Asian Pacific Journal of Cancer Prevention

  • 제16권10호
  • /
  • Pages.4211-4214
  • /
  • 2015
  • /
  • 1513-7368(pISSN)
  • /
  • 2476-762X(eISSN)
아시아태평양암예방학회 (Asian Pacific Journal of Cancer Prevention)
권호 표지
DOI QR코드

DOI QR Code

Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients

  • Fayek, Ihab Samy (Department of Surgical Oncology, National Cancer Institute, Cairo University)
  • 발행 : 2015.06.03
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Prognostic value of prophylactic level VII nodal dissection in papillary thyroid carcinoma has been highlighted. Materials and Methods: A total of 27 patients with papillary thyroid carcinoma with N0 neck underwent total thyroidectomy with level VI and VII nodal dissection through same collar neck incision. Multicentricity, bilaterality, extrathyroidal extension, level VI and VII lymph nodes were studied as separate and independent prognostic factors for DFS at 24 months. Results: 21 females and 6 males with a mean age of 34.6 years old, tumor size was 5-24 mm. (mean 12.4 mm.), multicentricity in 11 patients 2-4 foci (mean 2.7), bilaterality in 8 patients and extrathyroidal extension in 8 patients. Dissected level VI LNs 2-8 (mean 5 LNs) and level VII LNs 1-4 (mean 1.9). Metastatic level VI LNs 0-3 (mean 1) and level VII LNs 0-2 (mean 0.5). Follow-up from 6-51 months (mean 25.6) with 7 patients showed recurrence (3 local and 4 distant). Cumulative DFS at 24 months was 87.8% and was significantly affected in relation to bilaterality (p-value <0.001), extrathyroidal extension (p-value <0.001), level VI positive ((p-value <0.001) and level VII positive ((p-value <0.001) LNs. No recurrences were detected during the follow-up period in the absence of level VI and level VII nodal involvement. Conclusions: Level VII prophylactic nodal dissection is an important and integral prognostic factor in papillary thyroid carcinoma. A larger multicenter study is crucial to reach a satisfactory conclusion about the necessity and safety of this approach.

키워드

참고문헌

  1. American Thyroid Association Surgery Working, Carty S, Cooper D, Doherty G, et al (2009). Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid, 19, 1153-8. https://doi.org/10.1089/thy.2009.0159
  2. Block M, Miller J, Horn R (1972). Significance of mediastinal lymph node metastases in carcinoma of the thyroid. Am J Surg, 123, 702-5. https://doi.org/10.1016/0002-9610(72)90358-3
  3. Carling T, Carty S, Ciarleglio M, et al (2012). American thyroid association surgical affairs committee. American thyroid association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid, 22, 237-44. https://doi.org/10.1089/thy.2011.0317
  4. Cheema Y, Repplinger D, Elson D, et al (2006). Is tumor size the best predictor of outcome for papillary thyroid cancer? Ann Surg Oncol, 13, 1524-8. https://doi.org/10.1245/s10434-006-9176-8
  5. Cisco R, Shen W, Gosnell J (2012). Extent of surgery for papillary thyroid cancer: preoperative imaging and role of prophylactic and therapeutic neck dissection. Curr Treat Options Oncol, 13, 1-10. https://doi.org/10.1007/s11864-011-0175-z
  6. Cooper D, Doherty G, Haugen B, et al (2009). Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 19, 1167-214. https://doi.org/10.1089/thy.2009.0110
  7. Dralle H (2012). Postoperative hypoparathyroidism: central neck dissection is a significant risk factor, Chirurg, 83, 1082. https://doi.org/10.1007/s00104-012-2400-0
  8. Dralle H (2013). Prophylactic central lymph node dissection improves prognosis for papillary thyroid cancer, Chirurg, 84, 149. https://doi.org/10.1007/s00104-012-2463-y
  9. Fritze D, Doherty G (2010). Surgical management of cervical lymph nodes in differentiated thyroid cancer. Otolaryngol Clin N Am, 43, 285-300. https://doi.org/10.1016/j.otc.2010.01.005
  10. Giordano D, Valcavi R, Thompson G, et al (2012). Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature, Thyroid, 22, 911-17. https://doi.org/10.1089/thy.2012.0011
  11. Hay I, Bergstralh E, Grant C, et al (1999). Impact of primary surgery on outcome in 300 patients with pathologic tumornode metastasis stage III papillary thyroid carcinoma treated at one institution from 1940 through. Surgery, 126, 1173-81;discussion 1181-2. https://doi.org/10.1067/msy.2099.101435
  12. Hughes D, Doherty G (2011). Central neck dissection for papillary thyroid cancer. Cancer Control, 18, 83-8. https://doi.org/10.1177/107327481101800202
  13. Ito Y, Miyauchi A (2007). Lateral and mediastinal lymph node dissection in differentiated thyroid carcinoma: indications, benefits, and risks. World J Surg, 31, 905-15. https://doi.org/10.1007/s00268-006-0722-0
  14. Laura Y, Mark A, Anthony J, et al (2013). Level VII is an important component of central neck dissection for papillary thyroid cancer. Ann Surg Oncol, 20, 2261-5. https://doi.org/10.1245/s10434-012-2833-1
  15. Leboulleux S, Rubino C, Baudin E, et al (2005). 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 Clin Endocrinol Metab, 90, 5723-9. https://doi.org/10.1210/jc.2005-0285
  16. Machens A, Dralle H (2009). Prediction of mediastinal lymph node metastasis in papillary thyroid cancer. Ann Surg Oncol, 16, 171-6. https://doi.org/10.1245/s10434-008-0201-y
  17. Mazzaferri E, Doherty G, Steward D (2009). The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma, Thyroid, 19, 683-9. https://doi.org/10.1089/thy.2009.1578
  18. Mulla M (2012). Central cervical lymph node metastases in papillary thyroid cancer: a systematic review of imagingguided and prophylactic removal of the central compartment. Clin Endocrinol (Oxf), 76,131-6. https://doi.org/10.1111/j.1365-2265.2011.04162.x
  19. Popadich A, Levin O, Lee J, et al (2011). A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery, 150, 1048-57. https://doi.org/10.1016/j.surg.2011.09.003
  20. Roh J, Kim J, Park C (2008). Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol, 15, 2482-6. https://doi.org/10.1245/s10434-008-0044-6
  21. Siegel R, Naishadham D, Jemal A (2013). Cancer statistics. CA Cancer J Clin, 63, 11-30. https://doi.org/10.3322/caac.21166
  22. Sobin L, Gospodarowicz M, Wittekind C (Eds.), (2010). UICC International union against cancer. TNM classification of malignant tumors, seventh ed., Wiley, West Sussex, UK, 58-62.
  23. Steinmuller T, Klupp J, Rayes N, et al (2000). Prognostic factors in patients with differentiated thyroid carcinoma. Eur J Surg, 166, 29-33. https://doi.org/10.1080/110241500750009663
  24. Wang S, Zhao W, Wang W, et al (2013). Clinical features and prognosis of patients with benign thyroid disease accompanied by an incidental papillary carcinoma. Asian Pac J Cancer Prev, 14, 707-11. https://doi.org/10.7314/APJCP.2013.14.2.707
  25. White M, Gauger P, Doherty G, (2007). Central lymph node dissection in differentiated thyroid cancer. World J Surg, 31, 895-904. https://doi.org/10.1007/s00268-006-0907-6
  26. Yu W, Tao S, Zhang N (2012). Is level V dissection necessary for low-risk patients with papillary thyroid cancer metastasis in lateral neck levels II, III, and IV. Asian Pac J Cancer Prev, 13, 4619-22. https://doi.org/10.7314/APJCP.2012.13.9.4619

피인용 문헌

  1. Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma vol.16, pp.18, 2016, https://doi.org/10.7314/APJCP.2015.16.18.8425