Service de chirurgie générale, viscérale et endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne université, 47-83, avenue de l'hôpital, 75013 Paris, France.
Service de chirurgie générale, endocrinienne et métabolique, CHU La Conception, AP-HM, Aix Marseille université, Marseille, France.
J Visc Surg. 2023 Jun;160(3S):S79-S83. doi: 10.1016/j.jviscsurg.2023.04.012. Epub 2023 May 9.
When metastatic ipsilateral central lymph nodes from thyroid cancer are identified pre- or intraoperatively (cN1a), ipsilateral central lymph node dissection should be performed concomitantly with thyroidectomy. When the patient is N1a on one side, contralateral prophylactic central lymph node dissection can also be considered. Prophylactic ipsilateral lymph dissection is not recommended. Ipsilateral compartment lymph node dissection is recommended in the corresponding sector for treatment of thyroid cancer with lymph node involvement (cN1b). Lymph node dissection can be limited to sectors III and IV when one of these sectors (or both) is involved and ultrasound does not demonstrate involvement of the other lateral sectors. Associated prophylactic lymph node dissection of sectors IIA and IIB is not recommended, while lymph node dissection of sector V (and exceptionally sector I) is indicated only when metastatic lymph nodes are proven. Prophylactic lymph node dissection of sector VB can be considered when positive lymph nodes are identified in sectors II, III and IV. When isolated metastatic lateral lymph nodes are identified (cN1b), prophylactic central (sector VI) lymph node dissection is recommended on the same side as the lateral compartment in addition to ipsilateral lateral lymph node compartment dissection. The level of evidence is insufficient to recommend prophylactic lateral lymph node dissection on the contralateral side for unilateral cN1b tumors. This type of lymph node dissection can be discussed for tumors that are at high risk of recurrence, bilateral tumors, in case of ipsilateral lateral lymph nodes > 3cm or in presence of > 4 metastatic lymph nodes in the central compartment.
当甲状腺癌同侧中央淋巴结在术前或术中被识别为转移（cN1a）时，应同时进行同侧中央淋巴结清扫术。当患者一侧为 N1a 时，也可以考虑对侧预防性中央淋巴结清扫术。不建议预防性同侧淋巴结清扫术。对于有淋巴结受累的甲状腺癌（cN1b），建议对相应区域进行同侧隔室淋巴结清扫术。当其中一个区域（或两个区域）受累且超声未显示其他侧区域受累时，淋巴结清扫术可仅限于第三和第四区域。不建议行 IIA 和 IIB 区域的预防性淋巴结清扫术，而仅当证实存在转移性淋巴结时才建议行 V 区（和异常的 I 区）淋巴结清扫术。当在 II、III 和 IV 区发现阳性淋巴结时，可以考虑行 VB 区预防性淋巴结清扫术。当孤立性转移性侧方淋巴结被识别为（cN1b）时，建议在同侧行中央（VI 区）淋巴结清扫术，除了同侧侧方淋巴结隔室清扫术之外。对于单侧 cN1b 肿瘤，对侧预防性侧方淋巴结清扫术的证据不足。对于复发风险高的肿瘤、双侧肿瘤、同侧侧方淋巴结>3cm 或中央隔室有>4 个转移性淋巴结的情况下，可以讨论进行这种类型的淋巴结清扫术。
