Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: Influence on serum thyroglobulin level, recurrence rate, and postoperative complications

So, Yoon Kyoung; Seo, Min Young; Son, Young‐Ik

doi:10.1016/j.surg.2011.02.004

Cited by 98 publications

(100 citation statements)

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“…[4][5][6] Metastatic lymph node ratio (LNR) (defined as number of metastatic lymph nodes divided by number of lymph nodes examined) after prophylactic lymphadenectomy has been shown to be a promising prognostic variable in a variety of nonthyroidal primary cancers (e.g., colorectal, gastric, and pancreatic cancers). [7][8][9] The concept of LNR is based on the assumption that it indirectly reflects the extent who did not (100% vs. 39.1%, P = 0.013).…”

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confidence: 99%

Significance of Metastatic Lymph Node Ratio on Stimulated Thyroglobulin Levels in Papillary Thyroid Carcinoma after Prophylactic Unilateral Central Neck Dissection

Lang

Wong

Wan

et al. 2012

Indian J Surg Oncol

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Background. Prognostic significance of metastatic central lymph node ratio (CLNR) in papillary thyroid carcinoma (PTC) remains unknown. Because postsurgical detectable stimulated thyroglobulin (DsTg) after radioiodine ablation may imply persistent or recurrent disease, we evaluated the association between CLNR and rate of DsTg in patients with PTC who underwent unilateral prophylactic central neck dissection. Methods. To be eligible for analysis, the prophylactic central neck dissection specimen had to contain C3 central lymph nodes (CLNs) with C1 harboring metastasis. Of 129 specimens, 51 (39.5%) were eligible. CLNR was calculated as follows: (number of metastatic CLNs/number of CLNs retrieved) 9 100. They were categorized into group 1 (CLNR \33.34%) (n = 14), group 2 (CLNR 33.34-66.67%) (n = 15), and group 3 (CLNR[66.67%) (n = 22). Postablation sTg level was measured 6 months after radioiodine ablation. A multivariate analysis was conducted to identify factors for postablation DsTg. Results. Young age, palpable neck swelling, large tumor size, advanced tumor, node, metastasis system (TNM) stage, and large number of metastatic CLNs were significantly associated with high CLNR (P \ 0.05). Compared to groups 1 and 2, group 3 had significantly higher DsTg rate (P = 0.018). Those who developed subsequent recurrence had significantly higher DsTg rate than those Conclusions. A higher CLNR was associated with a higher rate of postablative DsTg; this may imply higher future recurrence rate.Papillary thyroid carcinoma (PTC) is the most common type of differentiated thyroid carcinoma, and its ageadjusted incidence has doubled in the last 25 years. 1Despite its relatively good prognosis with a 10-year cancerspecific survival above 90%, locoregional recurrence is common.2 With recognition of the concept of stepwise progression of lymph node metastasis originating from the central (level VI) to the lateral compartment (levels II-V), a growing number of surgeons are advocating routine prophylactic central neck dissection (pCND) at the time of the total thyroidectomy for PTC.3 Although the role of pCND remains controversial because there is still no good evidence to show that it improves long-term outcomes such as cancer-specific or disease-free survival when compared to without pCND, the analysis of short-term markers for recurrence (e.g., postsurgical stimulated thyroglobulin level, sTg) seems to indicate that pCND may improve short-term outcomes. [4][5][6] Metastatic lymph node ratio (LNR) (defined as number of metastatic lymph nodes divided by number of lymph nodes examined) after prophylactic lymphadenectomy has been shown to be a promising prognostic variable in a variety of nonthyroidal primary cancers (e.g., colorectal, gastric, and pancreatic cancers). [7][8][9] The concept of LNR is based on the assumption that it indirectly reflects the extent who did not (100% vs. 39.1%, P = 0.013). In the multivariate analysis for postablative DsTg, after adjusting for age, palpable neck swelling, tumor size, TNM stage, a...

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confidence: 99%

Significance of Metastatic Lymph Node Ratio on Stimulated Thyroglobulin Levels in Papillary Thyroid Carcinoma after Prophylactic Unilateral Central Neck Dissection

Lang

Wong

Wan

et al. 2012

Indian J Surg Oncol

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“…was a predictor of ipsilateral central lymph node metastasis (CLNM) recommending pCND in patients with a tumor size >1 cm. DFS was not statistically different between both groups [ Table 8], as many studies comparing TT+ pCND versus TT alone didn't find a survival benefit between both groups (Sywak et al, 2006;Costa et al, 2009;Zuniga et al, 2009;So et al, 2012). The most recent controversy has been provided by Barczewski et al, 2013 who published the first paper in the literature showing a benefit not only for local recurrence (5.5% vs 12.4%) but also for specific disease survival (98% vs 92.5%) for patients with PTC having TT + pCND in comparison with those who had only TT, major bias in this study are its retrospective nature and that patients considered at risk in any group had RAI treatment.…”

Section: Discussionmentioning

confidence: 99%

Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

Fayek

Kamel²,

Sidhom³

2016

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 16 (18), 8425-8430 IntroductionPapillary thyroid cancer (PTC) is the most common type of thyroid cancer accounting for about 80% of all thyroid cancers, and is the fifth leading malignancy in females (Cisco et al., 2012;Siegel et al., 2013).Given the high rate of subclinical nodal metastases in PTC, many centers, have moved to routine prophylactic central nodal dissection (pCND) at the time of total thyroidectomy (TT) for all patients with PTC, pCND allows for more accurate assessment of nodal status, decreases the rate of local recurrence, reduces morbidity from reoperation if required, and may guide the dose of ablative postoperative radioiodine given (Mazzaferri EL Jhiang 1994;Scheumann et al., 1994;Hughes et al., 1996).Dralle (2012)

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“…For both children and adults with TMCs of nonpapillary histology (Hurthle cell, follicular and tallcell) or with extrathyroidal extension, strong consideration should be made for performing a TTx given the increased rate of recurrence and death in these patients [9,[18][19]. Male gender and non-White race may also influence survival and therefore influence surgical decisions.…”

Section: What Operation To Performmentioning

confidence: 99%

Thyroid Microcarcinoma in Pediatric Patients: How Aggressive do we Need to be?

Goldfarb¹

2015

Int. J. Endo. Oncol.

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Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: Influence on serum thyroglobulin level, recurrence rate, and postoperative complications

Cited by 98 publications

References 24 publications

Significance of Metastatic Lymph Node Ratio on Stimulated Thyroglobulin Levels in Papillary Thyroid Carcinoma after Prophylactic Unilateral Central Neck Dissection

Significance of Metastatic Lymph Node Ratio on Stimulated Thyroglobulin Levels in Papillary Thyroid Carcinoma after Prophylactic Unilateral Central Neck Dissection

Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

Thyroid Microcarcinoma in Pediatric Patients: How Aggressive do we Need to be?

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