Right Paraesophageal Lymph Node Dissection in Papillary Thyroid Carcinoma

Bae, Soo Youn; Yang, Jung‐Hyun; Choi, Min Yeong; Choe, Jun-Ho; Kim, Jung-Han; Kim, Jee Soo

doi:10.1245/s10434-011-2144-y

Cited by 31 publications

(40 citation statements)

References 27 publications

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“…This may be because of some limitations in our sample selection, in that we excluded patients with tumors only involved in the left lobe. Notably, Kim and Park 19 found that right paraesophageal lymph nodes could be the solely metastatic region from PTC, which was supported by the evidence from both our study (6.4%; 26 of 405) and Bae et al 18 Of interest, Kim and Park 19 also observed that 1 of the patients with PRRLN positivity had a tumor only in the left thyroid lobe, which thus indicated the necessity for routine detection of right paraesophageal lymph nodes during PTC surgery regardless of whether tumors were located in the right or left lobe. According to the review by Weber and Holsinger, 21 for a PTC tumor arising in 1 lobe of the thyroid, tumor emboli may traverse the subcapsular lymph nodes and consequently produce metastatic deposits in the contralateral lobe.…”

Section: Discussionsupporting

confidence: 88%

“…Very few other studies have produced data on associations with lymph node PRRLN positivity in patients with PTC. To our knowledge, so far, there are only 4 related reports (Table ) with the lymph nodes deep to the right RLN called “right paraesophageal lymph nodes.” Unlike our study, Bae et al and Kim and Park defined right paraesophageal lymph nodes as an isolated region from the central compartment. The frequency of lymph node PRRLN positivity in our patient population was a little higher than the 4 previous studies.…”

Section: Discussioncontrasting

confidence: 60%

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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

Zhang

Jianlong

et al. 2013

Head Neck

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Section: Discussionsupporting

confidence: 88%

Section: Discussioncontrasting

confidence: 60%

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

Zhang

Jianlong

et al. 2013

Head Neck

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“…The left and right RLNs have slight differences in anatomical position, and the cervical part of the esophagus located closely next to the left. Therefore, there was a triangular space located posterior to the right RLN, which makes space for lymph adipose tissue [15][16][17] . In the literatures, the presence of Hashimoto's thyroiditis leads to reactive lymphaden proliferation 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Lymph node metastasis around the entrance point to recurrent laryngeal nerve in papillary thyroid carcinoma

Liu

Yan

2020

Sci Rep

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there are few reports on the lymph nodes of entrance point to recurrent laryngeal nerve (Ln-epRLn) in patients with papillary thyroid carcinoma (PTC). Thus, we investigated the clinical significance of LN-epRLN and implications it may have. An observational analysis of 878 consecutive patients with PTC who underwent thyroidectomy from April 2016 to March 2017 was conducted. We explored the surrounding tissue of laryngeal entry point, during routine central lymph node dissection (CLND). The lymph node specimens were sent separately for routine histopathological examination. Thereafter, complications and follow-ups were recorded. LN-epRLNs were found in 73 of the 878 patients, with the metastatic rate of 3.76%. Univariate and multivariate analysis showed central lymph node metastases can serve as independent predictors for LN-epRLN metastasis. In summary, we confirmed the significance of LN-epRLN in metastasis and recurrence, which required precise anatomy and thorough CLND. In PTC patients, especially in suspicious presence of central cervical lymph node metastasis, attention should be given to excising the nodal tissue at the laryngeal entry point. Papillary thyroid carcinoma (PTC) is the most common type of endocrine malignancy yet 1. Advocates of partial central lymph node dissection (CLND) cite the reduction in risks of postoperative complications 2. Taken collectively, studies 3-5 showed that the most common metastases and local recurrences of PTC nodal disease were in the central neck compartment. Additionally, recurrent malignancy after partial CLND may require a second surgery, which is considered more hazardous than a primary operation. Reoperation on patients with regional recurrence at the laryngeal entry point would pose challenges due to its complexity 6. Variations in the extent of adhesions around the lymph nodes of entrance point to recurrent laryngeal nerve (LN-epRLN)and neck muscle remnants make identification of the recurrent laryngeal nerve (RLN) and parathyroid glands more difficult compared to primary operation, and risks of certain postoperative complications, such as RLN palsy or hypoparathyroidism, are significantly higher 7. In this study, we evaluated a series of patients who underwent thyroidectomies with the aim of highlighting LN-epRLN metastasis in PTC patients. Methods A total of 878 consecutive PTC patients received initial thyroidectomy at Shanghai Ruijin Hospital between April 2016 and March 2017. A prophylactic or therapeutic CLND was routinely performed in PTC patients. Exclusion criteria: those who underwent previous thyroid surgery; possess pathological types of thyroid carcinomas other than PTC; gross extrathyroidal extension invading the surrounding tissue of entrance point to RLN. According to the guidance of the 2018 Tumour Node Metastasis (TNM) staging system of American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) 8 , we identified all the sample as T 1-3 N 0-1a M 0 PTC. All patients involved in this study gave their informed consent, and the...

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“…We also investigated the same issue for pre-and right paratracheal to this region is very difficult. To date, few studies have been published regarding this issue [5][6][7] and only two demonstrated any statistical data for these nodes [6,7]. However, the number of patient employed in their studies is small, and they analyzed patients with various N factors [8] in a single group.…”

mentioning

confidence: 99%

“…However, the number of patient employed in their studies is small, and they analyzed patients with various N factors [8] in a single group. One study performed multivariate logistic analysis, but they analyzed pre-, intra-, and postoperative factors at the same time [7].…”

mentioning

confidence: 99%

Incidence and predictors of right paraesophageal lymph node metastasis of N0 papillary thyroid carcinoma located in the right lobe

et al. 2013

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Papillary thyroid carcinoma (PTC) frequently metastasizes to the regional lymph nodes and, thus, guidelines edited by Japan Association of Endocrine Surgeons/Japanese Society of Thyroid Surgery routinely recommend central node dissection even for patients with no clinically detectable node metastasis (N0). However, in the central compartment, metastasis to the right paraesophageal node has not been intensively investigated. We investigated the incidence and predictors of right paraesophageal node metastasis based on pre- and intraoperative findings in 922 patients with N0 PTC in the right lobe. Fourteen percent of patients were microscopically positive for right paraesophageal node metastasis, and the incidence was smaller than that for pre- and right paratracheal node metastasis (46%). On multivariate analysis, a tumor size ≥ 2 cm and significant extrathyroid extension were independent predictors of metastasis. Microscopically pre- and right paratracheal node-positive PTC more often (p < 0.0001) metastasized to the right paraesophageal node. Taken together, in N0 PTC in the right lobe, right paraesophageal node dissection should be considered in tumors 2 cm or larger and/or with significant extrathyroid extension, or when pre- and right paratracheal node metastasis is suspected based on the intraoperative findings.

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Right Paraesophageal Lymph Node Dissection in Papillary Thyroid Carcinoma

Abstract: RPELN dissection should be considered in patients with right thyroid cancer, tumors larger than 1 cm, or multiple CLN metastases.

Cited by 31 publications

References 27 publications

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

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

Lymph node metastasis around the entrance point to recurrent laryngeal nerve in papillary thyroid carcinoma

Incidence and predictors of right paraesophageal lymph node metastasis of N0 papillary thyroid carcinoma located in the right lobe

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