Significance of modified radical neck dissection in papillary thyroid carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the recurrence of the neck and survival incidence of clinically possible positive lateral cervical nodes in patients with well-differentiated papillary thyroid cancer and the essentiality of the perforation of modified radical neck dissection.@*METHOD@#Retrospective datum of 267 cases of papillary thyroid carcinoma were collected and analyzed. They were divided into two groups with time; selective neck dissection with VI area was performed in 151 cases of group A and selective neck dissection was performed without VI area in 116 cased of group B. They were received the same treatment in the thyroid--total thyroidectomy on initial part and subtotal thyroidectomy on the other, and total thyroidectomy on both parts if both were invited. Incidence of positive lateral cervical nodes of VI area in group A and the recurrence in the neck and survival incidence in groups B were analyzed.@*RESULT@#Fifty nine patients in group A were treated with the modified radical neck dissection, and 22 patients of them were found metastasis in lateral cervical nodes with VI area. The other 92 patients were treated with neck dissection of II, III, IV, VI area, and 31 patients weren't metastasis, 33 patients were metastasis in both VI area and the others (35.8%), 17 patients were metastasis only in VI area (18.4%), 11 patients weren't metastasis only in VI area (11.9%). Thus, the incident of metastasis in VI area was 47.70% in group A (72/151). 47 patients in group B had metastasis in lateral cervical nodes though without performing VI area neck dissection (40.5%), and the survival rate of 5 years was 99.3%. The recurrence rate in the neck of group two was 6.0% (7/116). The metastasis rate of neck lymph node was higher in group A (54.9%) than group B (40.5%).@*CONCLUSION@#Pretracheal and peripheral recurrent nerve lymph node are very susceptible to the metastasis of well-differentiated papillary thyroid cancer. The neck dissection of VI area could be performed as routine.

Clinical research on 2228 cases of thyroid gland tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss outcome of thyroid tumor patients treated with surgery.</p><p><b>METHODS</b>Total number of patients was 2228. These patients of thyroid tumors from 1992-2004 (2072 cases of benign thyroid diseases and 156 cases of thyroid carcinoma) were recruited. The clinical and follow-up datum were retrospective analyzed.</p><p><b>RESULTS</b>(1) Benign thyroid tumors with near-total thyroidectomy including 1761 thyroid adenoma, 207 nodular goiter and 104 Hashimoto thyroiditis, the incidence of recurrent laryngeal nerve paralysis was 0.2%, 55 cases (2.6%) received secondary surgery. All the patients have no hypocalcemia or hemorrhage after operation. (2) Eighty-one cases of papillary carcinoma of the thyroid ( > 1 cm) and 60 cases of microcarcinoma. Unilateral thyroidectomy, contralateral near-total thyroidectomy and ipsilateral modified neck dissection were performed in unilateral papillary carcinoma of thyroid. Among the 9 cases of follicular carcinoma of thyroid, 7 were performed of near-total thyroidectomy without neck dissection, others were the same as papillary carcinoma. Bilateral total thyroidectomy and bilateral modified neck dissection were performed in 2 cases of the medullary thyroid cancer and 1 case of the undifferentiated thyroid cancer. By direct method the 5-year survival was 95.5% (64/67), and by Kaplan-Meier method, it was 98.0%. The treatment of microcarcinoma are multiple. There is no relapse or metastases in 60 cases of papillary thyroid microcarcinoma. The 5-year survival was 100.0%, 1 cases occurred recurrent laryngeal nerve paralysis in thyroid cancer. No hypocalcemia or hemorrhage. Eight case relapsed in 156 cases of thyroid carcinoma,3 cases died.</p><p><b>CONCLUSION</b>The correct surgical management for the patients with thyroid tumor should benefit for the prognosis and reduce the complications and the recurrence of the operation.</p>