Dissection of lymph node posterior to right recurrent laryngeal nerve in the operation of papillary thyroid carcinoma / 中华内分泌外科杂志

ABSTRACT

Objective:To investigate the risk factors associated with lymph node posterior to right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC) , and analyze the clinical value of surgical dissection of LN-prRLN.Methods:Clinical data of 140 PTC patients admitted to the same treatment group from Jun. 2014 to Oct. 2015 (all patients underwent LN-prRLN area dissection, group A) were retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were used to analyze high-risk factors for LN- prRLN metastasis, and another 171 cases without LN-prRLN area dissection (group B) were collected as the control group. The total number of lymph nodes dissected in the central area on the right was compared to analyze the proportion of lymph nodes in the LN-prRLN area.Results:Of the 140 patients in group A, the right cervical lymph node metastasis rate was 64.3% (90/140) , the central zone lymph node metastasis rate was 63.6% (89/140) , and the LN-prRLN regional lymph node metastasis rate was 17.9% (25/140) . Univariate analysis showed that tumors>1 cm, multiple tumors, capsule invasion, clinical lymph node staging cN1,VI-1 and cervical lymph node metastasis were correlated with LN-prRLN metastasis ( P<0.05) . Multivariate analysis showed that capsule invasion ( OR=4.599, P=0.037) and cervical lymph node metastasis ( OR=3.505, P=0.036) were risk factors for LN-prRLN metastasis. By comparison with the control group, the total number of lymph node dissections in the right central area of group B was significantly less than that of group A ( P<0.01) . Conclusions:PTC patients have a high rate of lymph node metastasis in the right central area, and lymph nodes in the LN-prRLN area occupy a certain proportion. RN-prRLN should be routinely cleaned to ensure the completeness and thoroughness of the dissection, and to minimize the possibility of performing a second operation due to recurrence of residual lymph nodes after operation. More importance should be attached to LN-prRLN dissection when the tumor is more than 1 cm, the tumor is multiple, the capsule is invaded, in clinical lymph node stage cN1, VI-1 and with cervical lymph node metastasis.