Surgical management of mediastinal lymph node metastasis of thyroid carcinoma / 中华内分泌外科杂志

ABSTRACT

Objective To explore the surgical technique for mediastinal lymph node metastasis of thyroid cancer.Methods We retrospectively reviewed clinical records of 46 patients with metastatic thyroid cancer in mediastinal lymph nodes and having received surgical treatment in Department of Head Neck Surgery and Thoracic Surgery of Sichuan Cancer Hospital from Feb.2004 to Apr.2015.We analyzed the diagnosis,surgical treatment methods,operative approach,and postoperative complications of these patients.Results The main metastatic region was superior mediastinum especially level 2 (2R/2L,lower parathymic lymph nodes) according to AJCC-UICC standard in 31 patients (67.39％);16 patients (34.78％) had level 3 and level 4 (4R/4L lower parathymic) lymph node netastasis and 4 patients (8.696％) had level 5 (subaortic lymph node) and level 6 (para-aortic lymph node) metastasis.39 patients were pathologically diagnosed with papillary carcinoma,6 patients were diagnosed with medullary carcinoma,and 1 patient was diagnosed with follicular carcinoma.There were 14 patients with stage Ⅰ disease,5 patients with stage Ⅱ disease,3 patients with stage Ⅲ disease,22 patients with stage Ⅳa disease,and 2 patients with stage Ⅳc disease.The most common complications were hoarseness,chylous fistula,hypocalcaemia,and airway obstruction.Patients were followed-up from 1 to 8 years.During the follow-up period,4 cases were lost to follow-up and 2 patients died.Conclusions The main treatment approach for mediastinal lymph node metastasis of thyroid cancer is surgical operation.Pre-operative CT or MRI is needed to evaluate the metastatic region of the lymph nodes and to choose appropriate operative approach.