Ito Yasuhiro, Miyauchi Akira, Kudo Takumi, Kihara Minoru, Fukushima Mitsuhiro, Miya Akihiro
Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe, 650-0011, Japan.
Department of Internal Medicine, Kuma Hospital, Kobe, Japan.
World J Surg. 2017 Sep;41(9):2283-2289. doi: 10.1007/s00268-017-4023-6.
The most frequent recurrence site of papillary thyroid carcinoma (PTC) is the cervical lymph nodes. The introduction of an electric linear probe for use with ultrasonography in 1996 improved preoperative lateral neck evaluations. Before 2006, however, our hospital routinely performed prophylactic modified neck dissection (p-MND) for N0 or N1a PTCs >1 cm to prevent node recurrence. In 2006, we changed our policy and the indications for p-MND to PTCs >3 cm and/or with significant extrathyroid extension. Here, we retrospectively compared lymph node recurrence-free survival between PTCs with/without p-MND.
We examined the cases of N0 or N1 and M0 PTC patients who underwent initial surgery in 1992-2012. To compare lymph node recurrence-free survival between patients who did/did not undergo p-MND, we divided these patients into three groups (excluding those whose surgery was in 2006): the 2045 patients whose surgery was performed in 1992-1996 (Group 1), the 2989 with surgery between 1997 (post-introduction of ultrasound electric linear probes) and 2005 (Group 2), and the 5332 operated on in 2007-2012 (Group 3).
The p-MND performance rate of Group 3 (9%) was much lower than that of Group 1 (80%), but the lymph node recurrence-free survival of the former was significantly better, probably due to differences in clinical features and neck evaluations by ultrasound between the two groups. Our analysis of the patients aged <75 years with 1.1-4-cm PTCs in Groups 2 and 3 showed that p-MND did not improve lymph node recurrence-free survival. p-MND did significantly improve lymph node recurrence-free survival for the extrathyroid extension-positive 3.1-4-cm PTCs, but not for the other subsets.
Abolishing routine p-MND for PTCs in 2006 did not decrease lymph node recurrence-free survival, probably due to improved ultrasound preoperative neck evaluations and clinical feature changes. Selective p-MND for high-risk cases improved lymph node recurrence-free survival.
甲状腺乳头状癌（PTC）最常见的复发部位是颈部淋巴结。1996年引入用于超声检查的电子线性探头改善了术前颈部外侧评估。然而，在2006年之前，我院对直径>1 cm的N0或N1a期PTC常规进行预防性改良颈清扫术（p-MND）以预防淋巴结复发。2006年，我们改变了策略，将p-MND的适应证改为直径>3 cm和/或有明显甲状腺外侵犯的PTC。在此，我们回顾性比较了接受/未接受p-MND的PTC患者的无淋巴结复发生存率。
我们检查了1992 - 2012年接受初次手术的N0或N1且M0期PTC患者的病例。为了比较接受/未接受p-MND患者的无淋巴结复发生存率，我们将这些患者分为三组（不包括2006年手术的患者）：1992 - 1996年接受手术的2045例患者（第1组），1997年（引入超声电子线性探头后）至2005年接受手术的2989例患者（第2组），以及2007 - 2012年接受手术的5332例患者（第3组）。
第3组的p-MND实施率（9%）远低于第1组（80%），但其无淋巴结复发生存率明显更好，这可能是由于两组之间临床特征和超声颈部评估的差异。我们对第2组和第3组中年龄<75岁、肿瘤直径1.1 - 4 cm的PTC患者的分析表明，p-MND并未改善无淋巴结复发生存率。p-MND确实显著改善了甲状腺外侵犯阳性的3.1 - 4 cm PTC患者的无淋巴结复发生存率，但对其他亚组则不然。
2006年取消对PTC的常规p-MND并未降低无淋巴结复发生存率，这可能是由于术前超声颈部评估的改善和临床特征的变化。对高危病例进行选择性p-MND可改善无淋巴结复发生存率。
