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Objective:To explore the risk factors affecting central lymph node metastasis in cN0 isthmus papillary thyroid carcinoma and the significance and feasibility of preventive dissection, so as to provide reference for clinical treatment.Methods:The clinical data of 108 patients with cN0 stage isthmus papillary thyroid cancer who underwent surgery in the General Surgery Department of Lianyungang Oriental Hospital from January 2014 to December 2021 were retrospectively analyzed. There were 32 males and 76 females, with an age range of 24 to 70 years, with a mean age of (46.0±12.7) years. Statistical analysis was performed using the SPSS 22.0 statistical software. Chi-square test and logistic regression were used to analyze the relationship between central lymph node metastasis and patients Relationship between clinical case factors.Explore the feasibility of preventive cleaning.Results:The positive rate of lymph node metastasis in central region of isthmic papillary thyroid carcinoma was 37.9% (41/108). Univariate analysis showed that central lymph node metastasis was associated with tumor diameter ( χ2=5.36, P=0.021), capsular infiltration ( χ2=7.69, P=0.006), and elevated thyroglobulin ( χ2=7.73, P=0.005). Multivariate analysis showed that capsular infiltration ( HR=2.75, P=0.037) and tumor diameter ( HR=4.454, P=0.004) were independent risk factors for central lymph node metastasis. The ROC curve of tumor diameter to predict central lymph node metastasis was drawn, and the AUC value of the area under the curve was calculated to be 0.720. When the diameter was 0.695 cm, the Youden index was 0.326, the sensitivity was 0.878, and the specificity was 0.448. 6 cases (5.56%) had temporary recurrent laryngeal nerve palsy, 13 cases (12.04%) had temporary hypoparathyroidism, no permanent complications occurred. Conclusions:cN0 stage PTCI has the risk of early occult lymph node metastasis. Prophylactic CLND can clarify the stage of the tumor, assess the risk, and guide the follow-up treatment of patients. CLND should be routinely performed for patients with tumor diameter >0.695 cm and capsular invasion.
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OBJECTIVE: To explore the pathogeny, the clinical characteristics, diagnosis and treatment of chylous leakage after thyroid cancer surgery with central lymph node dissection(CLND). METHODS: The clinical data of 14 cases of chylous leakage after thyroid cancer surgery with CLND admitted in the Department of Thyroid Surgery, the First Hospital of China Medical University between December 2011 and February 2017 were analyzed retrospectively.RESULTS: The incidence of chylous leakage was 0.5%. It occurred in the median of postoperative 1.5 days(range 1 to 2). The median volume of peak drainage before chylous leakage was 49 mL(range 30 to 76). When it happened, the volume increased. The median volume of the maximum drainage after surgery was 57.5 m L(range 30 to 135). Chylous fistula occurred after left CLND in 3 cases(21.4%). Right CLND in 8 cases(57.2%), in which 4 cases had rⅥb lymph node dissection. Bilateral CLND in 3 cases(21.4%, which did not have rⅥb lymph node dissection). The number of dissected lymph node were 0 to 14. After chylous leakage happened, 2 cases were cured by low fat diet and 7 cases were cured by water fasting. The remaining 5 cases had poor effect of adjusting diet. They recovered with continuous low negative pressure drainage. The median healing time was 3 days(range 1 to 8). CONCLUSION: The incidence of chylous leakage after thyroid cancer surgery with CLND is low. Chylous leakage should be watch out after CLND, when drainage increases abnormally or the liquid property change. It can be treated by diet adjustment and continuous suction in a very short time.
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Objective: To evaluate central lymph node dissection (CLND) and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma (PTMC). Methods: Clinical data and neck lymph node metastasis of 187 PTMC patients treated by the same surgeon from October 2012 to November 2015 in Department of Endocrine Breast Surgery, First Affiliated Hospital of Chongqing Medical University were analyzed retrospectively. Results: Postoperative pathology inspection confirmed that 94 of the 187 patients were accompanied with lymph node metastasis in central region, and the metastasis rate was 50.2%. Furthermore, lymph node metastasis rate in central region was not associated with gender and age (P>0.05), but the metastasis rates of the patients with multifocal lesion, tumor diameter greater than 5 mm, capsular invasion, or tumor location in the lower third of thyroid lobe were higher (P<0.05). Twenty-two cases of the 69 patients who underwent CLND were confirmed to have lymph node metastasis in this region. When the number of lymph node metastases in the central region was greater than or equal to 2, the cases were accompanied by increased risk of lymph node metastasis in the cervical region (P<0.05). The diagnosis level of lymph node metastasis in central region by intraoperative frozen-section examination was relatively higher than current cervical lymph node-negative (cN0) standard (P<0.05), which had lower false negative rate (20.2%) than current cN0 standard (88.8%) and was highly consistent with the postoperative pathology in central lymph node metastasis diagnosis (K=0.765, P=0.000). Conclusion: PTMC has high lymph node metastasis rate in the central region. Regular CLND is recommended. Intraoperative frozen-section examination can accurately evaluate cervical lymph node metastasis to help guide operation scope of thyroid and cervical lymph nodes.
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Objective·To evaluate central lymph node dissection (CLND) and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma (PTMC).Methods· Clinical data and neck lymph node metastasis of 187 PTMC patients treated by the same surgeon from October 2012 to November 2015 in Department of Endocrine Breast Surgery,First Affiliated Hospital of Chongqing Medical University were analyzed retrospectively.Results · Postoperative pathology inspection confirmed that 94 of the 187 patients were accompanied with lymph node metastasis in central region,and the metastasis rate was 50.2％.Furthermore,lymph node metastasis rate in central region was not associated with gender and age (P＞0.05),but the metastasis rates of the patients with multifocal lesion,tumor diameter greater than 5 mm,capsular invasion,or tumor location in the lower third of thyroid lobe were higher (P＜0.05).Twenty-two cases of the 69 patients who underwent CLND were confirmed to have lymph node metastasis in this region.When the number of lymph node metastases in the central region was greater than or equal to 2,the cases were accompanied by increased risk of lymph node metastasis in the cervical region (P＜0.05).The diagnosis level of lymph node metastasis in central region by intraoperative frozen-section examination was relatively higher than current cervical lymph node-negative (cN0) standard (P＜0.05),which had lower false negative rate (20.2％) than current cN0 standard (88.8％) and was highly consistent with the postoperative pathology in central lymph node metastasis diagnosis (K=0.765,P=0.000).Conclusion· PTMC has high lymph node metastasis rate in the central region.Regular CLND is recommended.Intraoperative frozen-section examination can accurately evaluate cervical lymph node metastasis to help guide operation scope of thyroid and cervical lymph nodes.
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Objective To assess the significance of the right paraesophageal node(Ⅵb area) dissection in cN0 stage papillary thyroid microcarcinoma(PTMC)central lymph node dissection.Methods The clinical data of three hundred and five cN0 PTMC patients who underwent radical thyroidectomy from 2010 to 2015 was retrospectively analyzed.The metastasis rate of central compartment(Ⅵa area.Ⅵb area)and the clinical data were collected and analyzed.Results 305 cN0 stage PTMC patients underwent total thyroidectomy and bilateral central compartment dissection or right lobectomy combined with ipsilateral central compartment dissection,the mean diameter of the tumors was 6.75 mm.The incidence rate of central compartment metastasis was 35%.The incidence rate ofⅥb area metastasis was 11.1%.The status ofⅥb area metastasis was correlated with major clinicopathologic parameters such as sex,age<45,tumor diameter≥0.8 cm,bilateral multiple lesions, capsule invasion,VI a lymph node metastasis≥3 were all related risk factors of PTMC VIb area metastasis(χ2=6.913,4.241,4.517,5.185,12.400,34.745,P<0.05).Conclusion Because of the high rate of central lymph node metastasis in patients with PTMC and the poor efficiency in the evaluation for central lymph node metastasis before operation,the right paraesophageal lymph nodes(Ⅵb area)dissection is needed to be done in cN0 stage PTMC patients with tumor size≥0.8 cm,multifocal lesions,membrane invasion,Ⅵa area metastasis≥3,especially male patients.
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PURPOSE: The use of sealing devices such as Harmonic scalpel and Ligasure is increasing steadily in thyroid surgery. The Harmonic Focus (HF) is an ultrasonic device that enables simultaneous vessel sealing and tissue coagulation, designed for open surgery such as thyroidectomy. The aim of this study is to assess the efficiency and safety of HF use in thyroid surgery compared to Conventional Tying (CT). METHODS: A prospective study was conducted to compare the efficacy of HF versus CT. We evaluated 50 patients who underwent surgery for thyroid tumor at Korea University Anam Hospital. All patients underwent total thyroidectomy with central neck dissection after being randomly allocated into two groups: HF group and CT group. The differences in surgical outcomes and postoperative complications by device use, i.e. group assignment, were statistically analyzed. RESULTS: There were no differences in number of retrieved lymph nodes (P=0.595), number of resected parathyroid glands (P=0.330), immediate postoperative iPTH (P=0.252), length of hospitalization (P=0.375) between HF group and CT group. However, operative time was shorter in HF group than CT group (106.07±20.92 min vs. 136.54±38.24 min, P=0.046). Postoperative complications of wound infection, seroma, hematoma, chyle leakage, vocal cord palsy, and hypoparathyroidism did not differ between groups. CONCLUSION: HF is a safe, effective, and time-saving technique; outcomes are comparable with CT. Both intraoperative and postoperative variables were similar between groups. Future larger studies are warranted to further investigate the effect on postoperative complications.
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Humans , Chyle , Hematoma , Hospitalization , Hypoparathyroidism , Korea , Lymph Nodes , Neck Dissection , Neck , Operative Time , Parathyroid Glands , Postoperative Complications , Prospective Studies , Seroma , Thyroid Gland , Thyroidectomy , Ultrasonics , Vocal Cord Paralysis , Wound InfectionABSTRACT
Objective:To analyze the factors related to metastasis of contralateral central lymph node (CLN) in cN0 papillary thyroid car-cinoma (PTC) and discuss the indications for CLN dissection. Methods:We enrolled 149 unilateral PTC patients who underwent total thyroidectomy and prophylactic bilateral (CLN) dissection. This work analyzed the relationship of gender, age, extrathyroidal extension, multifocality, thyroiditis, ipsilateral central lymph nodes, and prelaryngeal lymph node with CLNs. Results:The rates of metastasis to ip-silateral and contralateral central compartments were 73.2%and 23.5%, respectively. In univariate analysis, gender, age, tumor size, multifocality, and thyroiditis were not important in predicting contralateral central compartment lymph node metastasis (P=0.792, 0.097, 0.531, 0.269, and 1.000, respectively);by contrast, extrathyroidal extension (P=0.017), prelaryngeal lymph nodes (P=0.006), and ipsilateral CLNs (P<0.001) are related to CLN metastasis. However, multivariate analysis showed that ipsilateral central metastasis was an independent risk factor for lymph node metastasis in the contralateral central region when the number of ipsilateral central metas-tases is≥3 (P=0.010). Conclusion:Extracapsular invasion, prelaryngeal lymph nodes, and ipsilateral CLN influence the metastases of CLN. Bilateral CLN dissection should be performed when the number of ipsilateral central metastases is≥3 and there is merger of ex-tra-laryngeal lymph nodes or capsule invasion.
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Objective To explore the significance of carbon nanoparticles in routine central lymph node dissection of papillary thyroid microcarcinoma (PTMC).Methods 272 cases of PTMC admitted from 2013 to 2015 were retrospectively analyzed and they were divided into two groups,the experimental group who were given carbon nanoparticles during surgery (136 cases) and the control group (136 cases) without carbon nanoparticles.The total number of central lymph nodes,number of transfer,and the black dye lymph node number and transfer number in the experimental group were recorded.The total number of lymph nodes,and number of transfer in the control group were recorded.The metastasis rate of the two groups were analyzed.The number of parathyroid mistakenly cut and hypocalcemia cases of the two groups were counted.Parathyroid function was observed by determination of Ca2+ and PTH in blood.The incidence of recurrent laryngeal nerve (RLN) injury of the two groups was compared.Results The total number of central lymph nodes was 1216 and the transfer number was 481 in the experimental group,higher than those of the control group.The positive lymph node rate of the two groups was 39.6％ and 25.9％ respectively,and the difference was statistically significant.The mumber of patients with central lymph node metastasis was 63 and 42 respectively for the experimental group and the control group,and the transfer rate was 46.3％ and 30.8％ respectively.The difference was statistically significant.The rate of parathyroid mistakenly cut was 2.6％(7/261) and 14.7％ (28/193) respectively for the experimental group and the control group,and the difference was statistically significant.The difference of Ca2+ and PTH value at 3h,6h,and 12h after surgery between the two group was statistically significant.No RLN injury occured.5 cases in the experimental and 8 cases in the control group had temporary RLN injury.The difference was not statistically significant.Conclusions The application of carbon nanoparticles in PTMC surgery can help to improve the thoroughness of central lymph node dissection and to protect parathyroid function.However,its benefits to protect the recurrent laryngeal is uncertain.
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Objective:To discuss the causes and effective measures of prevention and treatment of chylous fistula after central lymph node dissection (CLND) of thyroid cancer. Methods:A total of 6 127 patients who underwent CLND of thyroid cancer in the Tianjin Medical University Cancer Institute and Hospital between July 2013 and June 2015 were analyzed;of which, 14 patients acquired the complication of postoperative chylous fistula. The following conservative treatments were initially performed:systemic therapy, local pressure bandaging, normal pressure drainage, 50%glucose injection, or pingyangmycin injection through a drainage tube. Surgical op-eration was then conducted when the efficacy of the treatment was poor. Results:After the conservative treatment of the 14 patients, the drainage volume gradually decreased in 12 patients, and surgery was performed on the remaining two patients. Conclusion:The CLND of thyroid cancer must be carefully conducted to prevent postoperative chylous fistula. An active conservative treatment must be the first option when chylous fistula occurs. Surgery must only be performed if the treatment is invalid.
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BACKGROUND AND OBJECTIVES: Surgical options for low-risk papillary thyroid carcinoma (PTC) have been in debate. The purpose of this study was to analyze the treatment results of lobectomy and prophylactic ipsilateral central lymph node dissection (cND) for low-risk PTC. SUBJECTS AND METHOD: We retrospectively analyzed 906 patients who were diagnosed as PTC pre- or post-operatively and underwent lobectomy and/or prophylactic ipsilateral cND from 2001 to 2010. Studied variables were clinicopathologic data, complications, sites of recurrence, overall survival, and recurrence free survival rates. RESULTS: Fifty two (5.7%) patients showed recurrence during follow-up. Of the 52 recurrent cases, 32 (61.5%) cases recurred in a remnant thyroid only, 11 (21.2%) cases in a lymph node (LN) only, and 9 (17.3%) cases in a remnant thyroid and the LN. One (0.1%) patient showed permanent vocal cord palsy. Overall survival rate at 10 years was 99.6%. Overall recurrence free survival rates at 5 and 10 years were 97.1% and 81.0%, respectively. Risk factors for recurrences were old age (>45), contralateral nodule(s) at initial surgery, large tumor, no prophylactic cND, and pathological LN metastasis. CONCLUSION: Lobectomy with prophylactic ipsilateral cND may be a good option for low risk PTC patients due to excellent overall survival rates, recurrence rates, and minimal complication rates.
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Humans , Follow-Up Studies , Lymph Node Excision , Lymph Nodes , Neck , Neoplasm Metastasis , Recurrence , Retrospective Studies , Risk Factors , Survival Rate , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , Vocal Cord ParalysisABSTRACT
Objective To explore the value of carbon nanoparticles in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy combined with ipsilateral central lymph node dissection.Methods 43 patients with unilateral PTC were retrospectively analyzed.All patients underwent total thyroidectomy combined with central lymph node dissection.Patients were divided into carbon nanoparticles group and the control group according to whether carbon nanoparticles were used in the operation.The operation time,postoperative hospitalization time,the serum calcium level and its rate of change,the parathyroid hormone and its rate of change on the 1 st day after surgery,the number of central lymph node and the transfer rate,and the postoperative complications were compared between the 2 groups.Results There was no statistical difference between the 2 groups in operation time(P ＞ 0.05),while the postoperative hospitalization time of the carbon nanoparticles group was shorter than that of the control group(P ＜ 0.05).The serum calcium and the parathyroid hormone on the 1 st day after surgery in the carbon nanoparticles group was (2.31 ± 0.13) mmol/L and (33.45 ± 14.37) pg/ml respectively,higher than those of the control group (P ＜ 0.05).The low blood calcium rate (3/20 (15％)),the temporary hypoparathyroidism rate (2/20 (10％)) and the decline degree of parathyroid hormone (47.3 ± 14.31)％ in the carbon nanoparticles group were lower than those of the control group(P ＜0.05).The number of central lymph node dissected (9.45 ± 2.33) pieces/case in the carbon nanoparticles group was more than that of the control group (P ＜ 0.05).The number of lymph node in the right recurrent laryngeal nerve (3.12 ± 0.65) pieces/case was more than that of the control group(P ＜ 0.05).The lymph node metastasis rate had no significant difference between the 2 groups(P ＞ 0.05).The incidence of postoperative complications in the carbon nanoparticles group was lower than that of the control group (P ＜ 0.05).Conclusion The application of carbon nanoparticles in total thyroidectomy combined with central lymph node dissection can contribute to the recognition and protection of parathyroid glands and its blood supply,improve the rate of central lymph node dissection,and reduce the incidence of postoperative complications.
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Objective To investigate activated nano carbon in prophylactic central lymph node dissection of T1 papillary thyroid non-microcarcinoma.Methods Patients with T1 papillary thyroid non-microcarcinoma in Thyroid Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University undergoing surgery from Jan.2012 to Jun.2013 were divided into 2 groups:odd numbers were the experimental group,and even numbers were the control group.Activated nano carbon was injected in the affected side of the thyroid in the experimental group.The lymph node metastasis,parathyroid function,and the rate of recurrent laryngeal nerve (RLN) injury were compared between the 2 groups.Results The total number of resected lymph nodes in the experimental group and the control group were 327 and 238 respectively.The positive lymph nodes in the experimental group and the control group were 120 (36.7％)and 56 (23.5 ％)respectively.The difference had statistical significance (P =0.000 85).The number of patients with lymphatic metastasis in the experimental group and the control group was 42 (56％) and 30 (40％) respectively.The difference had statistical significance (P =0.049 9).The average number of positive lymph node for patients in the experimental group and the control group was (2.86 ± 0.13) and(1.87 ± 0.09) respectively.The difference had statistical significance(P =0.009).The rate of transient hypoparathyroidism in the experimental group and the control group was 34.7％ and 60％ respectively.The difference had statistical significance (P =0.002).The incidence of hoarseness caused by RLN injury was 2.7％ and 4％ respectively in the experimental group and the control group.The difference had no statistical significance(P =1.000).Conclusions Activated nano carbon plays an important role in prophylactic central lymph node dissection of T1 papillary thyroid non-microcarcinoma phase.It not only contributes to lymph node dissection,but also protects parathyroid.However,it can't reduce the incidence of RLN injury.
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Objective To investigate the clinical pathological factors of papillary thyroid microcarcinoma (PTMC) with clinically node-negative sides of neck stage central lymph node metastasis.Methods Analysis of 136 cases of cNo stage of PTMC of clinical and pathological data,and using the PCR method for the detection of BRAFV600E mutation in the paraffin coated tissue.Results One hundred and thirty-six cases with PTMC lymph node metastasis rate was 38.2％ (52/136),BRAFV600E mutation rate was 44.9％ (61/136).Single factor analysis showed that the lymph node metastasis was related with BRAFV600E mutation and capsular invasion (P＜ 0.05).The size of the tumor was close to significant level (P=0.057).Multiple regression analysis showed that BRAFV600E mutation and capsular invasion were independent factors for affecting the central lymph node metastasis (P ＜ 0.05).Conclusion The routine central lymph node dissection should be performed in patients with BRAFV600E mutation and tumor invasion.
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Objective To evaluate the safety of performing thyroidectomy together with central lymph node dissection(CLND). Methods Meta analysis was performed on 7 selected clinical papers using MantelHaenszel method and relative risk was calculated. Results A total of 1524 patients were eligible to be included,among whom 904 cases underwent thyroidectomy alone and 620 cases underwent total thyroidectomy combined with CLND. The risk rate of temporary hypocalcemia and temporary vocal cord palsy for CLND was 24. 77% and 9. 12% respectively, which was higher than that in performing thyroidectomy alone. However, the risk of permanent hypocalcemia and permanent vocal cord palsy had no statistic difference between the two groups. Conclusion As there is no increased morbidity of CLND, it is prudently suggested to give a prophylactic CLND for patients with high risk of thyroid papillary carcinoma.
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PURPOSE: There have been controversies on the scope of central lymph node dissection (CND) in papillary thyroid cancer (PTC). We performed this study to determine the role of CND for patients having PTC measuring 2 cm or less. METHODS: 530 cases of PTC less than 2 cm had undergone lobectomy plus isthmectomy (LI) with CND or without CND. Clinicopathologic records and clinical outcome were evaluated, retrospectively. RESULTS: Comparing recurrence rates in LI with CND group (4/174, 2.30%) and LI without CND group (16/356, 4.49%), there was no significant statistical difference in recurrence (P=0.331). We compared 20 patients with recurrences and 510 patients of no recurrence. The size of tumor seemed to influence recurrence (P<0.001) and the size of tumor developing recurrence was larger than the other (1.11 cm vs. 0.75 cm). When considering division into PTC and papillary thyroid microcarcinoma (PTMC), PTMC showed less recurrence significantly (P=0.006). No other variables such as age, sex, tumor location, extrathyroidal extension seemed to be related to the recurrence. CONCLUSION: We could not find any relevant role of CND to prevent recurrence either locally or regionally in cases of no lymph node metastasis after CND for patients having PTC measuring 2 cm or less. Moreover, prophylactic CND is not mandatory for all cases of PTC less than 2 cm.