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01-07-2008 | Endocrine Tumors

Extent of Prophylactic Lymph Node Dissection in the Central Neck Area of the Patients with Papillary Thyroid Carcinoma: Comparison of Limited Versus Comprehensive Lymph Node Dissection in a 2-Year Safety Study

Authors: Young-Ik Son, MD, PhD, Han-Sin Jeong, MD, PhD, Chung-Hwan Baek, MD, PhD, Man Ki Chung, MD, Junsun Ryu, MD, PhD, Jae Hoon Chung, MD, PhD, Yoon Kyung So, MD, Jeon Yeob Jang, MD, Jeesun Choi, MD

Published in: Annals of Surgical Oncology | Issue 7/2008

Abstract

Background

To compare the “comprehensive” (including bilateral paratracheal, pretracheal, prelaryngeal lymph nodes) (CCND) with “limited” (saving contralateral paratracheal lymph nodes) central node dissection (LCND) for postoperative complications and disease recurrence rate in sonographically node-negative papillary thyroid carcinomas.

Materials and Methods

From 2003 to 2005, 114 consecutive patients, diagnosed as sonographically node-negative thyroid papillary carcinomas, were included retrospectively. Among them, the LCND was performed in 56 patients and CCND in 58 patients, in combination with total thyroidectomy, based on the operator-dependent decision. We compared the complication rates and the recurrence rates between these two groups with a mean follow-up duration of 2 years.

Results

Transient hypocalcemia was more frequent in the CCND group than in the LCND group (48.3% vs 26.8%, P = .02, odds ratio [OR] = 2.55). However, the other complication rates were similar in the two groups. In addition, the immediate postoperative reduction of parathyroid hormone (PTH) was more evident in the CCND group. The postoperative PTH levels increased up to a similar level (12.4 vs 11.8 pg/mL) over 6 months. The incidence of permanent hypocalcemia did not differ significantly between the two groups. Four (7.1%) and five recurrences (8.6%) were found in two groups, respectively, implying similar oncological safety during the 2-year follow-up.

Conclusion

The LCND with total thyroidectomy could be an alternative treatment option for node-negative papillary thyroid carcinomas, because LCND had fewer short-term hypocalcemia and similar oncological outcomes during the 2-year follow-up. Further study enrolling a large number of patients with long-term follow-up is needed.

Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg 2006; 30:91–9.PubMedCrossRef

Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg 1998; 383:167–9.PubMed

Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16:109–42.PubMedCrossRef

Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 2003; 237:399–407.PubMedCrossRef

Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 2007; 245:604–10.PubMedCrossRef

Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 2005; 138:1095–100, discussion 100–1.PubMedCrossRef

Andersen PE, Cambronero E, Shaha AR, et al. The extent of neck disease after regional failure during observation of the N0 neck. Am J Surg 1996; 172:689–91.PubMedCrossRef

Ferlito A, Rinaldo A, Robbins KT, et al. Neck dissection: past, present and future? J Laryngol Otol 2006; 120:87–92.PubMedCrossRef

Sivanandan R, Kaplan MJ, Lee KJ, et al. Long-term results of 100 consecutive comprehensive neck dissections: implications for selective neck dissections. Arch Otolaryngol Head Neck Surg 2004; 130:1369–73.PubMedCrossRef

10.

Spiro RH, Morgan GJ, Strong EW, et al. Supraomohyoid neck dissection. Am J Surg 1996; 172:650–3.PubMedCrossRef

11.

Qubain SW, Nakano S, Baba M, et al. Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery 2002; 131:249–56.PubMedCrossRef

12.

Shindo M, Wu JC, Park EE, et al. The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 2006; 132:650–4.PubMedCrossRef

13.

Hay ID, Bergstralh EJ, Goellner JR, et al. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993; 114:1050–7 discussion 7–8.PubMed

14.

Voutilainen PE, Siironen P, Franssila KO, et al. AMES, MACIS and TNM prognostic classifications in papillary thyroid carcinoma. Anticancer Res 2003; 23:4283–8.PubMed

15.

Mazzaferri EL, Young RL. Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 1981; 70:511–8.PubMedCrossRef

16.

Wada N, Suganuma N, Nakayama H, et al. Microscopic regional lymph node status in papillary thyroid carcinoma with and without lymphadenopathy and its relation to outcomes. Langenbecks Arch Surg 2007; 392:417–22.PubMedCrossRef

17.

McHenry CR, Rosen IB, Walfish PG. Prospective management of nodal metastases in differentiated thyroid cancer. Am J Surg 1991; 162:353–6.PubMedCrossRef

18.

Hughes CJ, Shaha AR, Shah JP, et al. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck 1996; 18:127–32.PubMedCrossRef

19.

Sugino K, Kure Y, Iwasaki H, et al. Metastases to the regional lymph nodes, lymph node recurrence, and distant metastases in nonadvanced papillary thyroid carcinoma. Surg Today 1995; 25:324–8.PubMedCrossRef

20.

Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case–control study. Cancer 2006; 106:524–31.PubMedCrossRef

21.

Grodski S, Cornford L, Sywak M, et al. Routine level VI lymph node dissection for papillary thyroid cancer: surgical technique. ANZ J Surg 2007; 77:203–8.PubMedCrossRef

22.

Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 2006; 140:1000–5 discussion 5–7.PubMedCrossRef

23.

Cheah WK, Arici C, Ituarte PH, et al. Complications of neck dissection for thyroid cancer. World J Surg 2002; 26:1013–6.PubMedCrossRef

Title: Extent of Prophylactic Lymph Node Dissection in the Central Neck Area of the Patients with Papillary Thyroid Carcinoma: Comparison of Limited Versus Comprehensive Lymph Node Dissection in a 2-Year Safety Study
Authors: Young-Ik Son, MD, PhD
Han-Sin Jeong, MD, PhD
Chung-Hwan Baek, MD, PhD
Man Ki Chung, MD
Junsun Ryu, MD, PhD
Jae Hoon Chung, MD, PhD
Yoon Kyung So, MD
Jeon Yeob Jang, MD
Jeesun Choi, MD
Publication date: 01-07-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 7/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-008-9928-8

At a glance: The STEP trials

Springer Medicine

Extent of Prophylactic Lymph Node Dissection in the Central Neck Area of the Patients with Papillary Thyroid Carcinoma: Comparison of Limited Versus Comprehensive Lymph Node Dissection in a 2-Year Safety Study

Abstract

Background

Materials and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusion

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