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, Mölne 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.	滕卫平, 刘永锋, 高明, 等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床, 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.	朱永学, 王弘士, 吴毅, 等.甲状腺乳头状癌Ⅵ区淋巴结的归属[J].中华外科杂志, 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.	石岚, 黄韬.甲状腺乳头状癌淋巴结转移规律的研究[J].中华普通外科杂志, 2007, 22(7):524-526.
26.	江国斌, 方红燕, 蔡建明.纳米碳混悬液示踪前哨淋巴结在甲状腺乳头状癌中的应用[J].中国癌症杂志, 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.	郭卫平, 李玺, 邱万寿, 等.预防性中央区淋巴结清扫在cN0乳头状甲状腺癌的临床价值[J].中华全科医学, 2010, 8(10):1215-1216.
32.	苏清华, 周波, 赵军, 等.甲状腺乳头状癌预防性中央区淋巴结清扫可行性分析[J].临床外科杂志, 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.	张浩.Ⅵ区淋巴结清扫术中甲状旁腺保护和损伤处理[J].中国实用外科杂志, 2012, 32(5):361-363.
37.	朱精强.分化型甲状腺癌颈淋巴结清扫的相关问题[J].中国普外基础与临床杂志, 2012, 19(8):809-813.
38.	王晓雷, 吴跃煌, 徐震纲, 等.纳米碳在鉴别甲状腺周围淋巴结和甲状旁腺中的作用[J].中华耳鼻咽喉头颈外科杂志, 2009, 44(2):136-140.
39.	张筱骅, 郝儒田, 尤捷, 等.甲状腺淋巴管造影在鉴别甲状旁腺中的意义[J].温州医学院学报, 2010, 40(1):31, 35.
40.	曾玉剑, 钱军, 程若川, 等.甲状腺癌术中淋巴示踪剂应用对于甲状旁腺保护作用的研究[J].重庆医学, 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, Mölne 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. 滕卫平, 刘永锋, 高明, 等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床, 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. 朱永学, 王弘士, 吴毅, 等.甲状腺乳头状癌Ⅵ区淋巴结的归属[J].中华外科杂志, 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. 石岚, 黄韬.甲状腺乳头状癌淋巴结转移规律的研究[J].中华普通外科杂志, 2007, 22(7):524-526.
26. 江国斌, 方红燕, 蔡建明.纳米碳混悬液示踪前哨淋巴结在甲状腺乳头状癌中的应用[J].中国癌症杂志, 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. 郭卫平, 李玺, 邱万寿, 等.预防性中央区淋巴结清扫在cN0乳头状甲状腺癌的临床价值[J].中华全科医学, 2010, 8(10):1215-1216.
32. 苏清华, 周波, 赵军, 等.甲状腺乳头状癌预防性中央区淋巴结清扫可行性分析[J].临床外科杂志, 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. 张浩.Ⅵ区淋巴结清扫术中甲状旁腺保护和损伤处理[J].中国实用外科杂志, 2012, 32(5):361-363.
37. 朱精强.分化型甲状腺癌颈淋巴结清扫的相关问题[J].中国普外基础与临床杂志, 2012, 19(8):809-813.
38. 王晓雷, 吴跃煌, 徐震纲, 等.纳米碳在鉴别甲状腺周围淋巴结和甲状旁腺中的作用[J].中华耳鼻咽喉头颈外科杂志, 2009, 44(2):136-140.
39. 张筱骅, 郝儒田, 尤捷, 等.甲状腺淋巴管造影在鉴别甲状旁腺中的意义[J].温州医学院学报, 2010, 40(1):31, 35.
40. 曾玉剑, 钱军, 程若川, 等.甲状腺癌术中淋巴示踪剂应用对于甲状旁腺保护作用的研究[J].重庆医学, 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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