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Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

  • Fayek, Ihab Samy (Department of Surgical Oncology, National Cancer Institute, Cairo University) ;
  • Kamel, Ahmed Ahmed (Department of Otorhinolaryngology, National Cancer Institute, Cairo University) ;
  • Sidhom, Nevine FH (Department of Surgical Pathology, National Cancer Institute, Cairo University)
  • Published : 2016.01.11

Abstract

Purpose: To study the safety of prophylactic level VII nodal dissection regarding hypoparathyroidism (temporary and permanent) and vocal cord dysfunction (temporary and permanent) and its impact on disease free survival. Materials and Methods: This prospective study concerned 63 patients with papillary thyroid carcinoma with N0 neck node involvement (clinically and radiologically) in the period from December 2009 to May 2013. All patients underwent total thyroidectomy and prophylactic central neck dissection including levels VI and VII lymph nodes in group A (31 patients) and level VI only in group B (32 patients). The thyroid gland, level VI and level VII lymph nodes were each examined histopathologically separately for tumor size, multicentricity, bilaterality, extrathyroidal extension, number of dissected LNs and metastatic LNs. Follow-up of both groups, regarding hypoparathyroidism, vocal cord dysfunction and DFS, ranged from 6-61 months. Results: The mean age was 34.8 and 34.3, female predominance in both groups with F: M 24:7 and 27:5 in groups A and B, respectively. Mean tumor size was 12.6 and 14.7mm. No statistical differences were found between both groups regarding age, sex, bilaterality, multicentricity or extrathyroidal extension. The mean no. of dissected level VI LNs was 5.06 and 4.72 and mean no. of metastatic level VI was 1 and 0.84 in groups A and B, respectively. The mean no. of dissected level VII LNs was 2.16 and mean no. of metastatic LNs was 0.48. Postoperatively temporary hypoparathyroidism was detected in 10 and 7 patients and permanent hypoparathyroidism in 2 and 3 patients; temporary vocal cord dysfunction was detected in 4 patients and one patient, and permanent vocal cord dysfunction in one and 2 patients in groups A and B, respectively. No significant statistical differences were noted between the 2 groups regarding hypoparathyroidism (P=0.535) or vocal cord dysfunction (P=0.956). The number of dissected LNs at level VI only significantly affected the occurrence of hypoparathyroidism (<0.001) and vocal cord dysfunction (<0.001).The DFS was significantly affected by bilaterality, multicentricity and extrathyroidal extension. Conclusions: Level VII nodal dissection is a safe procedure complementary to level VI nodal dissection with prophylactic central neck dissection for papillary thyroid carcinoma.

Keywords

Papillary thyroid carcinoma;prophylactic central neck dissection;level VI lymph nodes;level VII

References

  1. American Thyroid Association Surgery Working, Carty S, Cooper D, et al (2009). Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid, 19, 1153-8. https://doi.org/10.1089/thy.2009.0159
  2. Barczynski M, Konturek A, Stopa M, et al (2013). Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg, 100, 410-8. https://doi.org/10.1002/bjs.8985
  3. Chen Q, Zou X, Wei T, et al (2015). Prediction of ipsilateral and contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma: a retrospective study. Gland Surg, 4, 288-94.
  4. Choi J, Choi Y, Park Y, et al (2011). Experience and analysis of level VII cervical lymph node metastases in patients with papillary thyroid carcinoma. J Korean Surg Soc, 80, 307-12. https://doi.org/10.4174/jkss.2011.80.5.307
  5. Choi Y, Yun J, Kook S, et al (2010). Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas. World J Surg, 34, 1494-9. https://doi.org/10.1007/s00268-010-0541-1
  6. Cisco R, Shen W, and Gosnell J (2012). Extent of surgery for papillary thyroid cancer: preoperative imaging and role of prophylactic and therapeutic neck dissection. Curr Treat Options Oncol, 13, 1-10. https://doi.org/10.1007/s11864-011-0175-z
  7. Costa S, Giugliano G, Santoro L, et al (2009). Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital, 29, 61-9.
  8. Crile G (1956). the pattern of metastasis of carcinoma of the thyroid. Ann Surg, 143, 580-7. https://doi.org/10.1097/00000658-195605000-00004
  9. Dralle H (2012). Postoperative hypoparathyroidism: central neck dissection is a significant risk factor, Chirurg, 83, 1082. https://doi.org/10.1007/s00104-012-2400-0
  10. Dralle H (2013). Prophylactic central lymph node dissection improves prognosis for papillary thyroid cancer. Chirurg, 84, 149. https://doi.org/10.1007/s00104-012-2463-y
  11. Fayek I (2015). Prophylactic level VII nodal dissection as a prognostic factor in papillary thyroid carcinoma: a pilot study of 27 patients. Asian Pac J Cancer Prev, 16, 4211-4. https://doi.org/10.7314/APJCP.2015.16.10.4211
  12. Giordano D, Valcavi R, Thompson G, et al (2012). Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid, 22, 911-7. https://doi.org/10.1089/thy.2012.0011
  13. Grebe S and Hay I (1996). Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am, 5, 43-63.
  14. Grubbs E, Rich T, Li G, et al (2008). recent advances in thyroid cancer. Curr Probl Surg, 45, 156-250. https://doi.org/10.1067/j.cpsurg.2007.12.010
  15. Hughes C, Shaha A, Shah J, et al (1996). Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched pair analysis. Head Neck, 18, 127-32. https://doi.org/10.1002/(SICI)1097-0347(199603/04)18:2<127::AID-HED3>3.0.CO;2-3
  16. Hughes D and Doherty G (2011). Central neck dissection for papillary thyroid cancer, Cancer Control, 18, 83-8. https://doi.org/10.1177/107327481101800202
  17. Lee D, Oh K, Cho J, et al (2015). The benefits and risks of prophylactic central neck dissection for papillary thyroid carcinoma: prospective cohort study. Int J Endocrinol, 2015, 1-6.
  18. Lee Y, Kim S, Kim S, et al (2007). Extent of Routine Central Lymph Node Dissection with Small Papillary Thyroid Carcinoma. World J Surg, 31, 1954-9. https://doi.org/10.1007/s00268-007-9171-7
  19. Mazzaferri E and Jhiang S (1994). Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med, 97, 418-28 https://doi.org/10.1016/0002-9343(94)90321-2
  20. Moo T, Umunna B, Kato M, et al (2009). Ipsilateral versus bilateral central neck lymph node dissection in papillary thyroid carcinoma. Ann Surg, 250, 403-8.
  21. Mulla M (2012). Central cervical lymph node metastases in papillary thyroid cancer: a systematic review of imagingguided and prophylactic removal of the central compartment. Clin Endocrinol, 76, 131-6. https://doi.org/10.1111/j.1365-2265.2011.04162.x
  22. Pacini F, Schlumberger M, Dralle H, et al (2006). European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol, 154, 787-803. https://doi.org/10.1530/eje.1.02158
  23. Pereira J, Jimeno J, Miquel J, et al (2005). Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surg, 138, 1095-1100. https://doi.org/10.1016/j.surg.2005.09.013
  24. Popadich A, Levin O, Lee J, et al (2011). A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. J Surg, 150, 1048-57.
  25. Ramirez-Plaza C (2015). Central neck compartment dissection in papillary thyroid carcinoma: An update. World J Surg Proced, 5, 177-186. https://doi.org/10.5412/wjsp.v5.i2.177
  26. Roh J, Kim J and Park C (2011). Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol, 18, 2245-50. https://doi.org/10.1245/s10434-011-1600-z
  27. Roh J, Park J and Park C (2007). Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg, 245, 604-10. https://doi.org/10.1097/01.sla.0000250451.59685.67
  28. Scheumann G, Gimm O, Wegener G, et al (1994). Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg, 18, 559-68. https://doi.org/10.1007/BF00353765
  29. Siegel R, Naishadham D, Jemal A (2013). Cancer statistics. CA Cancer J Clin, 63, 11-30. https://doi.org/10.3322/caac.21166
  30. So Y, Seo M and Son Y (2012). Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surg, 151, 192-8. https://doi.org/10.1016/j.surg.2011.02.004
  31. Sywak M, Cornford L, Roach P, et al (2006). Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surg, 140, 1000-5. https://doi.org/10.1016/j.surg.2006.08.001
  32. Tartaglia F, Blasi S, Giuliani A, et al (2014). Central neck dissection in papillary thyroid carcinoma: Results of a retrospective study. Int J Surg, 12, 57-62.
  33. Wang L, Versnick M, Gill A, et al (2013). Level VII is an important component of central neck dissection for papillary thyroid cancer. Ann Surg Oncol, 20, 2261-5. https://doi.org/10.1245/s10434-012-2833-1
  34. White M, Gauger P and Doherty G (2007). Central lymph node dissection in differentiated thyroid carcinoma. World J Surg, 31, 895-904. https://doi.org/10.1007/s00268-006-0907-6
  35. Zuniga S and Sanabria A (2009). Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg, 135, 1087-91. https://doi.org/10.1001/archoto.2009.163