Outcome of Cervical Lymph Nodes Dissection for Thyroid Cancer with Nodal Metastases: A Southeast Asian 3-Year Experience

Introduction. Therapeutic nodal dissection is still the mainstay of treatment for patients with lymph node metastases in many centres. The local data, however, on the outcome of therapeutic LND remains limited. Hence, this study aims to inform practice by presenting the outcomes of LND for thyroid cancer patients and our experience in a tertiary referral centre.Methods. This is a single-centre retrospective observational study in a Malaysian tertiary endocrine surgery referral centre. Patients who underwent total thyroidectomy with lymph node dissection between years 2013 and 2015 were included and electronic medical records over a 3-year follow-up period were reviewed. The outcomes of different lymph node dissection (LND), including central neck dissection, lateral neck dissection, or both, were compared.Results. Of the 43 subjects included, 28 (65.1%) had Stage IV cancer. Among the 43 subjects included, 8 underwent central LND, and 15 had lateral LND while the remaining 20 had dissection of both lateral and central lymph nodes. Locoregional recurrence was found in 16 (37.2%) of our subjects included, with no statistical difference between the central (2/8), lateral (7/15), and both (7/20). Postoperative hypocalcaemia occurred in 7 (16.3%) patients, and vocal cord palsy occurred in 5 (11.6%), whereas 9 patients (20.9%) required reoperation. Death occurred in 4 of our patients.Conclusion. High recurrence and reoperative rates were observed in our centre. While the routine prophylactic LND remains controversial, high risk patients may be considered for prophylactic LND. The long-term risk and benefit of prophylactic LND with individualised patient selection in the local setting deserve further studies.

Download Full-text

2108 Cases of Thyroid Cancer: Cervical Lymph Node Dissection or Not

10.21203/rs.3.rs-133510/v1 ◽

2021 ◽

Author(s):

Lin Han ◽

Zhen Wu ◽

Wenlei Li ◽

Yingxue Li ◽

Jinglin Ma ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Cervical Lymph Node ◽

Tumor Diameter ◽

Node Dissection ◽

Cervical Lymph Nodes ◽

Node Metastasis

Abstract Based thyroid cancer data from patients treated in Liaocheng People’s Hospital from 2015 to 2018, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective. Clinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. The overall metastasis rate of all patients was 57.23%.With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54–73.33%, which showed positive correlation.49.32% of patients had lymph node metastasis in the lateral cervical region.When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases. It is recommended that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.When the tumor diameter exceeds 1 cm, the risk of cervical lymph node metastasis is high, we recommended the lateral lymph node dissection.

Download Full-text

Metastasis of Right Upper Para-Esophageal Lymph Nodes in Central Compartment Lymph Node Dissection of Papillary Thyroid Cancer

World Journal of Surgery ◽

10.1007/s00268-009-0149-5 ◽

2009 ◽

Vol 33 (10) ◽

pp. 2094-2098 ◽

Cited By ~ 24

Author(s):

Byung-Joo Lee ◽

Jin-Choon Lee ◽

Soo-Geun Wang ◽

Yong-Ki Kim ◽

In-Ju Kim ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Papillary Thyroid Cancer ◽

Lymph Node Dissection ◽

Central Compartment ◽

Papillary Thyroid ◽

Node Dissection

Download Full-text

Recurrent laryngeal nerve injury in endoscopic surgery for thyroid cancer

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.3.2 ◽

2020 ◽

Vol 10 (3) ◽

Author(s):

Hoàng Hiệp Phan ◽

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Recurrent Laryngeal Nerve ◽

Neck Dissection ◽

Lymph Node Dissection ◽

Differentiated Thyroid Cancer ◽

Endoscopic Thyroidectomy ◽

Central Compartment ◽

Laryngeal Nerve ◽

Node Dissection

Tóm tắt Đặt vấn đề: Tổn thương dây thần kinh thanh quản quặt ngược (TQQN) là một biến chứng hay gặp trong phẫu thuật ung thư tuyến giáp. Phẫu thuật nội soi mới được ứng dụng và biến chứng này cũng là một lo ngại với các phẫu thuật viên. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang, theo dõi dọc. Người bệnh được chẩn đoán là ung thư tuyến giáp thể biệt hóa giai đoạn sớm, được điều trị phẫu thuật bằng mổ nội soi tại Bệnh viện Nội tiết trung ương từ tháng 01 năm 2013 đến tháng 9 năm 2016. Kết quả: 95 người bệnh (NB) được chẩn đoán là ung thư tuyến giáp thể biệt hóa giai đoạn sớm được phẫu thuật nội soi theo chỉ định. Tổn thương dây thần kinh TQQN không gặp khi cắt 1 thùy tuyến giáp. Tổn thương dây thần kinh TQQN tạm thời khi cắt toàn bộ tuyến giáp tổn thương là 4,8%, cắt toàn bộ tuyến giáp và nạo vét hạch 1 khoang, 2 khoang và 3 khoang lần lượt là 3,6%, 5,6% và 1/5, tính chung là 5,3%. Tổn thương dây thần kinh TQQN vĩnh viễn (sau mổ 6 tháng) có 1 người bệnh (1,1%), trường hợp này thường là có nhân nằm tại vị trí dây chằng Berry đi vào của dây thần kinh TQQN. Tổn thương dây thần kinh của nhóm nạo vét hạch khoang trung tâm (5,6%) cao hơn so với nạo vét hạch khoang bên (3,6%) sự khác biệt có ý nghĩa thống kê (p=0,015). Liệt dây thần kinh TQQN trong nhóm nạo vét hạch cổ tăng hơn gấp 1,27 lần ở nhóm không nạo vét hạch (p = 0,025). Kết luận: Tỉ lệ tổn thương dây thần kinh TQQN phụ thuộc vào phương pháp phẫu thuật tuyến giáp và có nạo vét hạch cổ hay không. Tỉ lệ này sẽ tăng khi nạo vét hạch, đặc biệt là nạo vét hạch khoang trung tâm. Abstract Background: Recurrent laryngeal nerve (RLN) injury is a common complication in thyroidectomy. Endoscopic thyroidectomy has just been applied for thyroid cancer and RLN injury is also a concern of the surgeons. Materials and Methods: It’s a cross-sectional with longitudinal study. Patients with early differentiated thyroid cancer were enrolled into this study underwent endoscopic thyroidectomy in National hospital of Endocrinology from January 2013 to September 2016. Results: 95 patients with early differentiated thyroid cancer underwent endoscopic thyroidectomy were included. No RLN injury occurred for one lobectomy. Transient RLN injury was 5,3% in total of which was 4,8% after total thyroidectomy (TT), TT with compartment neck dissection were 3,6%; 5,6% and 1/5, respectively. One patient with permanent RLN injury (1,1%) due to the node is located into Berry ligament of RLN. There was a significantly increased risk of RLN injury after TT with central compartment neck dissection compared to TT with lateral compartment neck dissection (5,6% vs 3,6%, p=0,015). RLN injury was significantly higher for TT with lymph node dissection is 1,27 than the group without lymph node dissection (p=0.025). Conclusions: RLN injury rate was significantly influenced by types of thyroidectomy and with/without lymph node dissection. The rate was increased after TT with lymph node dissection, especially central compartment neck dissection. Keywords: Early differentiated thyroid cancer, Endoscopic thyroidectomy.

Download Full-text

Surgical or Radiosurgical Failures on Cervical Lymph Nodes in Treatment of Head and Neck Cancer

Tumori Journal ◽

10.1177/030089168407000311 ◽

1984 ◽

Vol 70 (3) ◽

pp. 261-266

Author(s):

Sante Basso-Ricci ◽

Gianfranco Coopmans de Yoldi ◽

Luca de Flaviis ◽

Franco Milani ◽

Gian Maria Danesini

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Head And Neck ◽

Lymph Node Dissection ◽

Radiation Treatment ◽

Postoperative Radiotherapy ◽

Head And Neck Carcinoma ◽

Preoperative Radiation ◽

Node Dissection ◽

Cervical Lymph Nodes

From a series of 850 patients with head and neck carcinoma and subjected to lymph node dissection, 80 cases of recurrences in the neck have been collected. Postoperative radiotherapy was performed only in cases with metastatic extranodal spread. Of these recurrences, 56 occurred in the area of lymph node dissection, 7 were marginal and 17 were contralateral. The recurrences occurred prevalently in node-positive (N +) patients (70 of 80). The incidence of recurrences in the dissection area was 41.6 % (25 of 60) in cases with metastatic extranodal spread, despite postoperative radiotherapy. The incidence of recurrences in cases with clinically evident metastases at the time of dissection but without extranodal spread and not subjected to postoperative radiotherapy was relatively high (24.1 %, or 28 of 116). Since recurrences occurred, despite postoperative radiotherapy, in a relatively high percentage of cases with carcinoma of the oral floor and of the tongue (59.1 % and 50 %, respectively), it seems justifiable to perform preoperative radiation treatment in cases with clinically evident metastatic lymph nodes. As regards marginal recurrences, which all occurred in patients with carcinoma of the oral floor, it is considered sufficient to extend the surgical treatment to the subhyoid region. The high incidence of contralateral recurrences, which occurred mainly in patients with carcinoma of the larynx (13 of 17), shows the usefulness of radiation treatment of the contralateral region of the neck in these tumors, when dissection is limited to only one side of the neck.

Download Full-text

Potential Role of Carbon Nanoparticles in Guiding Central Neck Dissection and Protecting Parathyroid Glands in Patients with Papillary Thyroid Cancer

Current Nanoscience ◽

10.2174/1573413714666180820125745 ◽

2019 ◽

Vol 15 (3) ◽

pp. 254-259

Author(s):

Zhiliang Xu ◽

Zhiyu Li ◽

Qi Wu ◽

Yimin Zhang ◽

Shan Zhu ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Papillary Thyroid Cancer ◽

Lymph Node Dissection ◽

Parathyroid Glands ◽

Control Group ◽

Papillary Thyroid ◽

Node Dissection

Background: Carbon nanoparticle (CN) suspensions have been widely used as lymph node tracers in cancers. Here, CN suspension was successfully applied to lymph node dissection. Objective: This study aimed to evaluate the role of CN suspension in identifying lymph nodes and preserving the parathyroid in patients with papillary thyroid cancer (PTC). Method: A total of 96 PTC patients were divided into a CN group (n = 46) and a control group (n = 50). All patients underwent total thyroidectomy with central lymph node dissection from 2014 to 2015. Results: The number of lymph nodes removed in the CN group and the control group was 9.6±2.4 and 7.8±2.2, respectively, and the number of dissected lymph nodes identified as <5 mm in both groups was 4.4±1.3 and 2.4±1.4, respectively. These results were significantly different between the two groups (P < 0.05). However, the number of metastatic lymph nodes was similar in the two groups. In addition, the results further revealed that the level of serum parathyroid hormone (PTH) was significantly lower in the control group than in the CN group on postoperative day 1 and week 1 (P < 0.05), but similar outcomes were observed at postoperative month 1. Conclusion: CN suspension plays an important role in accurately identifying lymph nodes and protecting parathyroid glands. The clinical utilization of CN suspension could increase the accuracy of surgery programs and protect parathyroid function.

Download Full-text