ABSTRACT
The incidence of thyroid cancer has increased all over the world in recent years,which has become a hot issue of widespread concern.Surgery is an important means for the treatment of thyroid cancer.Standard surgical treatment can effectively improve the prognosis and quality of life of patients,while non-standard surgical treatment can increase the risk of recurrence,reduce the survival rate,and bring serious physiological,psychological and economic burden to patients.In order to standardize the diagnosis and treatment of thyroid cancer and improve the prognosis of patients,many guidelines have been issued at home and abroad.With the application of new therapies and the emergence of new clinical evidences,guidelines are constantly updated in various countries,the most representative of which are the guidelines issued by the American Thyroid Association and the National Comprehensive Cancer Network.In the past,surgeons paid more attention to the European and American guidelines,but little was known about the treatment of thyroid cancer in neighbouring Japan. Following the publication of the first edition of Japanese Clinical Practice Guidelines for Thyroid Tumors in 2010,Japan formally released a revised edition of the old edition of the guidelines in 2018. Compared with the old version,the recommendations of the new version are more comprehensive and accurate,including risk stratification of papillary cancer and indications of primary lesion resection and lymph node dissection in patients with different risk stratification,principles of primary and complementary surgery for follicular carcinoma of different histological types,and principles of treatment for hereditary and sporadic medullary carcinoma,etc.
ABSTRACT
OBJECTIVE: To explore the clinical characteristics,and discuss the prevention of lateral neck lymph node reoperation.METHODS: The clinical data of 31 cases of lateral neck lymph node reoperation performed between January2013 and December 2017 in the First Affiliated Hospital of China Medical University were analyed retrospectively.RESULTS: All 31 patients accepted 1 to 3 times lateral neck lymph node dissection,but the extent of lymph node dissection was not described enough clear in 17 cases. Twenty-four of 31 cases were found within 12 months from last operation to abnormal lymph nodes. In imaging diagnosis,the rate of metastasis in level Ⅳ was 58.1%,level Ⅱ(outside the outer edge of internal jugular vein)was 41.9%,trigonum caroticum and level Ⅲ(outside the outer edge of internal jugular vein)were 22.6%,lymph node between sternocleidomastoid and sternohyoid muscle(LNSS)was 12.9%. In pathology after surgery the rate of metastasis at levels Ⅱ,Ⅲ,Ⅳ,Ⅴb,LNSS was 64.0%,81.8%,68.4%,8.3%,13.6% respectively.CONCLUSION: The imaging assessment has significant effects on lateral neck lymph node dissection,within standardized procedure in surgery,which should help reduce the reoperation caused by human factor.