Professional paper
https://doi.org/10.20471/acc.2020.59.s1.13
Total Thyroidectomy with Central Node Dissection is a Valuable Option in Papillary Thyroid Cancer Treatment
Marija Pastorčić Grgić
orcid.org/0000-0002-3405-3675
; Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumors, “Sestre milosrdnice” University Hospital Centre
Boris Stubljar
; Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumors, “Sestre milosrdnice” University Hospital Centre
Pavao Perše
; Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumors, “Sestre milosrdnice” University Hospital Centre
Mirta Zekan Vučetić
; Division of Radiology, University Hospital for Tumors, “Sestre milosrdnice” University Hospital Centre
Sanda Šitić
; Division of Pathology, University Hospital for Tumors, “Sestre milosrdnice” University Hospital Centre
Abstract
Papillary thyroid cancer is one of the cancers with favorable prognosis,
although the long-term recurrence rate in the paratracheal region is reported to be as high as 30%.
The use of ¹³¹I is considered to be a reliable treatment option for lymph node metastases in the paratracheal
region. According to the majority of internationally accepted guidelines, it is not recommended
to perform central node dissection (CND) routinely. Total thyroidectomy (TT) remains an
adequate treatment for these patients. According to many studies, CND is associated with higher rates
of hypoparathyroidism. However, CND improves staging. Methods: We performed a retrospective
study. We included 248 patients treated for papillary thyroid cancer during a 20-year period. Data
were collected on patient (age, sex) and tumor (size, focality) characteristics, presence of metastases in
the central neck compartment, incidence of postoperative hypoparathyroidism, and locoregional failure.
We divided patients into two groups based on pathological analysis: those without positive lymph
nodes (N0) and those with positive paratracheal lymph nodes (N1). We compared patient and tumor
characteristics and risk of recurrence between the two groups. Results: There were 39.5% patients with
central neck metastases in our series. In the central neck dissection specimen, 5.5 nodes were found on
average. Hypoparathyroidism was found in 23.4% of patients and remained permanent in 3.2% of
patients. Female and older patients had a lower chance of central compartment metastases, as did
patients with smaller and unifocal tumors. Recurrence risk was doubled for the N1 group. All tested
differences between the groups reached statistical significance. Discussion and conclusion: In our hands,
CND was a safe and effective surgical procedure. It improved staging and postsurgical management.
Efforts should be made to improve the preoperative work-up in order to more accurately identify
high-risk patients.
Keywords
differentiated thyroid cancer; total thyroidectomy; central compartment lymph node dissection
Hrčak ID:
248278
URI
Publication date:
1.11.2020.
Visits: 2.187 *