Holostenco Victoria, Khafif Avi
The Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel.
JAMA Otolaryngol Head Neck Surg. 2014 Aug;140(8):731-5. doi: 10.1001/jamaoto.2014.972.
Central neck dissection (CND) is considered an imperative part of the treatment of patients with high-risk, well-differentiated thyroid carcinoma.
To examine the presence of lymphatic tissue and/or metastatic nodes in the upper part of the paratracheal region to determine the need to dissect this region as part of a paratracheal neck dissection.
DESIGN, SETTING, AND PARTICIPANTS: We prospectively enrolled 27 nonselective patients with surgical thyroid cancer (4 men and 23 women; median age, 43 years; range, 21-74 years) from June 1, 2010, through March 31, 2011, from a head and neck surgical oncology specialist group practice within the largest private hospital in Israel. All patients were scheduled to undergo unilateral (n = 23) or bilateral (n = 4) CND as their definitive surgical care.
A total of 31 paratracheal neck dissections were performed among the 27 patients. The surgical specimens were divided into upper and lower paratracheal regions, separated by the nerve curve line (corresponding to the level of the cricoid). These specimens were thoroughly examined separately for normal and metastatic lymph nodes. A standard pathologic technique was used, with no dedicated personnel.
The existence of lymphatic tissue and metastatic cells in all upper paratracheal surgical specimens.
The surgical procedures were uneventful. Postoperative complications included temporary vocal cord palsy, minimal chyle leak, and wound infection. A median of 8 nodes were retrieved (range, 2-21). No lymphatic tissue was identified in all upper paratracheal dissection specimens. All benign and metastatic lymph nodes (mean, 5.3 and 2.5, respectively) were located in the lower paratracheal region specimens. All upper paratracheal surgical specimens (n = 31) consisted of only fibrofatty connective tissue and were devoid of lymph nodes, metastatic cells, or other endothelial-lined lymphatic structures.
In this series of paratracheal neck dissections, the upper part of the paratracheal region contained no lymphatic tissue or cancer-bearing lymph nodes. The necessity to dissect this region, as part of conventional CND, is therefore challenged.
中央区颈清扫术（CND）被认为是高危、高分化甲状腺癌患者治疗的重要组成部分。
检查气管旁区域上部淋巴组织和/或转移淋巴结的存在情况，以确定作为气管旁颈清扫术一部分而清扫该区域的必要性。
设计、地点和参与者：2010年6月1日至2011年3月31日，我们从以色列最大的私立医院内的头颈外科肿瘤专科诊所前瞻性纳入了27例非选择性甲状腺癌手术患者（4例男性和23例女性；中位年龄43岁；范围21 - 74岁）。所有患者均计划接受单侧（n = 23）或双侧（n = 4）CND作为其确定性手术治疗。
27例患者共进行了31次气管旁颈清扫术。手术标本被分为气管旁上部和下部区域，由神经曲线（对应环状软骨水平）分隔。这些标本分别彻底检查正常和转移淋巴结。采用标准病理技术，无专门人员。
所有气管旁上部手术标本中淋巴组织和转移细胞的存在情况
手术过程顺利。术后并发症包括暂时性声带麻痹、少量乳糜漏和伤口感染。中位取出8个淋巴结（范围2 - 21个）。在所有气管旁上部清扫标本中未发现淋巴组织
所有良性和转移淋巴结（分别平均为5.3个和个）均位于气管旁下部区域标本中。所有气管旁上部手术标本（n = 31）仅由纤维脂肪结缔组织组成，无淋巴结、转移细胞或其他内皮衬里的淋巴结构。
在这一系列气管旁颈清扫术中，气管旁区域上部未发现淋巴组织或含癌淋巴结。因此，作为传统CND一部分而清扫该区域的必要性受到质疑。
