Conzo Giovanni, Docimo Giovanni, Pasquali Daniela, Mauriello Claudio, Gambardella Claudio, Esposito Daniela, Tartaglia Ernesto, Della Pietra Cristina, Napolitano Salvatore, Rizzuto Antonia, Santini Luigi
BMC Surg. 2013;13 Suppl 2(Suppl 2):S3. doi: 10.1186/1471-2482-13-S2-S3. Epub 2013 Oct 8.
The significance of nodal metastases, very common in papillary thyroid cancer, and the role of lymph node dissection in the neoplasm management, are still controversial. The impact of lymph node involvement on local recurrence and long-term survival remains subject of active research. With the aim to better analyze the predictive value of lymph node involvement on recurrence and survival, we investigated the clinico-pathological patterns of local relapse following total thyroidectomy associated with lymph node dissection, for clinical nodal metastases papillary thyroid cancer, in order to identify the preferred surgical treatment.
Clinical records, between January 2000 and December 2006, of 69 patients undergoing total thyroidectomy associated with selective lymph node dissection for clinical nodal metastases papillary thyroid cancer, were retrospectively evaluated. Radioiodine ablation, followed by Thyroid Stimulating Hormone suppression therapy was recommended in every case. In patients with loco regional lymph nodal recurrence, a repeated lymph node dissection was carried out. The data were compared with those following total thyroidectomy not associated with lymph node dissection in 210 papillary thyroid cancer patients without lymph node involvement, at preoperative ultrasonography and intra operative inspection.
Incidence of permanent hypoparathyroidism (iPTH < 10 pg/ml) and permanent monolateral vocal fold paralysis were respectively 1.4 % (1/69) and 1.4% (1/69), similar to those reported after total thyroidectomy "alone". The rate of loco regional recurrence, with positive cervical lymph nodes, following 8 year follow-up, was 34.7% (24/69), higher than that reported in patients without nodal metastases (4.2%). A repeated lymph node dissection was carried out without significant complications.
Nodal metastases are a predictor of local recurrence, and a higher rate of lymph node involvement is expected after therapeutic lymph node dissection associated with total thyroidectomy. The prognostic significance of nodal metastases on long-term survival remains unclear, and more prospective randomized trials are requested to better evaluate the benefits of different therapeutic approaches.
在乳头状甲状腺癌中非常常见的淋巴结转移的意义以及淋巴结清扫在肿瘤治疗中的作用仍存在争议。淋巴结受累对局部复发和长期生存的影响仍是积极研究的课题。为了更好地分析淋巴结受累对复发和生存的预测价值，我们研究了全甲状腺切除联合淋巴结清扫术后，临床淋巴结转移的乳头状甲状腺癌局部复发的临床病理模式，以确定首选的手术治疗方法。
回顾性评估了2000年1月至2006年12月期间69例因临床淋巴结转移的乳头状甲状腺癌接受全甲状腺切除联合选择性淋巴结清扫的患者的临床记录。建议每例患者进行放射性碘消融，随后进行促甲状腺激素抑制治疗。对于局部区域淋巴结复发的患者，进行了再次淋巴结清扫。将这些数据与210例术前超声和术中检查未发现淋巴结受累的乳头状甲状腺癌患者单纯行全甲状腺切除后的数据进行比较。
永久性甲状旁腺功能减退症（iPTH<10 pg/ml）和永久性单侧声带麻痹的发生率分别为1.4%（1/69）和1.4%（1/69），与单纯全甲状腺切除术后报告的发生率相似。8年随访后，颈部淋巴结阳性的局部区域复发率为34.7%（24/69），高于无淋巴结转移患者报告的复发率（4.2%）。再次进行淋巴结清扫，无明显并发症。
淋巴结转移是局部复发的预测指标，全甲状腺切除联合治疗性淋巴结清扫术后预计淋巴结受累率更高。淋巴结转移对长期生存的预后意义仍不清楚，需要更多的前瞻性随机试验来更好地评估不同治疗方法的益处。
