Risk factors for lymph node metastasis and surgical scope in patients with cN0 non-small cell lung cancer: a single-center study in China.

BACKGROUND: It is difficult to determine the lymph node metastasis of patients with clinically negative lymph nodes (cN0) non-small cell lung cancer (NSCLC) before surgery. The purpose of this study is to investigate risk factors of lymph node metastasis in cN0 NSCLC, thereby to identify the surgical indications for lymph node dissection in cN0 NSCLC. METHODS: We conducted a retrospective study of patients with tumor size ≤ 30 mm who underwent radical resection of NSCLC. Binary logistic regression analysis was applied to predict risk factors for lymph node metastasis, and subject operating characteristics (ROC) curve was used to evaluate the independent risk factors. RESULTS: Overall, 44 patients (6.8%) with cN0 NSCLC had lymph node metastasis. Factors of tumor consolidation diameter (p < 0.001) and preoperative serum carcinoembryonic antigen (CEA) level (p = 0.017) are independent risk factors lymph node metastasis in cN0 NSCLC. The ROC curve showed that the cut-off value of consolidation diameter was 16.5 mm, and the area under the curve (AUC) was 0.825 (p < 0.001, 95% CI 0.780-0.870); the cut-off value of serum CEA level was 1.765 µg/L, and the AUC was 0.661 (p < 0.001, 95% CI: 0.568-0.754). Moreover, 8 of 461 patients with tumor parenchyma ≤ 16.5 mm had lymph node metastasis, and 36 of 189 patients with tumor parenchyma > 16.5 mm had lymph node metastasis. CONCLUSION: Tumor consolidation diameter and preoperative serum CEA are independent factors to predict cN0 NSCLC with tumor size ≤ 30 mm. For patients with tumor parenchyma > 16.5 mm, the probability of lymph node metastasis is higher and lymph node dissection is recommended. For patients with tumor parenchyma ≤ 16.5 mm, the probability of lymph node metastasis is lower and lymph node sampling is feasible.

Risk factors and clinical indication of metastasis to lymph nodes posterior to right recurrent laryngeal nerve in papillary thyroid carcinoma: a single-center study in China.

BACKGROUND: Lymph nodes posterior to right recurrent laryngeal nerve (PRRLN) may be frequently overlooked during central compartment dissection (CCD) for papillary thyroid carcinoma (PTC). The purpose of this study was to investigate risk factors of lymph node PRRLN metastasis in right-sided PTC, thereby to identify the indications for lymph node PRRLN dissection. METHODS: We conducted a retrospective study of patients with right-sided PTC who underwent a thyroidectomy plus lymph node PRRLN dissection during ipsilateral CCD. RESULTS: Overall, 108 patients (26.7%) had lymph node PRRLN metastases, including 26 (6.4%) who presented with solely lymph node PRRLN positivity. Factors of extrathyroidal extension, multifocality, larger tumor (≥1 cm), level VIa positivity (p < .0001 for each), and lateral compartments positivity (p = .0002) significantly predicted lymph node PRRLN metastasis in right-sided PTC. CONCLUSION: Lymph node PRRLN should be routinely explored during CCD because of the possibility of only involvement in PTC. Factors of tumors larger than 1 cm, multifocality, and extrathyroidal extension were independent predictors of lymph node PRRLN metastasis in right-sided PTC, and suggested the clinical indications of lymph node PRRLN dissection.

Prospective analysis of the risk factors and clinical indications of dissection of lymph node posterior to right recurrent laryngeal nerve in 283 cases of papillary thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the risk factors for metastasis and clinical indications for dissection of lymph node posterior to right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC).</p><p><b>METHODS</b>A prospective analysis including 283 consecutive patients with PTC who underwent total thyroidectomy with routine central lymph node dissection (CLND) in our hospital from Jan. 2010 to Jan. 2012 was performed. The right paratracheal lymph nodes in the central compartment lymph nodes (CCLN) were divided into the anterior (level VIa) and posterior (level VIb) compartments by recurrent laryngeal nerve (RLN), and were removed respectively. The complications and recurrences were recorded with a follow-up of 3 months to 3 years.</p><p><b>RESULTS</b>CCLN metastases were present in 47.7% (135/283) of the patients, and level VIb metastases were present in 27.2% (77/283) of the patients. The incidence of level VIb metastasis was 20.5% (58/283) in level VIa-positive patients, while 6.7% (19/283) in level VIa-negative patients. Complications of level VIb dissection were found in 4.9% (14/283) of all patients. 2.1% (6/283) of all patients were diagnosed with regional recurrence during the 3-year follow-up. Univariate analysis revealed that level VIb metastasis was significantly associated with tumor size, number, extrathyroidal invasion, clinical nodal stage, level VIa and lateral lymph node metastases. Multivariate analysis revealed that tumor larger than 1 cm, multifocality, extrathyroidal invasion, level VIa and lateral lymph node metastases were independent risk factors for level VIb metastasis.</p><p><b>CONCLUSIONS</b>Lymph node posterior to right recurrent laryngeal nerve can be the only site of metastasis from PTC without other cervical compartment involvements. Therefore, routine intraoperative detection of these nodes may be necessary for patients with right PTC, and dissection should be considered when a right-side PTC tumor is larger than 1 cm, multifocality, with extrathyroidal invasion or cervical nodal metastases.</p>

Variation of recurrent laryngeal nerve found in thyroid surgery / 中华普通外科杂志

Objective To summarize the anatomic variations of recurrent laryngeal nerve (RLN during thyroid surgery and to investigate the technical key points for identification and preservation of the nerve.Methods Clinical data of 1548 consecutive patients undergoing thyroid operation with intraoperative routine exposure of RLN from June 2010 to June 2012 was retrospectively analyzed.Results In this series,2620 RLNs at risk were clearly exposed and identified during a total of 1548 thyroid operations,wherein complete dissection was performed on 1886 nerves.Injury occurred in 11 of 2620 (0.42％) nerves.Through the analysis of all 2620 RLNs,conditional variations were found in 64 nerves.Of 1886 RLNs that were completely dissected,421 (22.3％)nerves presented with natural variations of six patterns,including morphological branching variation in 126 (6.68％) nerves,course and location variation in 124 (6.57％)nerves,variation in relationship with inferior thyroid artery (ITA)in 36 (1.91％)nerves,variation at the Berry ligament in 112 (5.94％) nerves,variation at the cricothyroid joint in 17 (0.80％) nerves,and 6 (0.32％)cases of non-recurrent laryngeal nerve (nRLN).Conclusions Variations in RLN found during thyroid surgery are of relatively high incidence,complex and diverse,which can be a potential reason of nerve injury due to visual misidentification.Thus,a thorough knowledge of the normal anatomy of RLN and its anatomic variations ensures a safe and effective thyroid surgery.