Top

Langenbeck's Archives of Surgery

Published in:

Open Access 01-02-2014 | Original Article

Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer

Authors: Marcin Barczyński, Aleksander Konturek, Małgorzata Stopa, Wojciech Nowak

Published in: Langenbeck's Archives of Surgery | Issue 2/2014

Abstract

Purpose

The aim of this study was to examine risk factors for nodal recurrence in the lateral neck (NRLN) in patients with papillary thyroid cancer (PTC) who underwent total thyroidectomy with prophylactic central neck dissection (TT + pCND).

Methods

This was a retrospective cohort study of patients with PTC who underwent TT + pCND. Data of all patients treated over a 10-year period (between 1998 and 2007) were analysed. The primary outcome was prevalence of NRLN within the 5-year follow-up after initial surgery. Predictors of NRLN were determined in the univariable and multivariable analysis.

Results

Of 760 patients with PTC included in this study, 44 (6.0 %) developed NRLN. In the univariable analysis, the following factors were identified to be associated with an increased risk of NRLN: positive/negative lymph node ratio ≥0.3 (odds ratio (OR) 14.50, 95 % confidence interval (CI) 7.21 to 29.13; p < 0.001), central lymph node metastases (OR 7.47, 95 % CI 3.63 to 15.38; p < 0.001), number of level VI lymph nodes <6 in the specimen (OR 2.88, 95 % CI 1.21 to 6.83; p = 0.016), extension through the thyroid capsule (OR 2.55, 95 % CI 1.21 to 5.37; p = 0.013), localization of the tumour within the upper third of the thyroid lobe (OR 2.35, 95 % CI 1.27 to 4.34; p = 0.006) and multifocal lesions (OR 1.85, 95 % CI 1.01 to 3.41; p = 0.048).

Conclusions

Central lymph node metastases together with positive to negative lymph node ratio ≥0.3 represent the strongest independent prognostic factors for the PTC recurrence in the lateral neck.

Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428PubMedCrossRef

American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214PubMedCrossRef

British Thyroid Association—BTA (2007) Guidelines for the management of thyroid cancer in adults. Available at: http://www.british-thyroid-association.org/Guidelines. Accessed 21 June 2013.

American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, Randolph GW, Stack BC Jr, Steward DL, Terris DJ, Thompson GB, Tufano RP, Tuttle RM, Udelsman R (2009) Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 19:1153–1158PubMedCrossRef

Lundgren CI, Hall P, Dickman PW, Zedenius J (2006) Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case–control study. Cancer 106:524–531PubMedCrossRef

Tisell LE, Nilsson B, Mölne J, Hansson G, Fjälling M, Jansson S, Wingren U (1996) Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg 20:854–859PubMedCrossRef

Monchik JM, Simon CJ, Caragacianu DL, Thomay AA, Tsai V, Cohen J, Mazzaglia PJ (2009) Does failure to perform prophylactic level VI node dissection leave persistent disease detectable by ultrasonography in patients with low-risk papillary carcinoma of the thyroid? Surgery 146:1182–1187PubMedCrossRef

White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904PubMedCrossRef

McHenry CR (2011) Prophylactic central compartment neck dissection for papillary thyroid cancer: the search for justification continues. Surgery 150:1058–1060PubMedCrossRef

10.

Roh JL, Park JY, Park CI (2007) 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 245:604–610PubMedCrossRef

11.

Forest VI, Clark JR, Ebrahimi A, Cho EA, Sneddon L, Gao K, O'brien CJ (2011) Central compartment dissection in thyroid papillary carcinoma. Ann Surg 253:123–130PubMedCrossRef

12.

Hughes DT, White ML, Miller B, Gauger PG, Burney RE, Doherty GM (2010) Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery 148:1100–1107PubMedCrossRef

13.

Carling T, Carty SE, Ciarleglio MM, Cooper DS, Doherty GM, Kim LT, Kloos RT, Mazzaferri EL Sr, Peduzzi PN, Roman SA, Sippel RS, Sosa JA, Stack BC Jr, Steward DL, Tufano RP, Tuttle RM, Udelsman R, American Thyroid Association Surgical Affairs Committee (2012) American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid 22:237–244PubMedCrossRef

14.

Clark OH (2011) Thyroid cancer and lymph node metastases. J Surg Oncol 103:615–618PubMedCrossRef

15.

Shaha AR (2009) Prophylactic central compartment dissection in thyroid cancer: a new avenue of debate. Surgery 146:1224–1227PubMedCrossRef

16.

Poppadich A, Levin O, Lee JC, Smooke-Praw S, Ro K, Fazel M, Arora A, Tolley NS, Palazzo F, Learoyd DL, Sidhu S, Delbridge L, Sywak M, Yeh MW (2011) A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery 150:1048–1057CrossRef

17.

Grodski S, Cornford L, Sywak M, Sidhu S, Delbridge L (2007) Routine level VI lymph node dissection for papillary thyroid cancer: surgical technique. ANZ J Surg 77:203–208PubMedCrossRef

18.

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) AJCC cancer staging handbook. From the AJCC cancer staging manual, 7th ed. Springer, New York

19.

Hartl DM, Leboulleux S, Al Ghuzlan A, Baudin E, Chami L, Schlumberger M, Travagli JP (2012) Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg 255:777–783PubMedCrossRef

20.

Gyorki DE, Untch B, Tuttle RM, Shaha AR (2013) Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence. Ann Surg Oncol 20:2285–2289PubMedCrossRef

21.

McLeod DS, Sawka AM, Cooper DS (2013) Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet 381:1046–1057PubMedCrossRef

22.

Bonnet S, Hartl D, Leboulleux S, Baudin E, Lumbroso JD, Al Ghuzlan A, Chami L, Schlumberger M, Travagli JP (2009) Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab 94:1162–1167PubMedCrossRef

23.

Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L (2006) Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 140:1000–1005PubMedCrossRef

24.

Podnos YD, Smith D, Wagman LD, Ellenhorn JD (2005) The implication of lymph node metastasis on survival of patients with well-differentiated thyroid cancer. Am Surg 71:731–734PubMed

25.

Shan CX, Zhang W, Jiang DZ, Zheng XM, Liu S, Qiu M (2012) Routine central neck dissection in differentiated thyroid carcinoma: a systematic review and meta-analysis. Laryngoscope 122:797–804PubMedCrossRef

26.

Zetoune T, Keutgen X, Buitrago D, Aldailami H, Shao H, Mazumdar M, Fahey TJ 3rd, Zarnegar R (2010) Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol 17:3287–3293PubMedCrossRef

27.

Mulla M, Schulte KM (2012) Central cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the central compartment. Clin Endocrinol (Oxf) 76:131–136CrossRef

28.

Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK (2009) Preoperative staging of preoperative thyroid carcinoma: comparison of ultrasound imaging and CT. Am J Roentgenol 193:871–878CrossRef

29.

Barczyński M, Konturek A, Stopa M, Nowak W (2013) Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg 100:410–418PubMedCrossRef

30.

Hartl DM, Mamelle E, Borget I, Leboulleux S, Mirghani H, Schlumberger M (2013) Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J Surg. doi:10.1007/s00268-013-2089-3

31.

Ducoudray R, Trésallet C, Godiris-Petit G, Tissier F, Leenhardt L, Menegaux F (2013) Prophylactic lymph node dissection in papillary thyroid carcinoma: is there a place for lateral neck dissection? World J Surg 37:1584–1591PubMedCrossRef

32.

Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, Tufano RP, Tuttle RM, American Thyroid Association Surgical Affairs Committee’s Taskforce on Thyroid Cancer Nodal Surgery (2012) The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 22:1144–1152PubMedCrossRef

33.

Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW (2012) Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol 19:4217–4222PubMedCrossRef

34.

Ricarte-Filho J, Ganly I, Rivera M, Katabi N, Fu W, Shaha A, Tuttle RM, Fagin JA, Ghossein R (2012) Papillary thyroid carcinomas with cervical lymph node metastases can be stratified into clinically relevant prognostic categories using oncogenic BRAF, the number of nodal metastases, and extra-nodal extension. Thyroid 22:575–584PubMedCrossRef

35.

Humphrey RW, Brockway-Lunardi LM, Bonk DT, Dohoney KM, Doroshow JH, Meech SJ, Ratain MJ, Topalian SL, Pardoll DM (2011) Opportunities and challenges in the development of experimental drug combinations for cancer. J Natl Cancer Inst 103:1222–1226PubMedCrossRef

36.

Barczynski M, Konturek A, Stopa M, Cichon S, Richter P, Nowak W (2011) Total thyroidectomy for benign thyroid disease: is it really worthwhile? Ann Surg 254:724–729PubMedCrossRef

37.

Shindo M, Stern A (2010) Total thyroidectomy with and without selective central compartment dissection: a comparison of complication rates. Arch Otolaryngol Head Neck Surg 136:584–587PubMedCrossRef

38.

Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R (1998) The importance of surgeon experience for the clinical and economic outcomes from thyroidectomy. Ann Surg 228:320–330PubMedCrossRef

39.

Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, Barbieri V (2012) Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 22:911–917PubMedCrossRef

Title: Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer
Authors: Marcin Barczyński
Aleksander Konturek
Małgorzata Stopa
Wojciech Nowak
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 2/2014
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-013-1135-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2014

BRAF mutation status in papillary thyroid carcinoma: significance for surgical strategy

Risk of lymph node metastases in multifocal papillary thyroid cancer associated with Hashimoto's thyroiditis

Multifocal papillary thyroid carcinoma—a consensus report of the European Society of Endocrine Surgeons (ESES)

Minimally invasive follicular thyroid cancer (MIFTC)—a consensus report of the European Society of Endocrine Surgeons (ESES)

Intraoperative neural monitoring in thyroid cancer surgery

Classification of locoregional lymph nodes in medullary and papillary thyroid cancer