Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지
DOI QR코드

DOI QR Code

The effectiveness of prophylactic ipsilateral central neck dissection in selected patients who underwent total thyroidectomy for clinically node-negative unilateral papillary thyroid carcinoma

  • Kang, Jin Gu (Department of Surgery, Yeungnam University Hospital) ;
  • Kim, Young Ah (Department of Surgery, Yeungnam University Hospital) ;
  • Choi, Jung Eun (Department of Surgery, Yeungnam University College of Medicine) ;
  • Lee, Soo Jung (Department of Surgery, Yeungnam University College of Medicine) ;
  • Kang, Su Hwan (Department of Surgery, Yeungnam University College of Medicine)
  • Received : 2020.01.23
  • Accepted : 2020.03.29
  • Published : 2020.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Prophylactic central neck dissection (CND) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial. The purpose of this study was to evaluate the benefits of prophylactic ipsilateral CND compared with bilateral CND in total thyroidectomy for cN0 unilateral PTC. Methods: We retrospectively enrolled 174 patients who underwent total thyroidectomies with prophylactic CND for cN0 unilateral PTC between January 2009 and May 2010. The prophylactic CND patients were divided into group 1, the ipsilateral CND group (n=74), and group 2, the bilateral CND group (n=100). The incidence of central lymph node metastasis (CLNM) and postoperative complications, such as hypoparathyroidism, recurrent laryngeal nerve injury, and recurrence were assessed. Results: CLNM was found in 22 (29.8%) in group 1 and 69 (69%) in group 2. The incidence of postoperative severe hypocalcemia less than 7.0 was also significantly different (six patients [8.1%] in group 1 and 23 [23%] in group 2; p=0.009). Permanent hypoparathyroidism was significantly more frequent in group 2 (4.1% vs. 19%; p=0.005). However, the incidence of transient hypoparathyroidism, recurrence, and recurrent laryngeal nerve injury was not significantly different. Conclusion: Prophylactic ipsilateral CND has advantage not only to reduce incidence of some complications but also to have similar recurrence rate compared with bilateral CND. We suggest that prophylactic ipsilateral CND may be safe and effective for selected patients undergoing total thyroidectomy for cN0 unilateral PTC.

Keywords

References

  1. Sciuto R, Romano L, Rea S, Marandino F, Sperduti I, Maini CL. Natural history and clinical outcome of differentiated thyroid carcinoma: a retrospective analysis of 1503 patients treated at a single institution. Ann Oncol 2009;20:1728-35. https://doi.org/10.1093/annonc/mdp050
  2. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004;28:271-6. https://doi.org/10.1007/s00268-003-6903-1
  3. Roh JL, Kim JM, Park CI. Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol 2011;18:2245-50. https://doi.org/10.1245/s10434-011-1600-z
  4. 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. Clin Endocrinol (Oxf) 2012;76:131-6. https://doi.org/10.1111/j.1365-2265.2011.04162.x
  5. Yan B, Hou Y, Chen D, He J, Jiang Y. Risk factors for contralateral central lymph node metastasis in unilateral cN0 papillary thyroid carcinoma: a meta-analysis. Int J Surg 2018;59:90-8. https://doi.org/10.1016/j.ijsu.2018.09.004
  6. Jiang LH, Chen C, Tan Z, Lu XX, Hu SS, Wang QL, et al. Clinical characteristics related to central lymph node metastasis in cN0 papillary thyroid carcinoma: a retrospective study of 916 patients. Int J Endocrinol 2014;2014:385787.
  7. Xiang Y, Lin K, Dong S, Qiao LI, He Q, Zhang X. Prediction of central lymph node metastasis in 392 patients with cervical lymph node-negative papillary thyroid carcinoma in Eastern China. Oncol Lett 2015;10:2559-64. https://doi.org/10.3892/ol.2015.3544
  8. Zhang Q, Wang Z, Meng X, Duh QY, Chen G. Predictors for central lymph node metastases in CN0 papillary thyroid microcarcinoma (mPTC): a retrospective analysis of 1304 cases. Asian J Surg 2019;42:571-6. https://doi.org/10.1016/j.asjsur.2018.08.013
  9. Xu S, Liu W, Zhang Z, Liu Y, Xu Z, Liu J. Routine prophylactic central neck dissection may not obviously reduce lateral neck recurrence for papillary thyroid microcarcinoma. ORL J Otorhinolaryngol Relat Spec 2019;81:73-81. https://doi.org/10.1159/000497407
  10. Garcia A, Palmer BJ, Parks NA, Liu TH. Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective. Clin Endocrinol (Oxf) 2014;81:754-61. https://doi.org/10.1111/cen.12506
  11. Sosa JA. Is routine prophylactic central neck dissection indicated for low-risk papillary thyroid cancer: can we determine cost-effectiveness if we are unsure about its effectiveness and safety? Surgery 2013;154:1146-7. https://doi.org/10.1016/j.surg.2013.06.026
  12. Lee DY, Oh KH, Cho JG, Kwon SY, Woo JS, Baek SK, et al. The benefits and risks of prophylactic central neck dissection for papillary thyroid carcinoma: prospective cohort study. Int J Endocrinol 2015;2015:571480.
  13. 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
  14. Zheng X, Peng C, Gao M, Zhi J, Hou X, Zhao J, et al. Risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: a study of 1,587 patients. Cancer Biol Med 2019;16:121-30. https://doi.org/10.20892/j.issn.2095-3941.2018.0125
  15. Xue S, Wang P, Liu J, Li R, Zhang L, Chen G. Prophylactic central lymph node dissection in cN0 patients with papillary thyroid carcinoma: a retrospective study in China. Asian J Surg 2016;39:131-6. https://doi.org/10.1016/j.asjsur.2015.03.015
  16. Mao LN, Wang P, Li ZY, Wang Y, Song ZY. Risk factor analysis for central nodal metastasis in papillary thyroid carcinoma. Oncol Lett 2015;9:103-7. https://doi.org/10.3892/ol.2014.2667
  17. Konturek A, Barczynski M, Nowak W, Wierzchowski W. Risk of lymph node metastases in multifocal papillary thyroid cancer associated with Hashimoto's thyroiditis. Langenbecks Arch Surg 2014;399:229-36. https://doi.org/10.1007/s00423-013-1158-2
  18. Wu X, Li B, Zheng C, He X. Predicting factors of lateral neck lymph node metastases in patients with papillary thyroid microcarcinoma. Medicine (Baltimore) 2019;98:e16386. https://doi.org/10.1097/md.0000000000016386
  19. Ryu YJ, Kang SJ, Cho JS, Yoon JH, Park MH. Identifying risk factors of lateral lymph node recurrence in clinically node-negative papillary thyroid cancer. Medicine (Baltimore) 2018;97:e13435. https://doi.org/10.1097/md.0000000000013435
  20. Gong Y, Yang J, Yan S, Su A, Liu F, Gong R, et al. Pattern of and clinicopathologic risk factors for lateral lymph node metastases in papillary thyroid carcinoma patients with lateral cervical lymphadenopathy. Medicine (Baltimore) 2018;97:e12263. https://doi.org/10.1097/MD.0000000000012263
  21. Calo PG, Conzo G, Raffaelli M, Medas F, Gambardella C, De Crea C, et al. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study. Eur J Surg Oncol 2017;43:126-32. https://doi.org/10.1016/j.ejso.2016.09.017
  22. Barczynski M, Konturek A, Stopa M, Nowak W. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg 2013;100:410-8. https://doi.org/10.1002/bjs.8985
  23. Liu H, Li Y, Mao Y. Local lymph node recurrence after central neck dissection in papillary thyroid cancers: a meta analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2019;136:481-7. https://doi.org/10.1016/j.anorl.2018.07.010
  24. 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;18:411-8. https://doi.org/10.1089/thy.2007.0269
  25. Roh JL, Park JY, Kim JM, Song CJ. Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J Surg Oncol 2009;99:28-31. https://doi.org/10.1002/jso.21164
  26. Canu GL, Medas F, Longheu A, Boi F, Docimo G, Erdas E, et al. Correlation between iPTH levels on the first postoperative day after total thyroidectomy and permanent hypoparathyroidism: our experience. Open Med (Wars) 2019;14:437-42. https://doi.org/10.1515/med-2019-0047
  27. Teshima M, Otsuki N, Morita N, Furukawa T, Shinomiya H, Shinomiya H, et al. Postoperative hypoparathyroidism after total thyroidectomy for thyroid cancer. Auris Nasus Larynx 2018;45:1233-8. https://doi.org/10.1016/j.anl.2018.04.008
  28. Su A, Wang B, Gong Y, Gong R, Li Z, Zhu J. Risk factors of hypoparathyroidism following total thyroidectomy with central lymph node dissection. Medicine (Baltimore) 2017;96:e8162. https://doi.org/10.1097/MD.0000000000008162