Baylor Scott & White Health, Texas A&M Health Science Center, 2401 South 31st Street, Temple, Texas, 76508, USA.
Baylor Scott & White Health, Texas A&M Health Science Center, 2401 South 31st Street, Temple, Texas, 76508, USA.
Int J Surg. 2018 Aug;56:102-107. doi: 10.1016/j.ijsu.2018.06.015. Epub 2018 Jun 18.
This study compares the pathological outcomes and operative morbidity for papillary thyroid cancer (PTC) patients undergoing a primary total thyroidectomy (TT) with central lymph node dissection (CLND), to those undergoing an interval CLND following a previous thyroid operation, or for the unsuspected diagnosis of PTC.
Single-institution, retrospective review of PTC patients from 2000 to 2015 was performed. Three treatment groups were identified: primary TT/CLND, interval prophylactic CLND, and interval therapeutic CLND. Primary outcome measures were number of lymph nodes removed, hypoparathyroidism and recurrent laryngeal nerve (RLN) injury.
Results for 30 prophylactic and 35 therapeutic interval CLND were compared with 218 patients undergoing primary TT/CLND. Interval CLND was associated with similar rates of cervical metastases, complications, and a trend towards decreased lymph node recovery.
Reoperative CLND for incidental PTC frequently identifies cervical lymph node metastases, potentially reduces recurrence, and can be performed with similar morbidity to a primary lymphadenectomy.
本研究比较了行初次甲状腺全切除术（TT）+中央区淋巴结清扫术（CLND）、先前甲状腺手术后行择期预防性 CLND 或意外诊断为甲状腺癌的患者的病理结果和手术并发症。
回顾性分析了 2000 年至 2015 年期间的甲状腺癌患者，共分为三组：初次 TT/CLND、间隔预防性 CLND 和间隔治疗性 CLND。主要结局指标为清扫的淋巴结数量、甲状旁腺功能减退和喉返神经（RLN）损伤。
将 30 例预防性间隔 CLND 和 35 例治疗性间隔 CLND 的结果与 218 例行初次 TT/CLND 的患者进行比较。间隔 CLND 与颈部转移率、并发症发生率相似，且淋巴结清除率呈降低趋势。
对于偶然发现的甲状腺癌患者，再次手术行 CLND 常可识别颈部淋巴结转移，可能降低复发风险，且与初次淋巴结清扫术的并发症发生率相似。
