Individualized surgical procedures for well-differentiated thyroid cancer located in the isthmus: report of 19 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PAN Lijie ^1,2 , ZHAO Jing ¹ ,  KANG Hua ¹

1. Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;
2. Department of General Surgery, The First Affiliated Hospital of Tsinghua University, Beijing 100016, P. R. China;

Corresponding?author：

KANG Hua, Email: kanghua@xwh.ccmu.edu.cn

Keywords：

well-differentiated thyroid cancer; isthmus; surgical procedure; lymph node excision

DOI：

10.7507/1007-9424.201904006

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.Methods Nineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.Results Among the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.Conclusions For patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.

Citation： PAN Lijie, ZHAO Jing, KANG Hua. Individualized surgical procedures for well-differentiated thyroid cancer located in the isthmus: report of 19 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 929-933. doi: 10.7507/1007-9424.201904006 Copy

1.	魏松鋒, 高明, 錢碧云, 等. 1954-2009年間天津市腫瘤醫院收治的甲狀腺癌構成分析. 中華腫瘤雜志, 2011, 33(8): 613-615.
2.	吳毅, 孫團起. 甲狀腺癌手術質量控制爭議與共識. 中國實用外科雜志, 2016, 36(1): 34-37.
3.	Li G, Lei J, Peng Q, et al. Lymph node metastasis characteristics of papillary thyroid carcinoma located in the isthmus: a single-center analysis. Medicine (Baltimore), 2017, 96(24): e7143.
4.	Lee YS, Jeong JJ, Nam KH, et al. Papillary carcinoma located in the thyroid isthmus. World J Surg, 2010, 34(1): 36-39.
5.	Vasileiadis I, Boutzios G, Karalaki M, et al. Papillary thyroid carcinoma of the isthmus: total thyroidectomy or isthmusectomy? Am J Surg, 2018, 216(1): 135-139.
6.	Lei J, Zhu J, Li Z, et al. Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis. Onco Targets Ther, 2016, 9: 5209-5216.
7.	Karatzas T, Charitoudis G, Vasileiadis D, et al. Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: a case control study. Int J Surg, 2015, 18: 64-68.
8.	王夢一, 袁宏偉, 張寧, 等. 峽部甲狀腺乳頭狀癌的診治探討. 中華內分泌外科雜志, 2015, 9(1): 9-12.
9.	黃輝, 徐震綱, 劉紹嚴, 等. 27例分化型甲狀腺峽部癌患者的臨床分析. 中華腫瘤雜志, 2013, 35(11): 871.
10.	Nixon IJ, Palmer FL, Whitcher MM, et al. Thyroid isthmusectomy for well-differentiated thyroid cancer. Ann Surg Oncol, 2011, 18(3): 767-770.
11.	Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. Lancet, 2016, 388(10061): 2783-2795.
12.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
13.	McLeod DS, Sawka AM, Cooper DS. Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet, 2013, 381(9871): 1046-1057.
14.	中華人民共和國國家衛生健康委員會. 甲狀腺癌診療規范 (2018年版). 中華普通外科學文獻: 電子版, 2019, 13(1): 1-15.
15.	吳昕, 徐協群, 鄭朝紀, 等. 分化型甲狀腺癌再次手術的臨床分析. 中國普外基礎與臨床雜志, 2017, 24(7): 813-818.
16.	王震宇, 李鋒, 張偉軍. 分化型甲狀腺癌再次手術臨床分析. 中華耳鼻咽喉頭頸外科雜志, 2010, 45(11): 951-953.
17.	Ahn D, Sohn JH, Park JY. Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma. Auris Nasus Larynx, 2014, 41(1): 63-68.
18.	Gschwandtner E, Seemann R, Bures C, et al. How many parathyroid glands can be identified during thyroidectomy? Evidence-based data for medical experts. Eur Surg, 2018, 50(1): 14-21.
19.	Sugenoya A, Shingu K, Kobayashi S, et al. Surgical strategies for differentiated carcinoma of the thyroid isthmus. Head Neck, 1993, 15(2): 158-160.
20.	Ywata de Carvalho A, Chulam TC, Kowalski LP. Long-term results of observation vs prophylactic selective level Ⅵ neck dissection for papillary thyroid carcinoma at a cancer center. JAMA Otolaryngol Head Neck Surg, 2015, 141(7): 599-606.
21.	Heaton CM, Chang JL, Orloff LA. Prognostic implications of lymph node yield in central and lateral neck dissections for well-differentiated papillary thyroid carcinoma. Thyroid, 2016, 26(3): 434-440.
22.	Ruel E, Thomas S, Perkins JM, et al. The impact of pathologically positive lymph nodes in the clinically negative neck: an analysis of 39,301 patients with papillary thyroid cancer. Ann Surg Oncol, 2017, 24(7): 1935-1942.
23.	朱一鳴, 藺晨, 王健, 等. 甲狀腺乳頭狀癌側頸部淋巴結二次清掃的治療經驗. 中國醫刊, 2016, 51(6): 59-63.
24.	吳紅偉, 沈豐, 孫少華, 等. 全甲狀腺切除+預防性中央區淋巴結清掃術治療多灶性甲狀腺乳頭狀癌103例臨床分析. 中國普外基礎與臨床雜志, 2016, 23(3): 324-327.
25.	趙菁, 凌煜瑋, 韓婧, 等. 前哨淋巴結活檢在分化型甲狀腺癌治療中的應用. 中國普外基礎與臨床雜志, 2017, 24(11): 1333-1341.
26.	許文, 費哲為. 前哨淋巴結活檢術在甲狀腺癌手術中的研究進展. 中國普外基礎與臨床雜志, 2016, 23(7): 891-894.
27.	Kaczka K, Luks B, Jasion J, et al. Sentinel lymph node in thyroid tumors-own experience. Contemp Oncol (Pozn), 2013, 17(2): 184-189.
28.	Saliba J, Payne RJ, Varshney R, et al. Sentinel lymph node biopsy status correlates with postoperative stimulated thyroglobulin levels in low-risk papillary thyroid cancer patients. Endocr Pract, 2014, 20(5): 399-404.
29.	Balasubramanian SP, Harrison BJ. Systematic review and meta-analysis of sentinel node biopsy in thyroid cancer. Br J Surg, 2011, 98(3): 334-344.

1. 魏松鋒, 高明, 錢碧云, 等. 1954-2009年間天津市腫瘤醫院收治的甲狀腺癌構成分析. 中華腫瘤雜志, 2011, 33(8): 613-615.
2. 吳毅, 孫團起. 甲狀腺癌手術質量控制爭議與共識. 中國實用外科雜志, 2016, 36(1): 34-37.
3. Li G, Lei J, Peng Q, et al. Lymph node metastasis characteristics of papillary thyroid carcinoma located in the isthmus: a single-center analysis. Medicine (Baltimore), 2017, 96(24): e7143.
4. Lee YS, Jeong JJ, Nam KH, et al. Papillary carcinoma located in the thyroid isthmus. World J Surg, 2010, 34(1): 36-39.
5. Vasileiadis I, Boutzios G, Karalaki M, et al. Papillary thyroid carcinoma of the isthmus: total thyroidectomy or isthmusectomy? Am J Surg, 2018, 216(1): 135-139.
6. Lei J, Zhu J, Li Z, et al. Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis. Onco Targets Ther, 2016, 9: 5209-5216.
7. Karatzas T, Charitoudis G, Vasileiadis D, et al. Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: a case control study. Int J Surg, 2015, 18: 64-68.
8. 王夢一, 袁宏偉, 張寧, 等. 峽部甲狀腺乳頭狀癌的診治探討. 中華內分泌外科雜志, 2015, 9(1): 9-12.
9. 黃輝, 徐震綱, 劉紹嚴, 等. 27例分化型甲狀腺峽部癌患者的臨床分析. 中華腫瘤雜志, 2013, 35(11): 871.
10. Nixon IJ, Palmer FL, Whitcher MM, et al. Thyroid isthmusectomy for well-differentiated thyroid cancer. Ann Surg Oncol, 2011, 18(3): 767-770.
11. Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. Lancet, 2016, 388(10061): 2783-2795.
12. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
13. McLeod DS, Sawka AM, Cooper DS. Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet, 2013, 381(9871): 1046-1057.
14. 中華人民共和國國家衛生健康委員會. 甲狀腺癌診療規范 (2018年版). 中華普通外科學文獻: 電子版, 2019, 13(1): 1-15.
15. 吳昕, 徐協群, 鄭朝紀, 等. 分化型甲狀腺癌再次手術的臨床分析. 中國普外基礎與臨床雜志, 2017, 24(7): 813-818.
16. 王震宇, 李鋒, 張偉軍. 分化型甲狀腺癌再次手術臨床分析. 中華耳鼻咽喉頭頸外科雜志, 2010, 45(11): 951-953.
17. Ahn D, Sohn JH, Park JY. Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma. Auris Nasus Larynx, 2014, 41(1): 63-68.
18. Gschwandtner E, Seemann R, Bures C, et al. How many parathyroid glands can be identified during thyroidectomy? Evidence-based data for medical experts. Eur Surg, 2018, 50(1): 14-21.
19. Sugenoya A, Shingu K, Kobayashi S, et al. Surgical strategies for differentiated carcinoma of the thyroid isthmus. Head Neck, 1993, 15(2): 158-160.
20. Ywata de Carvalho A, Chulam TC, Kowalski LP. Long-term results of observation vs prophylactic selective level Ⅵ neck dissection for papillary thyroid carcinoma at a cancer center. JAMA Otolaryngol Head Neck Surg, 2015, 141(7): 599-606.
21. Heaton CM, Chang JL, Orloff LA. Prognostic implications of lymph node yield in central and lateral neck dissections for well-differentiated papillary thyroid carcinoma. Thyroid, 2016, 26(3): 434-440.
22. Ruel E, Thomas S, Perkins JM, et al. The impact of pathologically positive lymph nodes in the clinically negative neck: an analysis of 39,301 patients with papillary thyroid cancer. Ann Surg Oncol, 2017, 24(7): 1935-1942.
23. 朱一鳴, 藺晨, 王健, 等. 甲狀腺乳頭狀癌側頸部淋巴結二次清掃的治療經驗. 中國醫刊, 2016, 51(6): 59-63.
24. 吳紅偉, 沈豐, 孫少華, 等. 全甲狀腺切除+預防性中央區淋巴結清掃術治療多灶性甲狀腺乳頭狀癌103例臨床分析. 中國普外基礎與臨床雜志, 2016, 23(3): 324-327.
25. 趙菁, 凌煜瑋, 韓婧, 等. 前哨淋巴結活檢在分化型甲狀腺癌治療中的應用. 中國普外基礎與臨床雜志, 2017, 24(11): 1333-1341.
26. 許文, 費哲為. 前哨淋巴結活檢術在甲狀腺癌手術中的研究進展. 中國普外基礎與臨床雜志, 2016, 23(7): 891-894.
27. Kaczka K, Luks B, Jasion J, et al. Sentinel lymph node in thyroid tumors-own experience. Contemp Oncol (Pozn), 2013, 17(2): 184-189.
28. Saliba J, Payne RJ, Varshney R, et al. Sentinel lymph node biopsy status correlates with postoperative stimulated thyroglobulin levels in low-risk papillary thyroid cancer patients. Endocr Pract, 2014, 20(5): 399-404.
29. Balasubramanian SP, Harrison BJ. Systematic review and meta-analysis of sentinel node biopsy in thyroid cancer. Br J Surg, 2011, 98(3): 334-344.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Individualized surgical procedures for well-differentiated thyroid cancer located in the isthmus: report of 19 cases

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content