EndocrineIncidence of metastases from 524 patients with papillary thyroid carcinoma in cervical lymph nodes posterior to the sternoclavicular joint (level VIa): Relevance for endoscopic thyroidectomy
Section snippets
Patients
A retrospective analysis was performed by the use of data collected prospectively from the database of the Head and Neck Surgery Department in Sir Run Run Shaw Hospital, Medical School of Zhejiang University. The study cohort comprised 524 consecutive patients scheduled to undergo standard, open transcervical thyroidectomy for primary PTC from January 2012 to December 2013. This study was approved by the Ethical Committee of Sir Run Run Shaw Hospital, Medical School of Zhejiang University. The
Patient characteristics
The 524 patients who underwent initial thyroidectomy for PTC included 128 men and 396 women, with a mean age of 43.6 years (range, 11–76) at time of first diagnosis. All patients were diagnosed with primary PTC by frozen section examination intraoperatively, with concomitant Hashimoto thyroiditis found in 54 patients. Overall, 3 different operative procedures were performed: (1) lobectomy (including isthmectomy and pyramidal lobectomy) with ipsilateral CND (right 157 patients, and left 137
Discussion
The role of CND (especially prophylactic) in primary surgery for PTC with cN0 is controversial. The consensus among surgeons in mainland China suggests that prophylactic CND (pCND) is indicated during the initial thyroidectomy.14 Major reasons include the following: (1) the estimated incidence of metastasis of the central lymph nodes has been reported to vary from 20 to 90%.15, 16 In our study, central lymph node metastases were confirmed in almost 50% of our 524 patients; these involved lymph
References (37)
- et al.
Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis
Surgery
(2010) - et al.
A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer
Surgery
(2011) - et al.
Scarless endoscopic thyroidectomy: breast approach for better cosmesis
Surg Laparosc Endosc Percutan Tech
(2000) - et al.
Endoscopic thyroidectomy by the axillary approach
Surg Endosc
(2001) - et al.
Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation
Surg Endosc
(2002) - et al.
Endoscopic thyroid surgery through the axillo-bilateral breast approach
Surg Laparosc Endosc
(2003) - et al.
Comparative study of thyroidectomies: endoscopic surgery vs conventional open surgery
Surg Endosc
(2002) - et al.
Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report
Surg Endosc
(2010) - et al.
Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma: a preliminary report
Surg Endosc
(2011) - et al.
Robotic modified radical neck dissection by bilateral axillary breast approach for papillary thyroid carcinoma with lateral neck metastasis
Head Neck
(2015)
Consensus statement on the terminology and classification of central neck dissection for thyroid cancer
Thyroid
Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer
Thyroid
The continuing development of the technique of thyroidectomy
Surgery
Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection
Ann Surg
Management guidelines for patients with thyroid nodules and differentiated thyroid cancer (2012 Chinese edition)
Chinese J Clin Oncol
Early diagnosis by genetic analysis of differentiated thyroid cancer metastases in small lymph nodes
J Clin Endocrinol Metab
Management guidelines for patients with thyroid nodules and differentiated thyroid cancer
Thyroid
Supported by the major science and technology project of Zhejiang Province (grant no. 2012C13020-1), the Natural Science Foundation of Zhejiang Province (grant no. Y2110461), and the key project from the Health and Family Planning Commission of Zhejiang Province (grant no. 2015101112).