Calò Pietro Giorgio, Lombardi Celestino Pio, Podda Francesco, Sessa Luca, Santini Luigi, Conzo Giovanni
Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, Monserrato, 09042, Cagliari, Italy.
Division of Endocrine Surgery, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy.
Updates Surg. 2017 Jun;69(2):241-248. doi: 10.1007/s13304-017-0438-8. Epub 2017 Apr 13.
Prophylactic central neck dissection in clinically node-negative patients remains controversial. The aim of this multicenter retrospective study was to determine the rate of metastases in the central neck in clinically node-negative differentiated thyroid cancer patients, to examine the morbidity, and to assess the risk of regional recurrence in patients treated with total thyroidectomy with concomitant bilateral or ipsilateral central neck dissection compared with those undergoing total thyroidectomy alone. 258 consecutive clinically node-negative patients were divided into three groups according to the procedures performed: total thyroidectomy only (group A), total thyroidectomy with concomitant ipsilateral central neck dissection (group B), and total thyroidectomy combined with bilateral central neck dissection (group C). Mean operative time and postoperative stay were shorter in Group A (p < 0.01). The incidence of postoperative transient hypoparathyroidism was lower in Group A (p = 0.03), whereas no differences in the incidence of permanent hypoparathyroidism and nerve palsy were present. Postoperative radioactive iodine administration was higher in group B and particularly C (p = 0.03) compared with group A. There were no statistically significant differences in terms of regional recurrence. Differentiated thyroid cancer has a high rate of central lymph node metastasis even in clinically node-negative patients; in the present study there was no statistically significant difference in the rates of locoregional recurrence between the three modalities of treatment. Total thyroidectomy appears to be an adequate treatment for clinically node-negative differentiated thyroid cancer. Prophylactic central neck dissection might be considered for differentiated thyroid cancer patients with large tumor size or extrathyroidal extension.
对于临床检查无淋巴结转移的患者，预防性中央区颈部淋巴结清扫术仍存在争议。这项多中心回顾性研究的目的是确定临床检查无淋巴结转移的分化型甲状腺癌患者中央区颈部淋巴结转移率，检查其并发症，并评估与单纯行全甲状腺切除术的患者相比，行全甲状腺切除术同时行双侧或同侧中央区颈部淋巴结清扫术的患者区域复发风险。连续纳入258例临床检查无淋巴结转移的患者，根据所施行的手术方式分为三组：仅行全甲状腺切除术（A组）、全甲状腺切除术同时行同侧中央区颈部淋巴结清扫术（B组）、全甲状腺切除术联合双侧中央区颈部淋巴结清扫术（C组）。A组的平均手术时间和术后住院时间较短（p<0.01）。A组术后暂时性甲状旁腺功能减退的发生率较低（p=0.03），而永久性甲状旁腺功能减退和神经麻痹的发生率无差异。与A组相比，B组尤其是C组术后放射性碘治疗的比例更高（p=0.03）。区域复发方面无统计学显著差异。即使在临床检查无淋巴结转移的患者中，分化型甲状腺癌的中央区淋巴结转移率也很高；在本研究中，三种治疗方式的局部区域复发率无统计学显著差异。全甲状腺切除术似乎是临床检查无淋巴结转移的分化型甲状腺癌的一种充分治疗方法。对于肿瘤体积大或有甲状腺外侵犯的分化型甲状腺癌患者，可考虑预防性中央区颈部淋巴结清扫术。
