What are Common complications after thyroid cancer surgery?

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What are Common complications after thyroid cancer surgery?

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What are Common complications after thyroid cancer surgery?

The treatment of thyroid cancer is mainly surgical treatment, supplemented by postoperative endocrine therapy, radionuclide therapy, and in some cases, radiation therapy and targeted therapy.

Surgical complications are other surgery-related diseases that occur during surgical treatment of diseases. These diseases have a certain probability of occurrence and cannot be completely avoided.

1. Bleeding 

The incidence of postoperative bleeding in thyroid cancer is about 1% to 2%, and it is more common within 24 hours after surgery. The main manifestations are increased drainage, bloody, neck swelling, and the patient feels dyspnea.

If the drainage volume is >100ml/h, it is considered that there is active bleeding, and debridement and hemostasis should be performed in time.

When a patient is in respiratory distress, the airway should be controlled first. In an emergency, an incision can be opened beside the bed to relieve the pressure of the hematoma on the trachea.

Risk factors for postoperative bleeding in thyroid cancer include hypertension, patients taking anticoagulant drugs or aspirin, etc. 

2. Recurrent laryngeal nerve injury, superior laryngeal nerve injury 

According to literature reports, the incidence of recurrent laryngeal nerve injury in thyroid surgery is 0.3% to 15.4%.

Common causes of recurrent laryngeal nerve injury include tumor adhesion or nerve invasion, and surgical procedures. If the tumor invades the recurrent laryngeal nerve, tumor removal or nerve resection can be performed according to the situation. If the nerve is removed, it is recommended to perform primary nerve transplantation or repair if conditions permit.

The recurrent laryngeal nerve was injured on one side, and the ipsilateral vocal cords were paralyzed after the operation, resulting in hoarseness and coughing when drinking water.

The surgical procedure itself may damage the recurrent laryngeal nerve, which cannot be completely avoided. Bilateral recurrent laryngeal nerve injury may cause dyspnea after operation, which is life-threatening. A tracheotomy should be performed at the same time as the operation to ensure unobstructed airway.

The superior laryngeal nerve was injured, and the patient’s voice became lower after the operation.

When dealing with the superior thyroid arteriovenous during operation, attention should be paid to close to the fine dissection of the thyroid gland, which can reduce the probability of superior laryngeal nerve injury.

Intraoperative neuromonitoring (IONM) technology can help locate the recurrent laryngeal nerve during surgery, detect the function of the recurrent laryngeal nerve after the specimen is taken, and help locate the damaged segment if there is nerve injury.

For situations such as secondary surgery, huge thyroid tumors, and nerve paralysis on one side before surgery, it is recommended to use IONM when conditions permit.

Fine dissection along the capsule, intraoperative exposure of the recurrent laryngeal nerve, rational application of energy instruments, and standardized use of IONM can reduce the probability of nerve injury. 

3. Hypoparathyroidism 

The postoperative permanent incidence rate is about 2% to 15%, and it is more common after total thyroidectomy. The main manifestation is postoperative hypocalcemia. The patient has numbness in the hands and feet, numbness around the mouth, or tetany, which can be relieved by intravenous infusion of calcium.

For temporary hypoparathyroidism, calcium can be given to relieve symptoms, and calcitriol can be added if necessary. In order to alleviate the postoperative symptoms of patients, prophylactic administration can be considered.

Those with permanent hypoparathyroidism need to supplement calcium and vitamin D drugs for life.

Pay attention to the fine dissection along the capsule during the operation, and protect the blood supply of the parathyroid glands when preserving them in situ. Autologous transplantation is recommended for parathyroid glands that cannot be preserved in situ. Some staining techniques can assist in the identification of parathyroid glands during surgery, such as nano-carbon negative imaging. 

4. Infection 

Most of the thyroid surgeries are Type I incisions, and a small number of operations involving the larynx, trachea, and esophagus are Type II incisions.

The incidence of incision infection after thyroidectomy is about 1% to 2%. Risk factors for wound infection include cancer, diabetes, and immunocompromise.

The manifestations of incision infection include fever, turbid drainage fluid, incision redness, swelling and exudate, elevated skin temperature, local pain with tenderness, etc.

If incision infection is suspected, antibiotic treatment should be given in time, and if there is abscess effusion, the incision should be opened and the dressing should be changed.

Superficial incision infection is easier to find, but deep incision infection is often difficult to detect early, and ultrasound can be used to judge the effusion in the deep part of the incision.

In a very small number of patients, the large blood vessels in the neck may rupture and bleed due to infection, which is life-threatening.

5. Lymphatic leakage 

Commonly seen after neck lymph node dissection, the drainage volume continues to be large, up to 500-1000ml per day, or even more, mostly in the form of milky white opaque fluid, also known as chyle leak.

Long-term lymphatic leakage can cause volume decline, electrolyte disturbance, hypoproteinemia, etc. After a lymphatic leak occurs, the drainage should be kept unobstructed.

First of all, conservative treatment can be adopted. Generally, fasting is required and parenteral nutrition is given.

After a few days, the drainage fluid can gradually change from milky white to light yellow clear fluid, and the drainage volume will gradually decrease.

If conservative treatment has no obvious effect for 1 to 2 weeks, surgical treatment should be considered.

Surgery options include ligation of the cervical thoracic duct, closure of the leak with a cervical transfer tissue flap, or thoracoscopic ligation of the thoracic duct. 

6. Local accumulation of fluid (seroma) 

The incidence of local effusion after thyroidectomy is about 1% to 6%. The larger the operation range, the higher the probability of occurrence, which is mainly related to the residual dead space after operation.

Indwelling a drainage tube in the operation area can help reduce the formation of local effusion. Treatment consists of close observation, multiple needle aspirations, and negative pressure drainage.

7. Other rare complications

Thyroid surgery can also cause some other complications, but the incidence rate is low, such as pneumothorax (caused by pleural rupture caused by cervical root surgery), Horner syndrome (injury to the cervical sympathetic chain), hypoglossal nerve injury caused tongue deviation , Injury to the marginal mandibular branch of the facial nerve causes the corners of the mouth to be skewed, etc.

Reference:

Guidelines for Diagnosis and Treatment of Thyroid Cancer (2022 Edition)

What are Common complications after thyroid cancer surgery?

(source:internet, reference only)

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Important Note: The information provided is for informational purposes only and should not be considered as medical advice.