Background
The role of central neck dissection (CND) in differentiated thyroid cancer remains
controversial. This study aims at elucidating the potential benefits and drawbacks
of CND associated to total thyroidectomy in papillary cancer.
Methods
Protocols of patients undergoing total thyroidectomy and CND for papillary cancer
were reviewed. The following data were recorded: macroscopic appearance of central
nodes; nodes obtained at operation; number of metastatic nodes and parathyroid glands
incidentally resected; metastases, age, completeness, invasiveness, size score; postoperative
s-Ca; complications; and recurrences. Differences between therapeutic (gross nodal
involvement) and prophylactic (no apparent node involvement) CNDs were studied.
Results
Forty-three patients (mean age, 52 ± 17 years) were studied. A mean of 8.4 ± 6.6 nodes
were resected per patient. A 60% prevalence (26/43) of presence of nodal involvement
(N+) was found with no difference between low- and high-risk patients. Twenty-five
(60%) patients developed transient hypocalcemia, which was associated with incidental
parathyroidectomy, number of nodes resected, and thymectomy. Two patients (4.6%) developed
permanent hypoparathyroidism and 3 (7%), transient vocal cord paralysis. Parathyroid
glands were found in 19% of the specimens. At follow-up, there were no central neck
recurrences, but 5 patients developed lateral recurrences despite treatment with I131. All 5 patients had had therapeutic CND with 6 or more metastatic nodes obtained
in the CND specimen. No lateral neck recurrences were observed after prophylactic
CND or in patients with < 6 nodes involved.
Conclusions
CND prevents central neck recurrences. Morbidity of bilateral CND is significant,
and its systematic implementation in the absence on gross nodal involvement requires
reassessment
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References
- Thyroid cancer: Extent of thyroidectomy.Cancer Control. 2000; 7: 240-245
- Localization of cervical node metastasis of papillary thyroid carcinoma.World J Surg. 1999; 23: 970-973
- Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.Am J Med. 1994; 97: 418-428
- Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer.World J Surg. 1994; 18: 559-568
- Impact of lymph node metastasis in differentiated carcinoma of the thyroid: A matched-pair analysis.Head Neck. 1996; 18: 127-132
- Do the level of nodal disease according to the TNM classification and the number of involved cervical nodes reflect prognosis in patients with differentiated carcinoma of the thyroid gland?.J Surg Oncol. 1998; 69: 151-155
- Prognostic factors in differentiated carcinoma of thyroid gland.Am J Surg. 1992; 164: 658-661
- Prognostic factors and management considerations in patients with cervical metastases of thyroid cancer.Am J Surg. 1992; 164: 671-676
- Prognostic significance of cervical lymph node metastases in differentiates thyroid cancer.Am J Surg. 1992; 164: 578-581
- Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study.Otolaryngol Head Neck Surg. 2001; 124: 261-265
- Reoperation in the treatment of asymptomatic metastasizing medullary thyroid carcinoma.Surgery. 1986; 99: 60-66
- Rationale for central and bilateral lymph node dissection in sporadic and hereditary medullary thyroid cancer.J Clin Endocrinol Metab. 2003; 88: 2070-2075
- Lymph node dissection in patients with differentiated thyroid carcinoma—who benefits?.Lang Arch Surg. 1998; 383: 355-358
- Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma.Lang Arch Surg. 1998; 383: 167-169
- 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: 1050-1058
- Pattern of lymph node metastases in papillary thyroid carcinoma.Br J Surg. 1998; 85: 252-254
- Efstratiou I: Value of the cervical compartments in the surgical treatment of papillary thyroid carcinoma.World J Surg. 2004; 28: 1275-1281
- Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma.World J Surg. 1996; 20: 860-866
- Preventable reoperations for persistent and recurrent papillary thyroid carcinoma.Surgery. 2004; 136: 1183-1191
Hamming JF, Roukema JA. Management of regional lymph nodes in papillary, follicular and medullary thyroid cancer. In: Clark OH, Duh QY, editors. Textbook of endocrine surgery. Philadelphia: Saunders; 1997 p. 155-66.
- Modified radical neck dissection for differentiated thyroid cancer: Operative technique.World J Surg. 2004; 28: 1199-1203
- Improved survival of patients with papillary thyroid cancer after surgical microdissection.World J Surg. 1996; 20: 854-859
- Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma.Cancer. 2003; 97: 90-96
Article info
Publication history
Barcelona, Spain
Footnotes
Presented at the 26th Annual Meeting of the American Association of Endocrine Surgeons, Cancun, Mexico, April 3-5, 2005.
Identification
Copyright
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
