Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Surgery. 2019 Jan;165(1):31-36. doi: 10.1016/j.surg.2018.04.063. Epub 2018 Oct 9.
There is a paucity of data regarding optimal treatment options and outcomes for recurrent disease after lateral neck dissection in patients with papillary thyroid carcinoma.
Retrospective review of patients who underwent either percutaneous ethanol injection or surgery for first-time ipsilateral recurrences after ipsilateral lateral neck dissection for papillary thyroid carcinoma was performed.
Follow-up data were available for 54 patients with recurrences in 57 lateral necks treated by either percutaneous ethanol injection (n = 32) or surgery (n = 25). Tumor burden at the time of lateral neck recurrence differed between the groups including the largest lymph node diameter (mean: 13 mm vs 18 mm, P < .01) and the mean number of metastatic lymph nodes identified on ultrasound (1.3 vs 1.9, P = .04). Each modality alone achieved similar estimated rates of disease control at 36 months (75% for percutaneous ethanol injection and 74% for surgery, P = .8) with similar number of reinterventions (1.8 for percutaneous ethanol injection, 1.6 for surgery, P = .6).
Both ethanol ablation and surgery can achieve disease control in the majority of patients with recurrences after ipsilateral lateral neck dissection for papillary thyroid carcinoma. Ethanol ablation, when used for treatment of a single small lymph node, can result in outcomes that are similar to reoperative surgery for larger and multiple lymph nodes.
关于甲状腺乳头状癌患者行侧颈部清扫术后复发的最佳治疗选择和结局，相关数据有限。
对行同侧侧颈部清扫术后同侧复发的患者，分别行经皮乙醇注射或手术治疗，对这些患者进行回顾性分析。
57 个侧颈部复发中有 54 例患者的随访资料可用于评估，其中经皮乙醇注射（n=32）和手术（n=25）治疗。两组患者的侧颈部复发时肿瘤负荷不同，包括最大淋巴结直径（平均值：13mm 比 18mm，P<.01）和超声检查确定的转移性淋巴结平均数（1.3 比 1.9，P=.04）。单独使用每种方法在 36 个月时的疾病控制率相似（经皮乙醇注射为 75%，手术为 74%，P=.8），再次干预的数量相似（经皮乙醇注射为 1.8 次，手术为 1.6 次，P=.6）。
对于甲状腺乳头状癌同侧侧颈部清扫术后复发的患者，乙醇消融和手术均可使多数患者获得疾病控制。对于单个较小淋巴结的治疗，乙醇消融可获得与较大和多个淋巴结再次手术相似的结果。
