Risk factors and clinical indication of metastasis to lymph nodes posterior to right recurrent laryngeal nerve in papillary thyroid carcinoma: A single-center study in China

Background: Papillary thyroid carcinoma is the most common thyroid carcinoma. There is a debate on prophylactic removal of central lymph nodes. Some authors advise it to avoid recurrence while other investigators condemn it due to its higher risk of recurrent laryngeal nerve injury and/or hypoparathyroidism. Aim of the Work: The aim of this study was to evaluate the safety and morbidity of central lymph nodes dissection during total thyroidectomy in the management of patients with papillary thyroid carcinoma. Patients and Methods: Twelve patients were confirmed by histopathological evaluation to have papillary thyroid examination. Total thyroidectomy was done through transverse neck incision followed by removal of bilateral central group of lymph nodes. Patients were examined postoperatively for recurrent laryngeal nerve injury or hypoparathyroidism. Follow up was done 6 months later with neck ultrasonography, thyroglobulin and antithyroglobulin antibodies. Results: Thirty four percent of the studied cases proved to have lymph nodes metastasis. temporary hypocalcemia occurred in only one patient in this study and was temporary. Recurrent laryngeal nerve affection happened in 17% of the studied cases and was reversible by medical treatment. No evidence of recurrence happened in the first 6 months after operation. Conclusion: The risk of postoperative recurrent laryngeal nerve injury or hypoparathyroidism is minimal after prophylactic CLND. Postoperative hypocalcemia and recurrent laryngeal nerve injury are usually reversible.

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Papillary Thyroid Carcinoma: Analysis of the Central Compartmentʼs Lymph Nodes Metastases

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2017.49 ◽

2017 ◽

Vol 60 (1) ◽

pp. 44-50 ◽

Cited By ~ 2

Author(s):

Ján Sojak ◽

Marian Sičák ◽

Adrian Kališ ◽

Michal Slašťan

Keyword(s):

Risk Factors ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Primary Tumour ◽

Papillary Thyroid ◽

Aggressive Disease ◽

Regional Metastases ◽

Metastatic Involvement ◽

Lymph Nodes Metastases

Background: Papillary thyroid carcinoma is typical by regional lymph nodes metastases. Therefore we decided to analyse associated risk factors. Objective: In this retrospective study we focused on the incidence of metastatic involvement of the central compartment’s lymph nodes correlated with age, size of the primary tumour, infiltration of thyroid gland capsule, positive lymphangioinvasion in order to assess risk factors. Method: We analysed group of 156 patients with papillary carcinoma, who have undergone total thyroidectomy and bilateral elective central compartment neck dissection. We evaluated the occurrence of metastases, size, infiltration and lymphangioinvasion based on definitive histology of the whole group and separately for subgroups of patients under and over 45 years. Result: We found metastatic involvement in 88 (56.4%) patients. When comparing the subgroups of patients under (73 patients) and over 45 years (83 patients), we found metastases in 56 vs. 32 (76.7% vs. 38.6%) patients. In the subgroup of younger patients we found significant higher incidence of metastases compared with the group of over 45 years, P < 0.001 (P = 0.000027). We found significant higher incidence of metastases in patients with positive capsule infiltration in the whole group, P < 0.001 (P = 0.00049); in the subgroup of under 45 years, P < 0.001 (P = 0.00091) and in patients with positive lymphangioinvasion in the whole group, P < 0.01 (P = 0.00177); in the subgroup of over 45 years, P < 0.001 (P = 0.0002). In patients with metastases we found tumour size ≥1cm more frequently in all groups. Conclusion: We recorded higher incidence of regional metastases in patients under 45 years, positive capsule infiltration, lymphangioinvasion. Age under 45 years itself does not correlate with less aggressive disease, to the contrary some of other analysed risk factors correlate with more aggressive disease.

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