.49606.3d, Department of Radiology, College of Medicine, , Hanyang University, ; 222 Wangsimniro, Seongdong-Gu, Seoul 04763 South Korea

[3 ]ISNI 0000 0001 1364 9317, GRID grid.49606.3d, Department of Internal Medicine, College of Medicine, , Hanyang University, ; 222 Wangsimniro, Seongdong-Gu, Seoul 04763 South Korea

Article

Publisher ID: 1160

DOI: 10.1186/s12957-017-1160-1

PMC ID: 5418722

PubMed ID: 28472951

SO-VID: 9e7682e1-d204-41c3-8b75-48e2f1a561a3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 28 November 2016

Date accepted : 23 April 2017

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ScienceOpen disciplines: Surgery

Keywords: papillary thyroid carcinoma,incision,lateral neck dissection,selective neck dissection,lymph node dissection

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ScienceOpen disciplines: Surgery

Keywords: papillary thyroid carcinoma, incision, lateral neck dissection, selective neck dissection, lymph node dissection

Low transverse incision for lateral neck dissection in patients with papillary thyroid cancer: improved cosmesis

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Karger: Oncology

Most cited references 20

The increasing incidence of thyroid cancer: the influence of access to care.

Overview of Surgical Scar Prevention and Management

Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis.

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