Ohshima Akira, Yamashita Hiroyuki, Noguchi Shiro, Uchino Shinya, Watanabe Shin, Koike Eisuke, Yamashita Hiroto, Kuroki Syoji, Tanaka Masao
Department of Surgery and Oncology, Graduate School of Medical Sciences, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan.
Surg Today. 2002;32(12):1027-30. doi: 10.1007/s005950200208.
We previously reported a poor prognosis in papillary thyroid carcinoma patients with recurrence in the contralateral cervical lymph nodes after thyroidectomy and ipsilateral modified radical neck dissection (MRND) with a curative intent. The aim of this study was to investigate whether bilateral MRND improved prognosis in patients at risk for contralateral nodal recurrence.
We retrospectively reviewed the cases of 86 patients with contralateral nodal metastasis who underwent a thyroidectomy with bilateral MRND (group 1) and the cases of 32 patients who suffered contralateral nodal recurrence after a thyroidectomy with ipsilateral MRND (group 2).
Although tumor progression was considered similar in patients from groups 1 and 2, group 1 developed fewer distant metastases than group 2 (6.8% vs 31.1%), thus resulting in a lower cancer death rate (5.8% vs 28.1%). Group 1 had a better 10-year survival rate than of group 2 (97.1% vs 83.7%).
Bilateral MRND during initial surgical management is thus considered to improve the prognosis of some papillary carcinoma patients at risk for recurrence in the contralateral cervical lymph nodes.
我们之前报道过，甲状腺癌患者在甲状腺切除术后对侧颈部淋巴结复发且同侧行改良根治性颈清扫术（MRND）以达到治愈目的时，预后较差。本研究的目的是调查双侧MRND是否能改善有对侧淋巴结复发风险患者的预后。
我们回顾性分析了86例行甲状腺切除及双侧MRND的对侧淋巴结转移患者（第1组）以及32例在甲状腺切除及同侧MRND后出现对侧淋巴结复发患者的病例（第2组）。
尽管第1组和第2组患者的肿瘤进展情况被认为相似，但第1组发生远处转移的患者比第2组少（6.8%对31.1%），因此癌症死亡率更低（5.8%对28.1%）。第1组的10年生存率高于第2组（97.1%对83.7%）。
因此，在初次手术治疗期间行双侧MRND被认为可改善一些有对侧颈部淋巴结复发风险的乳头状癌患者的预后。
