Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Ann Surg Oncol. 2012 Mar;19(3):996-1000. doi: 10.1245/s10434-011-2144-y. Epub 2011 Nov 18.
This study was designed to identify the patients with papillary thyroid carcinoma (PTC) who would benefit from RPELN dissection.
The value of the right paraesophageal lymph nodes (RPELNs), which are located posterior to the right recurrent laryngeal nerve, may be underestimated. Although the RPELNs are common sites of nodal recurrence, few related studies have been reported.
We retrospectively reviewed the medical records of 369 patients (286 female, 83 male) who underwent total thyroidectomy (327 patients) or right lobectomy (42 patients) with therapeutic or prophylactic central lymph node dissection for primary PTC between August 2008 and January 2010 at the Department of Surgery, Samsung Medical Center.
Central lymph node (CLN) metastases were present in 51.2% (189 of 369) of the patients, and RPELN metastases were present in 12.2% (45 of 369) of the patients. The rate of RPELN metastasis was 19.6% (37 of 189) in patients with CLN metastases, but only 4.4% (8 of 180) in patients with no CLN metastases (P < .001). A univariate analysis revealed that RPELN metastasis was significantly correlated with the size of the tumor, the perithyroidal extent (capsular invasion), CLN metastasis, and lateral lymph node metastases. There were no significant differences in terms of gender, mean age, or number of tumors between groups. A multivariate analysis revealed that tumor size (>1 cm) and number of CLN metastases (≥ 3) were significantly correlated with RPELN metastasis.
RPELN dissection should be considered in patients with right thyroid cancer, tumors larger than 1 cm, or multiple CLN metastases.
本研究旨在确定哪些甲状腺乳头状癌（PTC）患者将从预防性颈部中央区淋巴结清扫（RPELN 清扫）中获益。
右食管旁淋巴结（RPELNs）位于右侧喉返神经后方，其价值可能被低估。虽然 RPELNs 是淋巴结复发的常见部位，但很少有相关研究报道。
我们回顾性分析了 2008 年 8 月至 2010 年 1 月期间在三星医疗中心外科接受全甲状腺切除术（327 例）或右叶切除术（42 例）治疗或预防性中央淋巴结清扫术的 369 例（286 例女性，83 例男性）的原发性 PTC 患者的病历。
369 例患者中，51.2%（189 例）存在中央淋巴结（CLN）转移，12.2%（45 例）存在 RPELN 转移。CLN 转移患者的 RPELN 转移率为 19.6%（37 例），而无 CLN 转移患者的转移率仅为 4.4%（180 例）（P<0.001）。单因素分析显示，RPELN 转移与肿瘤大小、甲状腺周围侵犯、CLN 转移和侧方淋巴结转移显著相关。两组间在性别、平均年龄或肿瘤数量方面无显著差异。多因素分析显示，肿瘤大小（>1cm）和 CLN 转移数量（≥3 个）与 RPELN 转移显著相关。
对于右侧甲状腺癌、肿瘤大于 1cm 或 CLN 转移较多的患者，应考虑行 RPELN 清扫术。
