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Central Lymph Node Dissection Improves Lymph Node Clearance in Papillary Thyroid Cancer Patients with Lateral Neck Metastases, Even after Prior Total Thyroidectomy.

Abstract The oncologic benefit of a central lymph node dissection (CLND) at the time of modified radical neck dissection (MRND) in patients with papillary thyroid cancer who have previously undergone a total thyroidectomy (TT) has not been studied. Patients with lateral cervical metastases were divided into two treatment groups: the concurrent cohort (TT with CLND and MRND), and the interval cohort (CLND and MRND after prior TT). Primary outcomes were lymph node metastases, skip metastases, level VI cancer recurrence, hypoparathyroidism and recurrent laryngeal nerve injury. Treatment groups consisted of 63 and 16 patients in the concurrent and interval groups, respectively. More central lymph nodes were removed (15.4 ± 8.4 to 10.1 ± 5.2 (P = 0.02)), but similar level VI lymph node metastasis occurred (92.0-93.8% (P = 0.99)) in the concurrent group compared with the interval group, respectively. Skip metastases were identified in only 7.6 per cent of patients. The incidence of level VI recurrence and recurrent laryngeal nerve injury was 1.2 per cent. Three patients developed hypoparathyroidism (3.7%). All permanent morbidities occurred in the concurrent group. CLND at the time of MRND for metastatic papillary thyroid cancer frequently identifies level VI metastases and can be done with low operative morbidity by experienced endocrine surgeons, even in patients who have undergone a prior TT.
PMID
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Authors

Mayor MeshTerms

Thyroidectomy

Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 29712601
OWN - NLM
STAT- MEDLINE
DCOM- 20180509
LR  - 20180509
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 84
IP  - 4
DP  - 2018 Apr 1
TI  - Central Lymph Node Dissection Improves Lymph Node Clearance in Papillary Thyroid 
      Cancer Patients with Lateral Neck Metastases, Even after Prior Total
      Thyroidectomy.
PG  - 531-536
AB  - The oncologic benefit of a central lymph node dissection (CLND) at the time of
      modified radical neck dissection (MRND) in patients with papillary thyroid cancer
      who have previously undergone a total thyroidectomy (TT) has not been studied.
      Patients with lateral cervical metastases were divided into two treatment groups:
      the concurrent cohort (TT with CLND and MRND), and the interval cohort (CLND and 
      MRND after prior TT). Primary outcomes were lymph node metastases, skip
      metastases, level VI cancer recurrence, hypoparathyroidism and recurrent
      laryngeal nerve injury. Treatment groups consisted of 63 and 16 patients in the
      concurrent and interval groups, respectively. More central lymph nodes were
      removed (15.4 +/- 8.4 to 10.1 +/- 5.2 (P = 0.02)), but similar level VI lymph
      node metastasis occurred (92.0-93.8% (P = 0.99)) in the concurrent group compared
      with the interval group, respectively. Skip metastases were identified in only
      7.6 per cent of patients. The incidence of level VI recurrence and recurrent
      laryngeal nerve injury was 1.2 per cent. Three patients developed
      hypoparathyroidism (3.7%). All permanent morbidities occurred in the concurrent
      group. CLND at the time of MRND for metastatic papillary thyroid cancer
      frequently identifies level VI metastases and can be done with low operative
      morbidity by experienced endocrine surgeons, even in patients who have undergone 
      a prior TT.
FAU - Hall, Chad M
AU  - Hall CM
FAU - Snyder, Samuel K
AU  - Snyder SK
FAU - Lairmore, Terry C
AU  - Lairmore TC
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
RN  - Thyroid cancer, papillary
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Carcinoma, Papillary/pathology/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Lymph Nodes/pathology/*surgery
MH  - Lymphatic Metastasis
MH  - Male
MH  - Middle Aged
MH  - Neck Dissection/*methods
MH  - Retrospective Studies
MH  - Thyroid Neoplasms/pathology/*surgery
MH  - *Thyroidectomy
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2018/05/02 06:00
MHDA- 2018/05/10 06:00
CRDT- 2018/05/02 06:00
PHST- 2018/05/02 06:00 [entrez]
PHST- 2018/05/02 06:00 [pubmed]
PHST- 2018/05/10 06:00 [medline]
PST - ppublish
SO  - Am Surg. 2018 Apr 1;84(4):531-536.