Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, PR China.
Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, PR China.
Surg Oncol. 2020 Mar;32:90-98. doi: 10.1016/j.suronc.2019.11.007. Epub 2019 Dec 2.
Prophylactic dissection of the right paraesophageal lymph node (RPELN) in thyroid cancer is controversial. We performed a meta-analysis to provide evidence for RPELN dissection in thyroid cancer.
We searched the PubMed and Science Citation Index Expanded (SCIE) databases for relevant studies published up to January 31, 2019. The patients involved all had a pathological diagnosis of papillary thyroid cancer (PTC) and had undergone total thyroidectomy or right lobectomy with central compartment lymph node dissection. The RPELNs had been kept aside during the operation.
Fourteen cohort studies involving 11,090 patients with PTC were included in the meta-analysis. There was RPELN metastases (RPELNM) in 1038 patients (9.36%). The factors related to RPELNM were: age <45 years, male sex, right lobe tumor, tumor >1 cm, extrathyroidal extension, capsular invasion, right paratracheal lymph node metastasis (RPTLNM), central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM), and tumor multifocality. There was no association between RPELNM and Hashimoto's thyroiditis (HT) and inferior pole tumors or tumor in the middle of the gland. With superior pole tumors, there was even less RPELNM.
The clinical features related to RPELNM are age <45 years, male sex, tumor >1 cm, tumor diameter >2 cm, right lobe tumor, RPTLNM, extrathyroidal extension, capsular invasion, CLNM, CLNM ≥3, LLNM and multifocality, which should be considered when evaluating RPELN dissection.
预防性解剖右食管旁淋巴结（RPELN）在甲状腺癌中存在争议。我们进行了一项荟萃分析，为甲状腺癌的 RPELN 解剖提供证据。
我们检索了 PubMed 和科学引文索引扩展版（SCIE）数据库，以获取截至 2019 年 1 月 31 日发表的相关研究。所有患者均经病理诊断为甲状腺乳头状癌（PTC），并接受了全甲状腺切除术或右叶切除术伴中央区淋巴结清扫术。在手术过程中，将 RPELN 保留在一旁。
共有 14 项队列研究纳入了 11090 例 PTC 患者，其中 1038 例（9.36%）发生了 RPELN 转移（RPELNM）。与 RPELNM 相关的因素包括：年龄<45 岁、男性、右叶肿瘤、肿瘤>1cm、甲状腺外侵犯、包膜侵犯、右气管旁淋巴结转移（RPTLNM）、中央区淋巴结转移（CLNM）、侧区淋巴结转移（LLNM）和肿瘤多灶性。RPELNM 与桥本甲状腺炎（HT）、下极肿瘤或腺体中部肿瘤无关。上极肿瘤与 RPELNM 的相关性更低。
与 RPELNM 相关的临床特征包括年龄<45 岁、男性、肿瘤>1cm、肿瘤直径>2cm、右叶肿瘤、RPTLNM、甲状腺外侵犯、包膜侵犯、CLNM、CLNM≥3、LLNM 和多灶性，在评估 RPELN 解剖时应考虑这些因素。
