Identifying risk factors for metastasis to the level VII lymph node in papillary thyroid carcinoma patients

Abstract

Background: The level VI lymph nodes are anatomically connected to the level VII lymph nodes and papillary thyroid carcinoma (PTC) can metastasis to both regions. The aim of this study was to identify clinicopathologic factors associated with level VII lymph node metastasis. Methods: Between March 2015 and September 2016, a total of 275 consecutive patients were operated on for PTC with prophylactic level VII dissection at the Sir Run Run . Patients with PTC were performed via video-assisted approach. Multivariate logistic regression analysis was performed to evaluate the associations between clinicopathologic factors. Results: Of the 275 subjects enrolled in this study, 79 patients (28.73%) showed lymph node metastasis to the level VII. The multivariate logistic regression analysis showed ultrasonography-positive lymph nodes (p < 0.001), the location of primary carcinoma (p = 0.002) and hashimoto thyroiditis (HT) (p = 0.04) were associated with level VII lymph node metastasis. Conclusions: Based on the results of our study, we considered central-compartment lymph node dissection (CLND) as an integral strategy. On the basis of surgery safety, transcervical level VII lymph node dissection could be considered for PTC patients with high risk factors such as ultrasonography-positive lymph nodes, tumor located in middle and lower thirds of the thyroid lobe and the patients without HT. In future, prognostic significance of level VII lymph node dissection should be evaluated through long-term surveillance.

Effects of Patient and Tumor Characteristics on Central Lymph Node Metastasis in Papillary Thyroid Cancer: A Guide for Selective Node Dissection

“…On the other hand, there are studies reporting that the risk increases in tumors located in the middle and/or lower part of the thyroid lobe. 28,29 It was also reported that the risk of metastasis increased in tumors in the isthmus, inferior anterior-central, inferior posterior-lateral, and middle posterior-lateral regions. 30 It is clear that the results of studies examining the relationship between the intrathyroidal tumor localization and central compartment metastasis do not agree with each other.…”

Thoracoscopy-assisted treatment for mediastinal metastasis of thyroid cancer: a case report

“… 11 Other researchers have reported that when thyroid cancer invades the upper mediastinal vessels or leads to obvious upper mediastinal lymph node metastasis, endoscopic-assisted mediastinal lymph node dissection can be attempted. 5 …”

“…11 Other researchers have reported that when thyroid cancer invades the upper mediastinal vessels or leads to obvious upper mediastinal lymph node metastasis, endoscopicassisted mediastinal lymph node dissection can be attempted. 5 Many studies to date have indicated that three-port thoracoscopy under the xiphoid process has outstanding advantages in the treatment of thymic tumors and other upper mediastinal tumors and even in the performance of upper mediastinal lymph node dissection. With the favorable magnification and lighting functions of the endoscope, the tumors can be removed more thoroughly and with less trauma, more rapid recovery, and a more reliable effect.…”

“… 4 Standardized surgery is still the preferred treatment for upper mediastinal lymph node metastasis and can significantly improve the patients’ prognosis. 5 We herein describe the treatment of a patient with advanced thyroid cancer and upper mediastinal lymph node metastasis.…”