A NEW APPROACH FOR BILATERAL NECK BLOCK DISSECTION FOR PATIENTS UNDERGOING TOTAL THYROIDECTOMY FOR CANCER THYROID
Waseem A. Shoda
Department of General Surgery, Mansoura Military Hospital, Mansoura, Egypt
Objectives: To evaluate the intraoperative (IO) and immediate postoperative (PO) surgical and aesthetic outcomes after total thyroidectomy (TT) and bilateral lymph node dissection (LND) for thyroid cancer (TC) through the conventional low cervical Kocher's incision. Materials & Methods: 90 TC patients of grade 4b-c according to Thyroid Imaging Reporting and Data System; 45 had TT through a U-shaped incision (Retrospective/Part I) and 45 had TT through Kocher’s incision. Bilateral LND for patients of Part I was accessed through the new approach, which entails lateral retraction of sternomastoid muscle with concomitant medial retraction of strap muscles to expose the internal jugular vein and pre-tracheal LN. PO esthetical outcome was evaluated objectively using the Vancouver Scar Scale (VSS) and subjectively through evaluation of cosmetic satisfaction, scar consciousness and sensory changes. Results: The applied approach for bilateral LND required significantly longer operative time, but was associated with non-significantly higher incidence of additional IO events. Moreover, the new approach allowed significantly shorter hospital stay, drainage, and stitch-removal times with significantly superior aesthetic objective and subjective outcomes. Statistical analyses, defined young age, low body mass index (BMI) and female gender as the significant predictor for high scores for VSS score and subjective scorings. However, ROC curve analysis defined satisfaction by neck contour and sum of VSS as the scales mostly affected female gender. Conclusion: The results of Part-I of the study point to the feasibility and proper accessibility of bilateral neck LND in CT patients underwent TT using the new approach through Kocher’s incision with non-significant differences regarding IO data, but significantly superior PO wound-evaluation data and cosmetic outcomes.