双侧中央区颈部淋巴结清扫术治疗具有不良风险因素的早期单灶性甲状腺乳头状癌：单中心经验

Bilateral central neck dissection in the treatment of early unifocal papillary thyroid carcinomas with poor risk factors A mono-institutional experience.

作者信息

Tartaglia Nicola, Di Lascia Alessandra, Vovola Fernanda, Cianci Pasquale, Fersini Alberto, Pacilli Mario, Pavone Giovanna, Ambrosi Antonio

出版信息

Ann Ital Chir. 2020;91:161-165.

PMID:32149727

Abstract

INTRODUCTION

Papillary thyroid carcinoma is the most common type of thyroid cancer worldwide. While total thyroidectomy is widely considered the standard surgical approach for papillary thyroid carcinomas, the role of central lymphadenectomy in early stage poor-risk papillary thyroid tumors is still a matter of debate. This study was designed to assess surgical complications and local disease control rates in patients affected by poor-risk early stage papillary thyroid carcinomas.

METHODS

We retrospectively analyze three groups of patients affected by poor-risk early stage papillary thyroid carcinomas treated with three alternative surgical strategies: I) routine total thyroidectomy; II) total thyroidectomy and routine central lymphadenectomy; III) total thyroidectomy and central lymphadenectomy upon positive intraoperative histological evaluation of lymph node involvement.

RESULTS

Data from patients treated with routine total thyroidectomy showed 32% of persistence of disease in the central compartment with concurrent positivity in laterocervical compartment in 25% of these cases. By contrast, patients receiving total thyroidectomy and routine central lymphadenectomy showed the involvement of central compartment in 40% of cases, while the remaining 60% of patients were free from lymph node metastases. Finally, patients undergoing total thyroidectomy and central lymphadenectomy upon positive intraoperative lymph node biopsy exhibited lack of persistence of lymph node involvement in central compartment after surgery. Of note, postsurgical complications were lower in patients undergoing conservative surgical approaches.

CONCLUSIONS

These data suggest that central lymphadenectomy, performed only in case of positive intraoperative lymph node biopsy, ensures reduced incidence of postoperative complications and optimal loco-regional disease control.

KEY WORDS

Bilateral central neck dissection, Intraoperative lymph node biopsy, Papillary thyroid carcinoma, Poor risk factors.

摘要

引言

甲状腺乳头状癌是全球最常见的甲状腺癌类型。虽然全甲状腺切除术被广泛认为是甲状腺乳头状癌的标准手术方法，但中央区淋巴结清扫术在早期低危甲状腺乳头状癌中的作用仍存在争议。本研究旨在评估低危早期甲状腺乳头状癌患者的手术并发症和局部疾病控制率。

方法

我们回顾性分析了三组接受三种不同手术策略治疗的低危早期甲状腺乳头状癌患者：I）常规全甲状腺切除术；II）全甲状腺切除术和常规中央区淋巴结清扫术；III）术中淋巴结受累组织学评估阳性时行全甲状腺切除术和中央区淋巴结清扫术。

结果

接受常规全甲状腺切除术的患者数据显示，中央区疾病持续存在率为32%，其中25%的病例同时伴有颈侧区阳性。相比之下，接受全甲状腺切除术和常规中央区淋巴结清扫术的患者中，40%的病例中央区受累，而其余60%的患者无淋巴结转移。最后，术中淋巴结活检阳性时接受全甲状腺切除术和中央区淋巴结清扫术的患者术后中央区无淋巴结受累持续存在。值得注意的是，采用保守手术方法的患者术后并发症较低。