Caliskan Ozan, Cetinoglu Isik, Aygun Nurcihan, Taner Unlu Mehmet, Kostek Mehmet, Isgor Adnan, Uludag Mehmet
Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.
Department of General Surgery, Sisli Memorial Hospital, Istanbul, Türkiye.
Sisli Etfal Hastan Tıp Bul. 2024 Sep 30;58(3):298-304. doi: 10.14744/SEMB.2023.64507. eCollection 2024.
The incidence of papillary thyroid cancer (PTC) is increasing, and due to the favorable postoperative survival rates, the extent of surgery should be carefully determined, and complications during the operation should be avoided. The recurrent laryngeal nerve (RLN) divides the right paratracheal lymph node (RPTLN) into anteromedial and posterolateral compartments due to its anatomical course on the right and left sides of the neck, and the posterolateral lymph nodes are in close proximity to the RLN. Due to the risk of this complication, in this study, we aimed to determine the risk factors for the development of right paratracheal posterolateral lymph node (RPTPLLN) metastasis in PTC.
Between 2013 and 2022, patients who underwent central neck dissection (CLND) or central and lateral neck dissection due to the presence of PTC in the right lobe of the thyroid gland were included in the study. Descriptive data, along with preoperative imaging findings and postoperative pathology findings, were retrospectively evaluated.
The data of 55 patients who met the criteria were statistically analyzed. Of these patients, 24 (43.6%) were male and 31 (56.4%) were female. The mean age was 47.9±17.5 years (range: 16-81). The mean tumor size was 2.17±1.43 cm (range: 0.4-7.0). RPTPLLN was observed in 13 patients (23.6%). Univariate analysis revealed that extrathyroidal extension (p=0.008), lymphovascular invasion (p=0.044), presence of right paratracheal anteromedial (RPTAMLN) metastasis (p=0.001), and presence of left paratracheal metastasis (p=0.049) were statistically significant factors. However, in the multivariate analysis, only the presence of RPTAMLN was determined to be a significant variable (p=0.035).
In patients undergoing surgery for PTC, the risk of metastasis in the RPTPLLN should be considered higher when there is metastasis in the RPTAMLN. We believe that formal dissection of the RPTLN should be considered for optimal evaluation in patients with tumors in the right lobe where central dissection is planned. Posterolateral dissection (PLD) should be routinely performed in the presence of clinical lymph nodes in the RPTAMLN. When a decision cannot be made, PLD may not be performed if the anteromedial tissue is examined with frozen pathology and the result is negative.
甲状腺乳头状癌（PTC）的发病率正在上升，由于术后生存率良好，手术范围应谨慎确定，并应避免手术期间的并发症。由于喉返神经（RLN）在颈部左右两侧的解剖走行，它将右气管旁淋巴结（RPTLN）分为前内侧和后外侧区，而后外侧淋巴结紧邻RLN。鉴于此并发症的风险，在本研究中，我们旨在确定PTC中右气管旁后外侧淋巴结（RPTPLLN）转移发生的危险因素。
2013年至2022年期间，因甲状腺右叶存在PTC而接受中央区颈清扫术（CLND）或中央区及侧方颈清扫术的患者纳入本研究。对描述性数据以及术前影像学检查结果和术后病理检查结果进行回顾性评估。
对符合标准的55例患者的数据进行统计学分析。这些患者中，24例（43.6%）为男性，31例（56.4%）为女性。平均年龄为47.9±17.5岁（范围：16 - 81岁）。平均肿瘤大小为2.17±1.43 cm（范围：0.4 - 7.0 cm）。13例患者（23.6%）观察到RPTPLLN转移。单因素分析显示，甲状腺外侵犯（p = 0.008）、脉管侵犯（p = 0.044）、右气管旁前内侧（RPTAMLN）转移的存在（p = 0.001）以及左气管旁转移的存在（p = 0.049）是具有统计学意义的因素。然而，在多因素分析中，仅RPTAMLN转移的存在被确定为显著变量（p = 0.035）。
在接受PTC手术的患者中，当RPTAMLN存在转移时，应认为RPTPLLN转移的风险更高。我们认为，对于计划进行中央区清扫的右叶肿瘤患者，为了进行最佳评估，应考虑对RPTLN进行规范清扫。当RPTAMLN存在临床淋巴结时，应常规进行后外侧清扫（PLD）。当无法做出决定时，如果对前内侧组织进行冰冻病理检查结果为阴性，则可能不进行PLD。
