Surgical Treatment of Pediatric and Adolescent Papillary Thyroid Cancer: a Retrospective Study of 54 Patients in a Single Center

Abstract

Background: In 2015, American Thyroid Association (ATA) issued the first version of Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. The purpose of this study is to evaluate whether the ATA pediatric guidelines recommended surgical approach for the patient can be applied to surgical treatment of pediatric PTC in China.Method: From April 2012 to December 2020, clinical data of children (≤18 years) with PTC consecutively admitted and treated with initial surgery in our department were retrospectively reviewed. Result: A total of 54 children with PTC were enrolled in the study. We find that central lymph node metastasis (CLNM) rate was significantly higher than that in the lateral neck (83.33 % vs 62.96%，χ2= 5.704, p= 0.017), and the CLNM rate and LLNM rate both gradually increased with increasing of T stage. The lymph node metastasis rate was significantly lower in cN1b (-) patients than in cN1b (+) patient following routine CND (55.00% vs 100.00%, χ2=15.263, p=0.000). Meanwhile, the CLNM and LLNM rates of ipsilateral were significantly higher than those of contralateral central compartment (83.33％vs 57.41％%, χ2=8.704, p= 0.003) and contralateral lateral compartment (62.96% vs 31.48%, χ2 =10.737, p= 0.001). lymph nodes of 51 lateral LND from 34 children with cN1b (+) were analysed, which revealed the LNM rate of cN1b (-) patients was significantly lower than that of cN1b (+) patients (55.00% vs 100.00%, χ2 =15.263, p=0.000). Meanwhile, the CLNM and LLNM rates of ipsilateral were significantly higher than those of contralateral central compartment (83.33％vs 57.41％%, χ2=8.704, p= 0.003) and contralateral lateral compartment (62.96% vs 31.48%, χ2 =10.737, p= 0.001).Conclusion: Pediatric and adolescent PTC is characterized with high involvement of CLNM and LLNM at the time of diagnosis. TT should be conducted in the majority of children with PTC, and lobectomy with isthmustomy should be selectively applied. CND should be routinely performed, therapeutic LND is recommended for children with cN1b (+), SLND including level II-V is preferred, and SSLND should be performed with caution. Based on single-center data, we believe that the 2015 ATA guidelines for children are applicable to the surgical treatment of PTC in domestic children.