Department of Surgery, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital and Sydney University, Sydney, Australia.
Ann Surg. 2011 Jan;253(1):123-30. doi: 10.1097/SLA.0b013e3181fc9644.
Systematic elective paratracheal dissection for papillary thyroid carcinoma is controversial.
This study aims to analyze the pattern of locoregional recurrence (LRR) to determine the potential benefit of elective paratracheal dissection and to identify prognostic factors influencing locoregional control and disease specific survival.
A cohort of 342 patients who underwent a total thyroidectomy with or without neck dissection for a papillary thyroid carcinoma was retrospectively reviewed. Clinicopathological variables predicting for survival and control were examined.
All patients underwent total thyroidectomy and 84 underwent neck dissection as primary treatment. Sixty-six patients underwent a central compartment neck dissection. Twenty-eight (8.2%) patients developed LRR, of which 12 did not undergo neck dissection at initial surgery. The majority of neck recurrences were found in the lateral neck. Two patients (0.7%) without a paratracheal dissection done initially recurred only in the central compartment. On univariable analysis significant pathological predictors of locoregional control included tumor size, extrathyroidal extension (ETE), lymphovascular invasion and pathological lymph node status. Only ETE was a significant adverse prognostic variable for disease specific survival. On regression analysis, ETE and lymphovascular invasion were the only significant independent predictors of LRR. Paratracheal dissection did neither influence LRR nor central compartment control when adjusted for the effect of other variables.
Strong conclusions are difficult to draw without a comparable group, but these results suggest that the absolute benefit of elective paratracheal dissection is small.
系统性选择性甲状旁腺癌旁解剖术存在争议。
本研究旨在分析局部区域复发（LRR）的模式，以确定选择性甲状旁腺癌旁解剖术的潜在获益，并确定影响局部区域控制和疾病特异性生存的预后因素。
回顾性分析了 342 例接受全甲状腺切除术加或不加颈清扫术治疗甲状腺乳头状癌的患者队列。检查了预测生存和控制的临床病理变量。
所有患者均行全甲状腺切除术，84 例行颈清扫术作为初始治疗。66 例患者行中央区颈部清扫术。28 例（8.2%）患者发生 LRR，其中 12 例在初次手术时未行颈部清扫术。颈部复发的大部分发生在侧颈部。2 例（0.7%）最初未行甲状旁腺癌旁解剖术的患者仅在中央区复发。单变量分析显示，局部区域控制的显著病理预测因素包括肿瘤大小、甲状腺外侵犯（ETE）、血管淋巴管侵犯和病理淋巴结状态。只有 ETE 是疾病特异性生存的显著不良预后因素。回归分析显示，ETE 和血管淋巴管侵犯是 LRR 的唯一显著独立预测因素。当调整其他变量的影响时，甲状旁腺癌旁解剖术既不会影响 LRR，也不会影响中央区的控制。
由于没有可比的组，因此很难得出明确的结论，但这些结果表明，选择性甲状旁腺癌旁解剖术的绝对获益很小。
