IMPROVING THE QUALITY OF CENTRAL COMPARTMENT NECK DISSECTION BY FLUORESCENT-GUIDED SURGERY (AUTOFLUORESCENCE AND ICG)

AUTHORS:
M. Gorobeiko (Kyiv, Ukraine) , A. Dinets (Kyiv, Ukraine)
Background:
The central compartment neck dissection (CND) is associated with elevated risk for the unintentional removal of the parathyroid glands (PG) or injury to the reccurent laryngeal nerve (RLN), therefore, it is often performed in a smaller volume of dissection than necessary
Methods:
The aim of the study is to determine whether the quality of CND improved in the same team of endocrine surgeons with and without the fluorescent-guided surgery (FGS) by autofluorescence or with ICG. 166 patients were investigated after performing thyroid surgery and CND by same surgical team. Of these 166 patients, operations without FGS were perfromed in 83 patients (Group 1), with autofluorescence FGS in 64 patients (Group 2), operations with FGS+ICG in 19 patients (Group 3). The analyses included number of dissected lymph nodes (LNs), unintentionally removed PGs.
Results:
Higher number of excised LNs was in Group2 (8.72+-2.03 (range 2-19) and Group3 (range 10.49+-1.1 (range 7-11) compared to Group1 6.32+-2.87 (range 3-14), p<0.05 (comparing Group1 vs. Group2 and Group3) . The lower frequency of unintentionally removed PG was detected in Group Group 3 (n=0), highest in Group 1 (n=4). Unintentionally removed PG in Group 2 (n=1) was in metastatic mass, showing no autofluorescence signal. Group 3 is small, which is limitation, however it is associated with high number of removed LNs and preserved PG, which is good example for further research.
Conclusions:
Fluorescent-guided surgery (by autofluorescence or with ICG) is associated with increasing removed LN and preservations of PG during of central neck dissection.