Clinical Study of Central Lymph Node Dissection in Patients with cN0 Papillary Thyroid Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 PENGZhe ¹ ,  TIANWen ¹ , YAOJing ² , ZHANGYan-jun ¹ , LIChen ¹ , JIANYan-bing ¹ , SHICheng-yan ¹

1. Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China;
2. Department of General Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China;

Corresponding?author：

TIANWen, Email: tianwen301@sina.com

Keywords：

Papillary thyroid carcinoma; Central lymph node dissection; Complications

DOI：

10.7507/1007-9424.20140148

Video：

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Objective To investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. Method The clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. Results The central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. Conclusion As an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.

Citation： PENGZhe, TIANWen, YAOJing, ZHANGYan-jun, LIChen, JIANYan-bing, SHICheng-yan. Clinical Study of Central Lymph Node Dissection in Patients with cN0 Papillary Thyroid Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(5): 618-622. doi: 10.7507/1007-9424.20140148 Copy

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2.	Fardella C, Jiménez M, González H, et al.Pathological characteristics of thyroid microcarcinoma.A review of 402 biopsies[J].Rev Med Chil, 2005, 133(11):1305-1310.
3.	Roh JL, Park JY, Park CI.Total thyroidectomy plus neck dissection 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.	Lee KJ, Cho YJ, Kim SJ, et al.Analysis of the clinicopathologic features of papillary thyroid microcarcinoma based on 7-mm tumor size[J].World J Surg, 2011, 35(2):318-323.
5.	Caron NR, Clark OH.Papillary thyroid cancer:surgical management of lymph node metastases[J].Curr Treat Options Oncol, 2005, 6(4):311-322.
6.	Palestini N, Borasi A, Cestino L, et al.Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience[J].Langenbecks Arch Surg, 2008, 393(5):693-698.
7.	Kowalski LP, Bagietto R, Lara JR, et al.Prognostic significance of the distribution of neck node metastasis from oral carcinoma[J].Head Neck, 2000, 22(3):207-214.
8.	American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, et al.Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J].Thyroid, 2009, 19(11):1153-1158.
9.	Podnos YD, Smith D, Wagman LD, et al.The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer[J].Am Surg, 2005, 71(9):731-734.
10.	Zaydfudim V, Feurer ID, Griffin MR, et al.The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma[J].Surgery, 2008, 144(6):1070-1078.
11.	Tisell LE, Nilsson B, M?lne J, et al.Improved survival of patients with papillary thyroid cancer after surgical microdissection[J].World J Surg, 1996, 20(7):854-859.
12.	Steinmüller T, Klupp J, Rayes N, et al.Prognostic factors in patients with differentiated thyroid carcinoma[J].Eur J Surg, 2000, 166(1):29-33.
13.	Cooper DS, Doherty GM, Haugen BR, et al.Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J].Thyroid, 2009, 19(11):1167-1214.
14.	NCCN Clinical Practice Guidelines in Oncology.Thyroid carcinoma[EB/OL].Version 12013.http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.
15.	滕衛平, 劉永鋒, 高明, 等.甲狀腺結節和分化型甲狀腺癌診治指南[J].中國腫瘤臨床, 2012, 39(17):1249-1272.
16.	Forest VI, Clark JR, Ebrahimi A, et al.Central compartment dissection in thyroid papillary carcinoma[J].Ann Surg, 2011, 253(1):123-130.
17.	Moo TA, Mcgill J, Allendorf J, et al.Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma[J].World J Surg, 2010, 34(6):1187-1191.
18.	Stulak JM, Grant CS, Farley DR, et al.Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer[J].Arch Surg, 2006, 141(5):489-496.
19.	Ahn JE, Lee JH, Yi JS, et al.Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer[J].World J Surg, 2008, 32(7):1552-1558.
20.	Roh JL, Park JY, Kim JM, et al.Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma[J].J Surg Oncol, 2009, 99(1):28-31.
21.	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.
22.	朱永學, 王弘士, 吳毅, 等.甲狀腺乳頭狀癌Ⅵ區淋巴結的歸屬[J].中華外科雜志, 2004, 42(14):867-869.
23.	Gimm O, Rath FW, Dralle H.Pattern of lymph node metastases in papillary thyroid carcinoma[J].Br J Surg, 1998, 85(2):252-254.
24.	Machens A, Hinze R, Thomusch O, et al.Pattern of nodal metastasis for primary and reoperative thyroid cancer[J].World J Surg, 2002, 26(1):22-28.
25.	石嵐, 黃韜.甲狀腺乳頭狀癌淋巴結轉移規律的研究[J].中華普通外科雜志, 2007, 22(7):524-526.
26.	江國斌, 方紅燕, 蔡建明.納米碳混懸液示蹤前哨淋巴結在甲狀腺乳頭狀癌中的應用[J].中國癌癥雜志, 2010, 20(12):938-940.
27.	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.
28.	Bonnet S, Hartl D, Leboulleux S, et al.Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm:implications for radioiodine treatment[J].J Clin Endocrinol Metab, 2009, 94(4):1162-1167.
29.	Hughes DT, White ML, Miller BB, et al.Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer[J].Surgery, 2010, 148(6):1100-1107.
30.	Sywak M, Cornford L, Roach P, et al.Routine ipsilateral levelⅥlymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer[J].Surgery, 2006, 140(6):1000-1007.
31.	郭衛平, 李璽, 邱萬壽, 等.預防性中央區淋巴結清掃在cN0乳頭狀甲狀腺癌的臨床價值[J].中華全科醫學, 2010, 8(10):1215-1216.
32.	蘇清華, 周波, 趙軍, 等.甲狀腺乳頭狀癌預防性中央區淋巴結清掃可行性分析[J].臨床外科雜志, 2012, 20(7):469-470.
33.	Sosa JA, Bowman HM, Tielsch JM, et al.The importance of surgeon experience for clinical and economic outcomes from thyroidectomy[J].Ann Surg, 1998, 228(3):320-330.
34.	Scium C, Geraci G, Pisello.Non recurrent laryngeal nerve.Personal experience[J].G Chir, 2005, 26(11/12):434-437.
35.	Roh JL, Park JY, Park CI.Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection[J].Cancer, 2009, 115(2):251-258.
36.	張浩.Ⅵ區淋巴結清掃術中甲狀旁腺保護和損傷處理[J].中國實用外科雜志, 2012, 32(5):361-363.
37.	朱精強.分化型甲狀腺癌頸淋巴結清掃的相關問題[J].中國普外基礎與臨床雜志, 2012, 19(8):809-813.
38.	王曉雷, 吳躍煌, 徐震綱, 等.納米碳在鑒別甲狀腺周圍淋巴結和甲狀旁腺中的作用[J].中華耳鼻咽喉頭頸外科雜志, 2009, 44(2):136-140.
39.	張筱驊, 郝儒田, 尤捷, 等.甲狀腺淋巴管造影在鑒別甲狀旁腺中的意義[J].溫州醫學院學報, 2010, 40(1):31, 35.
40.	曾玉劍, 錢軍, 程若川, 等.甲狀腺癌術中淋巴示蹤劑應用對于甲狀旁腺保護作用的研究[J].重慶醫學, 2012, 41(11):1076, 1088.
41.	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.

1. Sherman SI.Thyroid carcinoma[J].Lancet, 2003, 361(9356):501-511.
2. Fardella C, Jiménez M, González H, et al.Pathological characteristics of thyroid microcarcinoma.A review of 402 biopsies[J].Rev Med Chil, 2005, 133(11):1305-1310.
3. Roh JL, Park JY, Park CI.Total thyroidectomy plus neck dissection 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. Lee KJ, Cho YJ, Kim SJ, et al.Analysis of the clinicopathologic features of papillary thyroid microcarcinoma based on 7-mm tumor size[J].World J Surg, 2011, 35(2):318-323.
5. Caron NR, Clark OH.Papillary thyroid cancer:surgical management of lymph node metastases[J].Curr Treat Options Oncol, 2005, 6(4):311-322.
6. Palestini N, Borasi A, Cestino L, et al.Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience[J].Langenbecks Arch Surg, 2008, 393(5):693-698.
7. Kowalski LP, Bagietto R, Lara JR, et al.Prognostic significance of the distribution of neck node metastasis from oral carcinoma[J].Head Neck, 2000, 22(3):207-214.
8. American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, et al.Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J].Thyroid, 2009, 19(11):1153-1158.
9. Podnos YD, Smith D, Wagman LD, et al.The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer[J].Am Surg, 2005, 71(9):731-734.
10. Zaydfudim V, Feurer ID, Griffin MR, et al.The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma[J].Surgery, 2008, 144(6):1070-1078.
11. Tisell LE, Nilsson B, M?lne J, et al.Improved survival of patients with papillary thyroid cancer after surgical microdissection[J].World J Surg, 1996, 20(7):854-859.
12. Steinmüller T, Klupp J, Rayes N, et al.Prognostic factors in patients with differentiated thyroid carcinoma[J].Eur J Surg, 2000, 166(1):29-33.
13. Cooper DS, Doherty GM, Haugen BR, et al.Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J].Thyroid, 2009, 19(11):1167-1214.
14. NCCN Clinical Practice Guidelines in Oncology.Thyroid carcinoma[EB/OL].Version 12013.http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.
15. 滕衛平, 劉永鋒, 高明, 等.甲狀腺結節和分化型甲狀腺癌診治指南[J].中國腫瘤臨床, 2012, 39(17):1249-1272.
16. Forest VI, Clark JR, Ebrahimi A, et al.Central compartment dissection in thyroid papillary carcinoma[J].Ann Surg, 2011, 253(1):123-130.
17. Moo TA, Mcgill J, Allendorf J, et al.Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma[J].World J Surg, 2010, 34(6):1187-1191.
18. Stulak JM, Grant CS, Farley DR, et al.Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer[J].Arch Surg, 2006, 141(5):489-496.
19. Ahn JE, Lee JH, Yi JS, et al.Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer[J].World J Surg, 2008, 32(7):1552-1558.
20. Roh JL, Park JY, Kim JM, et al.Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma[J].J Surg Oncol, 2009, 99(1):28-31.
21. 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.
22. 朱永學, 王弘士, 吳毅, 等.甲狀腺乳頭狀癌Ⅵ區淋巴結的歸屬[J].中華外科雜志, 2004, 42(14):867-869.
23. Gimm O, Rath FW, Dralle H.Pattern of lymph node metastases in papillary thyroid carcinoma[J].Br J Surg, 1998, 85(2):252-254.
24. Machens A, Hinze R, Thomusch O, et al.Pattern of nodal metastasis for primary and reoperative thyroid cancer[J].World J Surg, 2002, 26(1):22-28.
25. 石嵐, 黃韜.甲狀腺乳頭狀癌淋巴結轉移規律的研究[J].中華普通外科雜志, 2007, 22(7):524-526.
26. 江國斌, 方紅燕, 蔡建明.納米碳混懸液示蹤前哨淋巴結在甲狀腺乳頭狀癌中的應用[J].中國癌癥雜志, 2010, 20(12):938-940.
27. 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.
28. Bonnet S, Hartl D, Leboulleux S, et al.Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm:implications for radioiodine treatment[J].J Clin Endocrinol Metab, 2009, 94(4):1162-1167.
29. Hughes DT, White ML, Miller BB, et al.Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer[J].Surgery, 2010, 148(6):1100-1107.
30. Sywak M, Cornford L, Roach P, et al.Routine ipsilateral levelⅥlymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer[J].Surgery, 2006, 140(6):1000-1007.
31. 郭衛平, 李璽, 邱萬壽, 等.預防性中央區淋巴結清掃在cN0乳頭狀甲狀腺癌的臨床價值[J].中華全科醫學, 2010, 8(10):1215-1216.
32. 蘇清華, 周波, 趙軍, 等.甲狀腺乳頭狀癌預防性中央區淋巴結清掃可行性分析[J].臨床外科雜志, 2012, 20(7):469-470.
33. Sosa JA, Bowman HM, Tielsch JM, et al.The importance of surgeon experience for clinical and economic outcomes from thyroidectomy[J].Ann Surg, 1998, 228(3):320-330.
34. Scium C, Geraci G, Pisello.Non recurrent laryngeal nerve.Personal experience[J].G Chir, 2005, 26(11/12):434-437.
35. Roh JL, Park JY, Park CI.Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection[J].Cancer, 2009, 115(2):251-258.
36. 張浩.Ⅵ區淋巴結清掃術中甲狀旁腺保護和損傷處理[J].中國實用外科雜志, 2012, 32(5):361-363.
37. 朱精強.分化型甲狀腺癌頸淋巴結清掃的相關問題[J].中國普外基礎與臨床雜志, 2012, 19(8):809-813.
38. 王曉雷, 吳躍煌, 徐震綱, 等.納米碳在鑒別甲狀腺周圍淋巴結和甲狀旁腺中的作用[J].中華耳鼻咽喉頭頸外科雜志, 2009, 44(2):136-140.
39. 張筱驊, 郝儒田, 尤捷, 等.甲狀腺淋巴管造影在鑒別甲狀旁腺中的意義[J].溫州醫學院學報, 2010, 40(1):31, 35.
40. 曾玉劍, 錢軍, 程若川, 等.甲狀腺癌術中淋巴示蹤劑應用對于甲狀旁腺保護作用的研究[J].重慶醫學, 2012, 41(11):1076, 1088.
41. 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of Central Lymph Node Dissection in Patients with cN0 Papillary Thyroid Carcinoma

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