Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
권호 표지
DOI QR코드

DOI QR Code

Is Prophylactic Central Node Dissection Omissible?

갑상선유두상암에서 예방적 중심경부림프절제술은 생략할 수 있는가?

  • Shin, Sung-Chan (Department of Otolaryngology - Head and Neck Surgery, Pusan National University School of Medicine) ;
  • Lee, Byung-Joo (Department of Otolaryngology - Head and Neck Surgery, Pusan National University School of Medicine)
  • 신성찬 (부산대학교 의학전문대학원 이비인후과학교실) ;
  • 이병주 (부산대학교 의학전문대학원 이비인후과학교실)
  • Received : 2018.05.03
  • Accepted : 2018.05.14
  • Published : 2018.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Papillary thyroid carcinoma has a good prognosis, but the frequency of locoregional lymph node metastasis is high and is known to occur stepwise fashion. Prophylactic central node dissection in papillary thyroid carcinoma is widely performed from the past. But, the pros and cons of the prophylactic central node dissection has been ongoing for a long time. In the American Thyroid Association management guideline for thyroid nodules and differentiated thyroid cancer, which is the most widely used, recommendations about prophylactic central node dissection has been changed in past ten years. In recent systematic review and meta-analysis, prophylactic central node dissection increases the rate of transient hypocalcemia and recurrent laryngeal nerve injury, but there is no difference in the frequency of permanent hypocalcemia or recurrent laryngeal nerve injury. Prophylactic central node dissection has not been shown to improve patient survival, but recurrence has been reported to decrease. According to a questionnaire survey of the members of Korean Scociety of Thyroid-Head and Neck Surgery, Korean doctors tend to perform the prophylactic central node dissection more aggressively than other countries. The reason for this is that Korea has a large number of thyroid surgeries and therefore surgeons are more experienced than other countries.

Keywords

References

  1. Cranshaw IM, Carnaille B. Micrometastases in thyroid cancer. An important finding? Surg Oncol. 2008;17:253-258. https://doi.org/10.1016/j.suronc.2008.04.005
  2. Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22:1144-1152. https://doi.org/10.1089/thy.2012.0043
  3. Liu LS, Liang J, Li JH, Liu X, Jiang L, Long JX, et al. The incidence and risk factors for central lymph node metastasis in cN0 papillary thyroid microcarcinoma: a meta-analysis. Eur Arch Otorhinolaryngol. 2017;274:1327-1338. https://doi.org/10.1007/s00405-016-4302-0
  4. Machens A, Hinze R, Thomusch O, Dralle H. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002;26:22-28. https://doi.org/10.1007/s00268-001-0176-3
  5. Lee BJ, Lee JC, Wang SG, Kim YK, Kim IJ, Son SM. Metastasis of right upper para-esophageal lymph nodes in central compartment lymph node dissection of papillary thyroid cancer. World J Surg. 2009;33:2094-2098. https://doi.org/10.1007/s00268-009-0149-5
  6. Kim E, Park JS, Son KR, Kim JH, Jeon SJ, Na DG. Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid. 2008;18:411-418. https://doi.org/10.1089/thy.2007.0269
  7. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas:frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237:399-407.
  8. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418-428. https://doi.org/10.1016/0002-9343(94)90321-2
  9. Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005;71:731-734.
  10. Zhao W, You L, Hou X, Chen S, Ren X, Chen G, et al. The Effect of Prophylactic Central Neck Dissection on Locoregional Recurrence in Papillary Thyroid Cancer After Total Thyroidectomy: A Systematic Review and Meta-Analysis : pCND for the Locoregional Recurrence of Papillary Thyroid Cancer. Ann Surg Oncol. 2017;24:2189-2198. https://doi.org/10.1245/s10434-016-5691-4
  11. Onkendi EO, McKenzie TJ, Richards ML, Farley DR, Thompson GB, Kasperbauer JL, et al. Reoperative experience with papillary thyroid cancer. World J Surg. 2014;38:645-652. https://doi.org/10.1007/s00268-013-2379-9
  12. Korkmaz MH, Ocal B, Saylam G, Cakal E, Bayir O, Tutal E, et al. The need of prophylactic central lymph node dissection is controversial in terms of postoperative thyroglobulin follow-up of patients with cN0 papillary thyroid cancer. Langenbecks Arch Surg. 2017;402:235-242. https://doi.org/10.1007/s00423-017-1556-y
  13. Lang BH, Wong KP, Wan KY, Lo CY. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol. 2012;19:60-67. https://doi.org/10.1245/s10434-011-1833-x
  14. So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma:influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery. 2012;151:192-198. https://doi.org/10.1016/j.surg.2011.02.004
  15. Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW. Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol. 2012;19:4217-4222. https://doi.org/10.1245/s10434-012-2594-x
  16. 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. Laryngoscope. 2009;119:1135-1139. https://doi.org/10.1002/lary.20236
  17. Lang BH, Ng SH, Lau LL, Cowling BJ, Wong KP, Wan KY. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid. 2013;23:1087-1098. https://doi.org/10.1089/thy.2012.0608
  18. Costa S, Giugliano G, Santoro L, Ywata De Carvalho A, Massaro MA, Gibelli B, et al. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital. 2009;29:61-69.
  19. Hughes DT, White ML, Miller BS, Gauger PG, Burney RE, Doherty GM. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148: 1100-1106; discussion 1006-1107. https://doi.org/10.1016/j.surg.2010.09.019
  20. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109-142. https://doi.org/10.1089/thy.2006.16.109
  21. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167-1214. https://doi.org/10.1089/thy.2009.0110
  22. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1-133. https://doi.org/10.1089/thy.2015.0020
  23. Agrawal N, Evasovich MR, Kandil E, Noureldine SI, Felger EA, Tufano RP, et al. Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement. Head Neck. 2017;39:1269-1279. https://doi.org/10.1002/hed.24715
  24. Lee YS, Lee BJ, Hong HJ, Lee KD. Current trends of practical issues concerning micropapillary thyroid carcinoma: The Korean Society of Thyroid-Head and Neck Surgery. Medicine (Baltimore). 2017;96:e8596. https://doi.org/10.1097/MD.0000000000008596
  25. Al-Qurayshi Z, Robins R, Hauch A, Randolph GW, Kandil E. Association of Surgeon Volume With Outcomes and Cost Savings Following Thyroidectomy: A National Forecast. JAMA Otolaryngol Head Neck Surg. 2016;142:32-39. https://doi.org/10.1001/jamaoto.2015.2503
  26. Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery. 2013;154:1346-1352; discussion 1352-1343. https://doi.org/10.1016/j.surg.2013.04.068
  27. Leff DR, Yongue G, Vlaev I, Orihuela-Espina F, James D, Taylor MJ, et al. "Contemplating the Next Maneuver": Functional Neuroimaging Reveals Intraoperative Decision-making Strategies. Ann Surg. 2017;265:320-330. https://doi.org/10.1097/SLA.0000000000001651
  28. Shen WT, Ogawa L, Ruan D, Suh I, Kebebew E, Duh QY, et al. Central neck lymph node dissection for papillary thyroid cancer:comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg. 2010;145:272-275. https://doi.org/10.1001/archsurg.2010.9
  29. Kim SW, Lee HS, Lee KD. Intraoperative real-time localization of parathyroid gland with near infrared fluorescence imaging. Gland Surg. 2017;6:516-524. https://doi.org/10.21037/gs.2017.05.08
  30. Lang BH, Wong CK, Hung HT, Wong KP, Mak KL, Au KB. Indocyanine green fluorescence angiography for quantitative evaluation of in situ parathyroid gland perfusion and function after total thyroidectomy. Surgery. 2017;161:87-95. https://doi.org/10.1016/j.surg.2016.03.037
  31. Randolph GW, Dralle H, International Intraoperative Monitoring Study G, Abdullah H, Barczynski M, Bellantone R, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011;121 Suppl 1:S1-16. https://doi.org/10.1002/lary.21119
  32. Sung ES, Lee JC, Shin SC, Choi SW, Jung DW, Lee BJ. Development of a Novel Detachable Magnetic Nerve Stimulator for Intraoperative Neuromonitoring. World J Surg. 2018;42:137-142. https://doi.org/10.1007/s00268-017-4159-4

Cited by

  1. Optimal Neck Dissection Extent for Metastatic Lymph Nodes in Papillary Thyroid Cancer vol.13, pp.2, 2018, https://doi.org/10.11106/ijt.2020.13.2.79