Department of Surgery, University of California, San Francisco/Mt. Zion Medical Center, San Francisco, CA 94115, USA.
Surgery. 2010 Aug;148(2):398-403. doi: 10.1016/j.surg.2010.03.021. Epub 2010 May 7.
The role of routine prophylactic central-neck lymph node dissection (CLND) for papillary thyroid cancer (PTC) remains controversial. We perform CLND for PTC only in patients with enlarged nodes as determined by preoperative ultrasound and intraoperative inspection and palpation.
We identified all patients with PTC who underwent CLND during thyroidectomy (group 1) at our institution, and then we identified an equivalent number of demographically matched patients who underwent thyroidectomy without CLND (group 2) and compared the outcomes of the 2 groups.
In all, 191 patients were identified for each group; 49/191 (26%) patients in group 1 developed locoregional nodal recurrence (12% central neck and 21% lateral neck), compared with 11/191 (6%) patients in group 2 (3% central neck and 3% lateral neck; P < .05). Overall, 161/191 (84%) patients in group 1 were disease free at last survey, compared with 180/191 (94%) patients in group 2 (P < .05). Transient hypocalcemia was significantly greater in group 1. No difference was found in disease-specific mortality.
Surgeon assessment of the central neck compartment is an accurate predictor of which patients with PTC will benefit from CLND. Patients with nonenlarged central neck nodes who undergo total thyroidectomy without CLND have a low risk of developing recurrence.
对于甲状腺乳头状癌（PTC），常规预防性中央颈部淋巴结清扫术（CLND）的作用仍存在争议。我们仅在术前超声和术中检查及触诊确定存在淋巴结肿大的 PTC 患者中进行 CLND。
我们确定了在我院接受 CLND 的所有 PTC 患者（组 1），然后确定了数量相等的、未行 CLND 的甲状腺切除术患者（组 2），并比较了两组患者的结局。
每组各有 191 例患者；组 1 中有 49/191（26%）患者发生局部区域淋巴结复发（12%为中央颈部，21%为侧颈部），而组 2 中有 11/191（6%）患者（3%为中央颈部，3%为侧颈部；P<.05）。总的来说，组 1 中有 161/191（84%）患者在最后一次随访时无疾病，而组 2 中有 180/191（94%）患者（P<.05）。组 1 中暂时性低钙血症明显更为常见。两组间疾病特异性死亡率无差异。
外科医生对中央颈部区域的评估是预测哪些 PTC 患者将从 CLND 中获益的准确指标。行甲状腺全切除术且不进行 CLND 的无中央颈部淋巴结肿大患者发生复发的风险较低。
