Crank-Shaped Sternotomy for Upper Mediastinal Lymph Node Dissection in Patients with Differentiated Thyroid Cancer

Yamashita, Hiroyuki; Masatsugu, Toshihiro; Uchino, Shigehiko; Watanabe, Shin; Ogawa, Takahiro; Takamatsu, Yuji; Miyatake, Eiji; Noguchi, Shiro

doi:10.1007/s00595-003-2731-z

Cited by 13 publications

(12 citation statements)

References 3 publications

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“…The transcervical approach is more convenient but has a limited surgical field. Sternotomy and partial sternotomy are most frequently used for mediastinal dissection since they can offer greater exposure, but they also have greater surgical invasiveness [ 12 , 20 , 21 ]. Video mediastinoscopy is a minimally invasive strategy which is seldom used in the treatment of MLNM from thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

“…While lower MLNM requires a more extensive operation. Sometimes, a partial-complete median sternotomy or thoracotomy is mandatory, which could potentially increase the risk of complications [ 12 ]. Ultrasound-guided fine needle aspiration cannot be easily done on mediastinal lymph nodes due to interference of bony structures of the chest wall.…”

Section: Introductionmentioning

confidence: 99%

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Video mediastinoscopy-assisted superior mediastinal dissection in the treatment of thyroid carcinoma with mediastinal lymphadenopathy: preliminary results

Song

Dai

et al. 2021

BMC Surg

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Background Mediastinal lymph node metastases (MLNM) are not rare in thyroid cancer, but their treatment has not been extensively studied. This study aimed to explore the preliminary application of video mediastinoscopy-assisted superior mediastinal dissection in the diagnosis and treatment of thyroid carcinoma with mediastinal lymphadenopathy. Materials and methods We retrospectively reviewed the clinical pathologic data and short-term outcomes of thyroid cancer patients with suspicious MLNM treated with video mediastinoscopy-assisted mediastinal dissection at our institution from 2017 to 2020. Results Nineteen patients were included: 14 with medullary thyroid carcinoma and five with papillary thyroid carcinoma. Superior mediastinal nodes were positive in nine (64.3%) patients with medullary thyroid carcinoma and in four (80.0%) patients with papillary carcinoma. No fatal bleeding occurred. There were three cases of temporary recurrent laryngeal nerve (RLN) palsy postoperatively, one of which was bilateral. Four patients had temporary hypocalcemia requiring supplementation, one had a chyle fistula, and one developed wound infection after the procedure. Postoperative serum molecular markers decreased in all patients. One patient died of cancer while the other 18 patients remained disease-free, with a median follow-up of 33 months. Conclusion Video mediastinoscopy-assisted superior mediastinal dissection can be performed relatively safely in patients with suspicious MLNM. This diagnostic and therapeutic approach may help control locoregional recurrences.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Video mediastinoscopy-assisted superior mediastinal dissection in the treatment of thyroid carcinoma with mediastinal lymphadenopathy: preliminary results

Song

Dai

et al. 2021

BMC Surg

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“…However, the indications and extent of the mediastinal lymph node dissection in thyroid carcinoma are not clearly defined. Nevertheless, mediastinal lymph node dissection would be accompanied with greater surgical invasiveness and stress, especially through a transsternal procedure [ 26 , 27 ]. There were two approaches of mediastinal lymphadenectomy: transcervical and transsternal procedures.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Lymph Node Metastases in Thyroid Cancer: Characteristics, Predictive Factors, and Prognosis

Zhang

et al. 2017

International Journal of Endocrinology

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Background Mediastinal lymph node metastases (MLNM) have not been extensively studied. The aim of this study is to investigate the characteristics, predictive factors, and prognosis of MLNM in thyroid cancer. Methods This is a retrospective study based on the thyroid cancer patients with MLNM at our institution from 2008 to 2015. Results In total, 73 thyroid cancer patients with positive MLNM were included in this study. It contained sixty patients (82.2%) with papillary thyroid carcinoma (PTC), twelve (16.4%) with medullary thyroid carcinoma, and one (1.4%) with anaplastic thyroid carcinoma. Forty-eight patients had the surgery as initial treatment. Fifty-three (72.6%) patients remained disease-free, and fifteen (20.5%) developed a regional recurrence. Distant metastases occurred in four (5.5%) patients and five (6.8%) patients died. Five-year overall survival rate and disease-free survival (DFS) rate of the PTC patients for initial treatment are 95.4% and 77.2%, respectively. Extrathyroidal extension and multiple lymph nodes involved were associated with DFS in PTC patients. Conclusions Initial therapeutic control is very important for the thyroid cancer patients. Extrathyroidal extension and multiple mediastinal lymph nodes involved were the influence factors of prognosis in the thyroid cancer patients with MLNM.

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“…However, a mediastinal dissection for the treatment of PTC may be easier to perform than other tumor treatments. In fact, a mediastinal dissection is a safe procedure if performed by a skilled thoracic surgeon [11,12]. The dissection is typically performed from an easy area to ensure that the large vessels are restricted when dissecting the invasive lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Superior Mediastinal Dissection for Papillary Thyroid Carcinoma: Approaches and Outcomes

Liu

Wang

Liu

et al. 2013

ORL

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Background: Superior mediastinal surgery for thyroid carcinoma is not a standardized procedure like the neck dissection. The objective of this study was to evaluate the effectiveness of superior mediastinal dissection for mediastinal metastasis of papillary thyroid carcinoma (PTC). Methods: We conducted a retrospective review of 119 patients who underwent superior mediastinal dissection for the treatment of PTC. The postoperative characteristics and follow-up data were analyzed. Cox regression was performed to identify the factors related to the mediastinal control. Results: No severe complications occurred in this series. The five-year local (mediastinum) disease-free survival rates of comprehensive (n = 29) and partial (n = 90) superior mediastinal dissection were 86.3 and 84.0%, respectively (log-rank = 0.562; p = 0.452). Different patterns of superior mediastinal dissection did not turn out to be related to mediastinal recurrence in the cox regression. Bilateral paratracheal metastasis was identified as an individual risk factor of mediastinal recurrence with a relative risk value of 4.635 (95% CI: 1.399-15.355; p = 0.012). Conclusions: Both partial and comprehensive superior mediastinal dissections are effective and safe for the treatment of mediastinal metastasis of PTC if appropriately designed.

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Crank-Shaped Sternotomy for Upper Mediastinal Lymph Node Dissection in Patients with Differentiated Thyroid Cancer

Cited by 13 publications

References 3 publications

Video mediastinoscopy-assisted superior mediastinal dissection in the treatment of thyroid carcinoma with mediastinal lymphadenopathy: preliminary results

Video mediastinoscopy-assisted superior mediastinal dissection in the treatment of thyroid carcinoma with mediastinal lymphadenopathy: preliminary results

Mediastinal Lymph Node Metastases in Thyroid Cancer: Characteristics, Predictive Factors, and Prognosis

Superior Mediastinal Dissection for Papillary Thyroid Carcinoma: Approaches and Outcomes

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