Superior Mediastinal Dissection for Papillary Thyroid Carcinoma: Approaches and Outcomes

Abstract

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.

Predictive Factors of Superior Mediastinal Nodal Metastasis from Papillary Thyroid Carcinoma—A Prospective Observational Study

“…Surgeons prefer to avoid SMLND because of the incidence of surgical morbidity related to the procedure, stemming from major vessel injury, hypoparathyroidism, recurrent laryngeal nerve injury, pneumothorax, and pleural effusion[ 21 ]. However, a previous study has already reported the safety of SMLND without life-threatening complications[ 22 ]. Moreover, transcervical SMLND is a useful and safe surgical approach to access the superior mediastinum between the sternal notch and the innominate vasculature[ 1 , 22 ].…”

“…However, a previous study has already reported the safety of SMLND without life-threatening complications[ 22 ]. Moreover, transcervical SMLND is a useful and safe surgical approach to access the superior mediastinum between the sternal notch and the innominate vasculature[ 1 , 22 ]. However, it is worth noting that one study showed a high rate of transient hypoparathyroidism (70%) and of permanent hyperparathyroidism (50%)[ 7 ].…”

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

“…Many predictive factors for MLNM were discussed in previous studies [ 6 , 7 , 10 , 11 , 14 – 16 , 18 , 20 , 22 , 23 ], but most of them are still controversial ( Table 5 ). Nevertheless, it mainly came to an accordant conclusion that the patients with bilateral cervical metastasis [ 10 , 15 , 18 , 22 , 23 ] or with distant metastasis [ 10 , 11 , 15 , 18 ] and the patients who underwent reoperation [ 6 , 18 , 20 ] had increased risk of MLNM. And the predictive factors discussed in each study were shown in the supporting information.…”

“…There are totally five studies [ 7 , 10 , 13 , 16 , 19 ] revealing the prognosis of the patients with MLNM. Liu et al [ 10 ] demonstrated that the incidences of death, recurrence, and distant metastasis were 12.6%, 14.3%, and 16.8%, respectively, based on 119 PTC cases.…”

“…There are totally five studies [ 7 , 10 , 13 , 16 , 19 ] revealing the prognosis of the patients with MLNM. Liu et al [ 10 ] demonstrated that the incidences of death, recurrence, and distant metastasis were 12.6%, 14.3%, and 16.8%, respectively, based on 119 PTC cases. Kikumori and Imai [ 13 ] reported that, in a series of 184 PTC patients, the incidences of death, recurrence, and distant metastasis were 9.2%, 4.9%, and 0.5%, respectively, and the disease-specific survival (DSS) was 97.9%.…”