ROLE OF PROPHYLACTIC CENTRAL COMPARTMENT LYMPH NODE DISSECTION ON THE OUTCOME OF PATIENTS WITH PAPILLARY THYROID CARCINOMA AND SYNCHRONOUS IPSILATERAL CERVICAL LYMPH NODE METASTASES

2020 ◽  
Vol 26 (8) ◽  
pp. 807-817
Author(s):  
Luigi De Napoli ◽  
Antonio Matrone ◽  
Karin Favilla ◽  
Paolo Piaggi ◽  
David Galleri ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Lymph Node Metastases ◽  
Cervical Lymph Node ◽  
Central Compartment ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Cervical Lymph Node Metastases ◽  
Node Metastases ◽  
Group B

Objective: Prophylactic central compartment lymph node dissection (pCCND) results in a higher percentage of surgical-related complications. To date, no evidence of the impact of pCCND on the clinical outcome of papillary thyroid carcinoma (PTC) patients with synchronous ipsilateral cervical lymph node metastases has been reported. Methods: We evaluated all consecutive patients affected by PTC and synchronous ipsilateral cervical, but without evidence of central compartment, lymph node metastases. We selected 54 consecutive patients (group A) treated by total thyroidectomy, ipsilateral cervical lymph node dissection, and pCCND and 115 patients (group B) matched for sex, age at diagnosis, number and dimension of the metastatic lateral cervical lymph nodes, without pCCND. Clinical outcome after a median of 5 years and surgical-related complications were assessed. Results: The two groups were completely similar in terms of clinical features. Clinical outcomes showed a higher percentage of biochemical and indeterminate but not structural response in group B. Group B required significantly more radioiodine treatments, but no difference was shown in the need to repeat surgery for recurrences. Conversely, the prevalence of permanent hypoparathyroidism was significantly higher in group A (14.8%) than in group B (4.3%). Conclusion: In PTC patients with synchronous ipsilateral cervical lymph node metastases, in absence of clinically evident lymph node metastases of the central compartment, performing pCCND does not improve the 5-year outcome in terms of structural disease, despite a greater number of 131I treatments. However, pCCND is severely affected by a higher percentage of permanent hypoparathyroidism, even in the hands of expert surgeons. Abbreviations: IQR = interquartile range; pCCND = prophylactic central compartment lymph node dissection; PTC = papillary thyroid carcinoma; Tg = thyroglobulin; US = ultrasound

Is Prophylactic Central Compartment Lymph Node Dissection Necessary for Papillary Thyroid Carcinoma?

2010 ◽  
Vol 2 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Gerard M Doherty ◽  
Travis J McKenzie ◽  
Joseph B Lillegard ◽  
Clive S Grant ◽  
Ian D Hay ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Node Dissection ◽  
Lymph Node Metastases ◽  
Central Compartment ◽  
Common Finding ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Node Metastases

ABSTRACT The need for prophylactic central compartment lymph node dissection in patients with papillary thyroid carcinoma continues to be a subject of ongoing debate. Regional lymph node metastases are a common finding with papillary thyroid carcinoma, with an incidence as high as 50% or more. With the widespread use of high resolution ultrasound and sensitive thyroglobulin assays, lymph node metastases, not appreciated at the time of surgery, are showing up in the follow-up period, creating significant angst amongst patients, endocrinologists, and their surgeons. It was previously thought that lymph node metastases in papillary thyroid carcinoma had little bearing on survival, but this has more recently been challenged. Opponents of prophylactic central compartment node dissection cite high perioperative morbidity as a word of caution in performing prophylactic central neck dissections. The following review will look at the most up-to-date literature and best evidence for arriving at logical and sensible recommendations. This review will also look at specific definitions of what is a central compartment lymph node dissection. In the hands of experienced thyroid surgeons, prophylactic central compartment lymph node dissection, performed in a meticulous manner, can limit persistent or recurrent disease in the central compartment, and can diminish the need for routine administration of radioactive iodine, with acceptable perioperative morbidit

scholarly journals Analysis of risk factors for cervical lymph node metastases in patients with sporadic medullary thyroid carcinoma

2018 ◽  
Vol 46 (5) ◽  
pp. 1982-1989 ◽  
Author(s):  
Weina Fan ◽  
Cheng Xiao ◽  
Fusheng Wu
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Cervical Lymph Node ◽  
Central Compartment ◽  
Antigen Concentration ◽  
Cervical Lymph Node Metastases ◽  
Serum Carcinoembryonic Antigen ◽  
Node Metastases ◽  
Thyroid Capsule ◽  
Capsule Invasion

Objective Medullary thyroid carcinoma (MTC) is classified as either sporadic or inherited. This study was performed to analyze the risk factors for cervical lymph node metastases and predict the indication for prophylactic lateral neck dissection in patients with sporadic MTC. Methods Sixty-five patients with sporadic MTC were retrospectively reviewed. Univariate analysis with the chi-square test and multiple logistic regression analysis were applied to identify the clinicopathological features (sex, age, tumor size, number of tumor foci, capsule or vascular invasion, and others) associated with cervical lymph node metastases. Results The metastasis rates in the central and lateral compartments were 46.2% (30/65) and 40.0% (26/65), respectively. The incidence of cervical lymph node metastases was significantly higher in patients with a tumor size of >1 cm, tumor multifocality, and thyroid capsule invasion. Only thyroid capsule invasion was an independent predictive factor for central compartment metastases and lateral neck metastases. The possibility of central compartment metastases was significantly higher when the preoperative serum carcinoembryonic antigen concentration was >30 ng/mL (60.0% vs. 34.3%). Conclusions MTC is associated with a high incidence of cervical lymph node metastases. Prophylactic lateral node dissection is necessary in patients with thyroid capsule invasion or a high serum carcinoembryonic antigen concentration.

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