Secondary analyses of swallowing efficiency and safety outcomes following thyroidectomy versus thyroidectomy plus prophylactic central neck dissection.

Abstract

Background: Swallowing complaints are common following total thyroidectomy, though an exact mechanism of patient-reported swallowing symptoms following thyroidectomy is currently lacking. This secondary, blinded analysis of data collected in a randomized, controlled clinical trial hypothesized that patients randomly assigned to the central neck dissection group would exhibit increased aspiration and pharyngeal residue on videofluoroscopic swallowing evaluation, and reduced patient-rated swallowing outcomes, as compared to patients randomized to thyroidectomy alone. We further hypothesized that blinded analysis would reveal worse swallowing function two-weeks post-surgery when compared to their pre-operative status to explain qualitative patient-reported dysphagia symptoms.

Methods: Thirty-two participants randomized to total thyroidectomy treatment with or without central neck dissection underwent pre- and post-surgical evaluation of swallowing outcomes, including videofluoroscopic Penetration/Aspiration Scale ratings, Normalized Residue Ratio Scale measures of valleculae and pyriform sinus residue, and EAT-10 patient-rated outcomes.

Results: No statistically significant differences were found post-surgery between randomized treatment groups for patient-rated EAT-10 scores (p = 0.2406), penetration/aspiration scale (p = 0.4465) or Normalized Residue Rating Scale scores for either vallecular or pyriform sinus sites. When group data were combined for analysis of differences between pre- and post-operative swallow performance, no statistically significant differences were found in patient-rated EAT-10 scores (p = 0.1374), penetration/aspiration scale (p = 0.7588) or Normalized Residue Rating Scale scores.

Conclusions: Measures of penetration/aspiration and pharyngeal residue failed to substantiate perceptions of post-operative dysphagia reported by patients undergoing total thyroidectomy with or without central neck dissection.

Trial registration: ClinicalTrials.gov Identifier NCT02138214.