Clinical effects of different surgical methods on papillary carcinoma of the thyroid with clinically negative lymph nodes / 中国肿瘤临床

ABSTRACT

Objective:To explore the efficacy and safety of different surgical methods in papillary thyroid carcinoma (PTC) patients with negative cervical lymph nodes (cN0) and to provide theoretical basis for the selection of surgical procedures. Methods:A total of 225 PTC cN0 patients were selected and divided into two groups according to the operation method. Only 110 patients underwent total thy-roidectomy, whereas the 115 cases in the lobectomy group underwent ipsilateral lobectomy and isthmus resection. Al patients were treated with ipsilateral central lymph node dissection. We analyzed both groups of patients in terms of surgery, hospitalization, pathological characteristics, complications, follow-up, and recurrence. Results:(1) The length of incision, blood loss, operation time, and length of stay were not significantly different between the two groups (P>0.05). (2) In the total resection group, the number of multiple foci of the cancer cases was significantly more than that of the lobectomy patients (P0.05). Between the two groups, the number of central lymph node dissection and total lymph node metastasis, and the number of cases with central lymph node metastasis were not significantly different (P>0.05). Likewise, the incidence rates of mistakenly cut parathyroid, extremely low blood calcium levels, temporary larynx return nerve paralysis, and superior laryngeal nerve injury were not significantly different between the two groups (P>0.05). No permanent hypocalcemia or permanent recurrent laryngeal nerve injury occurred. (3) All patients were followed up for 2-4.5 years. No recurrent cases were reported in the total resection group. For the lobectomy group, 8 patients with adenocarcinoma had contralateral tumor metastasis and underwent contralateral lobe resection, whereas 4 patients suffered from ipsilateral neck lymph node metastasis at the side area and underwent functional lymph node clearance. Significant differences were noted in the metastasis and recurrence rates between the two groups of patients (P<0.05). No deaths were reported during the follow-up period. Conclusion:For PTC cN0 patients, total thyroidectomy with joint ipsilateral central lymph node clearance can reduce the residual tumor, metastasis, and risk of recurrence,compared with surgery limited to the affected lobe and isthmus. Postoperative complications were not significantly increased.