Unnecessity of Routine Dissection of Right Central Lymph Nodes in cN0 Papillary Thyroid Carcinoma Located at the Left Thyroid Lobe

Abstract

ObjectiveThe lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) is an important part of the central lymph nodes (LNs). We aimed to explore the rate and predictors of LN-prRLN metastasis in cN0 papillary thyroid carcinoma (PTC) located at the left thyroid lobe.MethodsPatients with surgically treated primary left lobe PTC were retrospectively enrolled. The metastatic distribution of LN-prRLN and postoperative complications were assessed. The association between LN-prRLN metastasis and clinicopathological variables was evaluated by univariate and multivariate analyses.ResultsA total of 857 patients were included for the analysis. Central LN metastasis was noted in 310 (35.3%) cases. The most (27.6%) and least (1.7%) commonly involved LNs were the left paratracheal LN and the LN-prRLN. In the univariate analysis, the tumor size, multifocality, the extent of extrathyroidal extension (none vs. macroscopic vs. macroscopic maximal), and perineural invasion were associated with positive LN-prRLN. In the multivariate analysis, tumor size of >40.0 mm and macroscopic maximal invasion were found as the only two independent predictors. Transient and permanent hypoparathyroidism were noted in 90 (10.2%) and 13 (1.5%) patients, respectively. Voice change was noted in 40 (4.6%) patients, and 20 patients recovered.ConclusionsIn cN0 PTC located at the left lobe, LN-prRLN metastasis was very uncommon. We found that LN-prRLN dissection is not required routinely, but should be performed if the tumor size is >40.0 mm and macroscopic maximal extrathyroidal extension is present.

Multimodal predictive factors of metastasis in lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma

“…Hypoparathyroidism and vocal cord paralysis were the two serious complications after thyroid surgery. Transient and permanent hypoparathyroidism occurred in 4.1-51.9% and 0-1.1% of patients, respectively ( 6 , 18 – 20 ). Postoperative voice change was found in 4.9-7.4% of patients, while consistent voice change with vocal cord immobility was found in 0-4.0% of patients ( 6 , 18 – 20 ).…”

“…Prelaryngeal LNs, pretracheal LNs, left paratracheal LNs, and right paratracheal LNs are the four groups that typically make up cervical central LNs. Due to the anatomical variations of the recurrent laryngeal nerves on both sides, the right paratracheal LNs are divided into those that are anterior to the right recurrent laryngeal nerve (LN-arRLN) and those that are posterior to the right recurrent laryngeal nerve (LN-prRLN) ( 5 , 6 ).…”

Contrast-enhanced ultrasound characteristics of preoperative central cervical lymph node metastasis in papillary thyroid carcinoma

“…The central cervical lymph nodes (CCLNs) are commonly referred to as level VI lymph nodes, which include the prelaryngeal, pretracheal, left paratracheal, and right paratracheal lymph nodes (13,14). However, due to the low sensitivity of CCLNs, most of the studies on CCLN metastasis were based on the predictive values of conventional US features of PTC nodules, and few studies reported the ultrasonographic characteristics of the CCLNs themselves (15)(16)(17)(18).…”

The Necessity of Lymph Node Dissection Between Sternocleidomastoid and Sternohyoid Muscles in pN1b Papillary Thyroid Carcinoma

“…Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy, and accounts for nearly 90% of differentiated thyroid carcinomas ( 1 ). Lymph node (LN) metastasis usually develops in PTCs, with a reported incidence of up to 90% ( 2 – 4 ).…”