Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General and Endocrine Surgery, Second University of Naples, Via Pansini 5, Build 17, 80131, Naples, Italy,
Endocrine. 2013 Oct;44(2):419-25. doi: 10.1007/s12020-013-9877-2. Epub 2013 Jan 19.
Total thyroidectomy (TT) is the standard of care for differentiated thyroid cancer (DTC), but still there is no consensus about the role of routine use of prophylactic central lymph node dissection. The aim of this study was to analyze our results of TT without prophylactic central lymphadenectomy in the treatment of DTC. Clinical records, between January 1998 and December 2005, of 221 patients undergoing TT, without prophylactic central lymph node dissection, were retrospectively evaluated. Two hundred and eleven patients (95.47 %) also underwent radioiodine (RAI) ablation followed by thyroid stimulating hormone (TSH) suppression therapy. In patients with loco-regional lymph nodal recurrence, lateral and central lymph node dissection was performed. The incidence of permanent hypoparathyroidism (iPTH <10 pg/ml) and permanent vocal fold paralysis were, respectively, 0.91 and 0.91 %. After a 9.6 ± 3.5 years mean follow-up, the rate of loco-regional recurrence, with positive cervical lymph nodes, was 3.16 % (7/221 patients). In these cases a lateral and central lymphadenectomy was carried out without significant complications. Our results showed that TT without prophylactic central lymph node dissection, followed by RAI ablation, was associated with low morbidity and low loco-regional recurrence rate, even if the lack of a control group treated with TT plus prophylactic central lymphadenectomy suggests caution against generalization of our assumption. Such last combined procedure could be indicated in high-risk patients, in whom loco-regional recurrence is more frequent. However, given the trend in the literature toward prophylactic lymphadenectomy and the avoidance of RAI treatment, prospective randomized trials should be conducted to better clarify this issue.
甲状腺全切除术（TT）是分化型甲状腺癌（DTC）的标准治疗方法，但对于预防性中央淋巴结清扫术的常规应用仍存在争议。本研究旨在分析我们在 DTC 治疗中不进行预防性中央淋巴结清扫术的 TT 结果。回顾性分析了 1998 年 1 月至 2005 年 12 月期间接受 TT 治疗且未行预防性中央淋巴结清扫术的 221 例患者的临床记录。211 例患者（95.47%）还接受了放射性碘（RAI）消融治疗，随后进行甲状腺刺激激素（TSH）抑制治疗。对于局部区域淋巴结复发的患者，进行了侧方和中央淋巴结清扫术。永久性甲状旁腺功能减退（iPTH <10 pg/ml）和永久性声带麻痹的发生率分别为 0.91%和 0.91%。平均随访 9.6±3.5 年后，局部区域复发率（伴有阳性颈部淋巴结）为 3.16%（221 例患者中的 7 例）。在这些情况下，进行了侧方和中央淋巴结清扫术，没有发生明显的并发症。我们的结果表明，不进行预防性中央淋巴结清扫术的 TT，随后进行 RAI 消融治疗，与低发病率和低局部区域复发率相关，即使缺乏接受 TT 加预防性中央淋巴结清扫术治疗的对照组，也表明需要谨慎推广我们的假设。这种联合手术可能适用于局部区域复发更常见的高危患者。然而，鉴于文献中预防性淋巴结清扫术的趋势以及避免 RAI 治疗的趋势，应该进行前瞻性随机临床试验来更好地阐明这个问题。
