Revathy A K, Sekhar Sidhu R, Gopalakrishnan Nair C, R Menon Riju, Jacob Pradeep, J C Babu Misha, Vasudevan Pillai Anoop
Dept. of General Surgery, Amrita Institute of Medical Science and Research Centre, Flat No 15 C, Kent Palm Grove 2, Stadium Link Road, Opp. IMA House, Palarivattom P.O., Kochi, 682041 Kerala India.
Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3256-3260. doi: 10.1007/s12070-024-04660-5. Epub 2024 Apr 12.
To see whether prophylactic central compartment dissection is recommended for advanced papillary thyroid cancer or as part of selective neck node dissection. Central compartment dissection is a technically demanding surgical procedure and carries a higher incidence of complications. The present retrospective case-control study analysed the impact of prophylactic central compartment dissection on the long-term outcome of advanced (N0-T3/T4) papillary thyroid cancer.
Case records of patients operated on for papillary thyroid cancer from 2005 to 2010 were reviewed and patients with Tumour stage 3-4 and N0 nodal status were included in the study. The institutional protocol was to perform total thyroidectomy with central compartment dissection during the early phase of the study period (2005 to 2008) but this strategy was shifted to total thyroidectomy alone during the latter phase. Fifty-five patients were included in the study and 29 of the cohort had total thyroidectomy with prophylactic central compartment dissection as the primary surgery and the remaining 26 had a total thyroidectomy as the primary surgical procedure.
Patients were followed up for a median duration of 115 months and found to have no significant difference in the incidences of loco-regional recurrences between the groups. (n:4 (14%) Vs n: 3 (12%) = .463). The disease-free survival and overall survival were not significantly different in the groups. There was a trend to an increase in the incidence of permanent hypoparathyroidism in patients who had central compartment dissection.
Prophylactic central compartment dissection did not influence the 10-year outcome of advanced node-negative papillary thyroid cancers.
探讨对于晚期甲状腺乳头状癌，预防性中央区淋巴结清扫术是否应作为选择性颈淋巴结清扫术的一部分被推荐。中央区淋巴结清扫术是一项技术要求较高的外科手术，并发症发生率较高。本回顾性病例对照研究分析了预防性中央区淋巴结清扫术对晚期（N0-T3/T4）甲状腺乳头状癌长期预后的影响。
回顾2005年至2010年接受甲状腺乳头状癌手术患者的病例记录，纳入肿瘤分期为3-4期且N0淋巴结状态的患者。研究机构的方案是在研究早期阶段（2005年至2008年）进行全甲状腺切除术并同时行中央区淋巴结清扫术，但在后期阶段该策略改为仅行全甲状腺切除术。本研究共纳入55例患者，其中29例患者以预防性中央区淋巴结清扫术作为主要手术方式行全甲状腺切除术，其余26例患者以全甲状腺切除术作为主要手术方式。
患者的中位随访时间为115个月，发现两组患者的局部区域复发率无显著差异（n：4（14%）对n：3（12%），P = 0.463）。两组患者的无病生存率和总生存率无显著差异。行中央区淋巴结清扫术的患者永久性甲状旁腺功能减退症的发生率有上升趋势。
预防性中央区淋巴结清扫术并未影响晚期淋巴结阴性甲状腺乳头状癌的10年预后。
