Clinical Value of Elective Central Compartment Lymph Node Dissection for cN0 Papillary Thyroid Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGPing , DONGWen-wu , CUIJun-shuai , TIANXin-shuai ,  ZHANGHao

Department of General Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China;

Corresponding author：

ZHANGHao, Email: haozhang@mail.cmu.edu.cn

Keywords：

Papillary thyroid carcinoma; Neck lymph node; Central compartment lymph node dissection

DOI：

10.7507/1007-9424.20140042

Video：

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Objective To investigate the clinical value of elective central compartment lymph node dissection for cN0 papillary thyroid carcinoma. Method The clinical data of 326 patients with cN0 papillary thyroid carcinoma from January 2007 to December 2011 in this hospital were analyzed retrospectively. Results The lymph node metastasis incidence was 35.89%(117/326) in 326 patients with cN0 papillary thyroid carcinoma, which in the patients with age < 45 years, tumor diameter > 1 cm, and thyroidal tumor infiltrated envelope were significantly higher than those in the pati-ents with age≥45 years, tumor diameter≤1 cm, and thyroidal tumor not-infiltrated envelope (age:46.56% versus 28.72%, P=0.001;tumor diameter:44.44% versus 26.45%, P=0.001;infiltrated envelope:50.00% versus 33.09%, P=0.020).Multivariate analysis showed that age < 45 years and tumor diameter > 1 cm were independent risk factors for central compartment lymph node metastasis of cN0 papillary thyroid carcinoma.There were 6 cases of temporary recu-rrent laryngeal nerve injury, 18 cases of temporary hypoparathyroidism, 4 cases of temporary superior laryngeal nerve injury, and 1 case of acute caryngeal edema.There were no complications such as permanent laryngeal nerve injury and permanent hypoparathyroidism.Three cases had lateral cervical lymph node metastases during a follow-up of 7-67 months (mean 31.2 months). Conclusions It is necessary and safe to perform elective central compartment lymph node dissec-tion for cN0 papillary thyroid carcinoma.The elective central compartment lymph node dissection should be considered in patients with cN0 papillary thyroid carcinoma, especially in patients with age of < 45 years and tumor diameter > 1 cm.

Citation： ZHANGPing, DONGWen-wu, CUIJun-shuai, TIANXin-shuai, ZHANGHao. Clinical Value of Elective Central Compartment Lymph Node Dissection for cN0 Papillary Thyroid Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(2): 182-186. doi: 10.7507/1007-9424.20140042 Copy

1.	Grebe SK, Hay ID.Thyroid cancer nodal metastases:biologic significance and therapeutic considerations[J].Surg Oncol Clin N Am, 1996, 5(1):43-63.
2.	Kouvaraki MA, Shapiro SE, Fornage BD, et al.Role of preo-perative ultrasonography in the surgical management of patients with thyroid cancer[J].Surgery, 2003, 134(6):946-954.
3.	Roh JL, Park JY, Park CI.Total thyroidectomy plus neck dissec-tion in differentiated papillary thyroid carcinoma patients:pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone[J].Ann Surg, 2007, 245(4):604-610.
4.	Leboulleux S, Rubino C, Baudin E, et al.Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis[J].J Clin Endocrinol Metab, 2005, 90(10):5723-5729.
5.	White ML, Gauger PG, Doherty GM.Central lymph node dissection in differentiated thyroid cancer[J].World J Surg, 2007, 31(5):895-904.
6.	Sywak M, Cornford L, Roach P, et al.Routine ipsilateral levelⅥlymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer[J].Surgery, 2006, 140(6):1000-1005.
7.	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[J].Arch Otolaryngol Head Neck Surg, 2006, 132(6):650-654.
8.	Kowalski LP, Bagietto R, Lara JR, et al.Prognostic significanceof the distribution of neck node metastasis from oral carcinoma[J].Head Neck, 2000, 22(3):207-214.
9.	Carty SE, Cooper DS, Doherty GM, et al.Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J].Thyroid, 2009, 19(11):1153-1158.
10.	Mulla M, Schulte KM.Central cervical lymph node metastases in papillary thyroid cancer:a systematic review of imaging-guided and prophylactic removal of the central compartment[J].Clin Endocrinol (Oxf), 2012, 76(1):131-136.
11.	Xiao GZ, Gao L.Central lymph node metastasis:is it a reliable indicator of lateral node involvement in papillary thyroid carcinoma?[J].World J Surg, 2010, 34(2):237-241.
12.	Forest VI, Clark JR, Ebrahimi A, et al.Central compartment dissection in thyroid papillary carcinoma[J].Ann Surg, 2011, 253(1):123-130.
13.	张浩.重视甲状腺乳头状癌治疗中Ⅵ区淋巴结清扫术的临床价值[J].中国实用外科杂志, 2011, 31(5):391-394.
14.	Mazzaferri EL, Doherty GM, Steward DL.The pros and cons of prophylactic central compartment lymph node dissection for papi-llary thyroid carcinoma[J].Thyroid, 2009, 19(7):683-689.
15.	Sadowski BM, Snyder SK, Lairmore TC.Routine bilateral central lymph node clearance for papillary thyroid cancer[J].Surgery, 2009, 146(4):696-703.
16.	孙辉, 刘晓莉, 张大奇, 等.甲状腺手术中喉返神经保护及监测的临床应用[J].中国普外基础与临床杂志, 2010, 17(8):768-771.
17.	Chisholm EJ, Kulinskaya E, Tolley NS.Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone[J].Laryngoscope, 2009, 119(6):1135-1139.
18.	吴毅.中央区淋巴结清扫术用于分化型甲状腺癌治疗[J].中国实用外科杂志, 2010, 30(10):898, 904.

1. Grebe SK, Hay ID.Thyroid cancer nodal metastases:biologic significance and therapeutic considerations[J].Surg Oncol Clin N Am, 1996, 5(1):43-63.
2. Kouvaraki MA, Shapiro SE, Fornage BD, et al.Role of preo-perative ultrasonography in the surgical management of patients with thyroid cancer[J].Surgery, 2003, 134(6):946-954.
3. Roh JL, Park JY, Park CI.Total thyroidectomy plus neck dissec-tion in differentiated papillary thyroid carcinoma patients:pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone[J].Ann Surg, 2007, 245(4):604-610.
4. Leboulleux S, Rubino C, Baudin E, et al.Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis[J].J Clin Endocrinol Metab, 2005, 90(10):5723-5729.
5. White ML, Gauger PG, Doherty GM.Central lymph node dissection in differentiated thyroid cancer[J].World J Surg, 2007, 31(5):895-904.
6. Sywak M, Cornford L, Roach P, et al.Routine ipsilateral levelⅥlymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer[J].Surgery, 2006, 140(6):1000-1005.
7. 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[J].Arch Otolaryngol Head Neck Surg, 2006, 132(6):650-654.
8. Kowalski LP, Bagietto R, Lara JR, et al.Prognostic significanceof the distribution of neck node metastasis from oral carcinoma[J].Head Neck, 2000, 22(3):207-214.
9. Carty SE, Cooper DS, Doherty GM, et al.Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J].Thyroid, 2009, 19(11):1153-1158.
10. Mulla M, Schulte KM.Central cervical lymph node metastases in papillary thyroid cancer:a systematic review of imaging-guided and prophylactic removal of the central compartment[J].Clin Endocrinol (Oxf), 2012, 76(1):131-136.
11. Xiao GZ, Gao L.Central lymph node metastasis:is it a reliable indicator of lateral node involvement in papillary thyroid carcinoma?[J].World J Surg, 2010, 34(2):237-241.
12. Forest VI, Clark JR, Ebrahimi A, et al.Central compartment dissection in thyroid papillary carcinoma[J].Ann Surg, 2011, 253(1):123-130.
13. 张浩.重视甲状腺乳头状癌治疗中Ⅵ区淋巴结清扫术的临床价值[J].中国实用外科杂志, 2011, 31(5):391-394.
14. Mazzaferri EL, Doherty GM, Steward DL.The pros and cons of prophylactic central compartment lymph node dissection for papi-llary thyroid carcinoma[J].Thyroid, 2009, 19(7):683-689.
15. Sadowski BM, Snyder SK, Lairmore TC.Routine bilateral central lymph node clearance for papillary thyroid cancer[J].Surgery, 2009, 146(4):696-703.
16. 孙辉, 刘晓莉, 张大奇, 等.甲状腺手术中喉返神经保护及监测的临床应用[J].中国普外基础与临床杂志, 2010, 17(8):768-771.
17. Chisholm EJ, Kulinskaya E, Tolley NS.Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone[J].Laryngoscope, 2009, 119(6):1135-1139.
18. 吴毅.中央区淋巴结清扫术用于分化型甲状腺癌治疗[J].中国实用外科杂志, 2010, 30(10):898, 904.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Value of Elective Central Compartment Lymph Node Dissection for cN0 Papillary Thyroid Carcinoma

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