Kim, Seok-Mo1; Kim, Soo Young1; Kim, Bup-Woo1; Lee, Yong Sang1; Chang, Hang-Seok1; Park, Cheong Soo1
1 Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Background: In thyroid cancer, mediastinal lymph node metastasis are extremely rare. But the invasiveness of the disease leads often to significant morbidity and also to frequent cause of death. The aim of this study is to evaluate the effectiveness and safety of surgical management
Material and Methods: From October 2000 to November 2016, 195 patients who underwent mediastinal dissection for thyroid cancer metastasis were retrospectively analyzed. Clinical characteristics including extent of surgery, pathologic features and prognosis were reviewed.
Results: There were 80 male (41.0%) and 115 female (59.0%) patients with a mean age of 49.9 ±15.1 years.
Synchronous mediastinal metastasis was found in 118 patients (60.5%). The most common thyroid cancer type was papillary thyroid cancer (165 patients, 84.6%). In 35 patients (18.3%) there was distant metastasis observed at time of surgery, whereas 13 (6.7%) developed distant metastasis during follow-up. In 46 cases, combined resection of either trachea (8, 4.1%), lung (5, 2.6%), major vessel (12, 6.2%) or nerve (21, 10.8%) was performed. Transcervical approach was the most common (126 cases, 64.6%), followed by full sternotomy (40, 20.5%) and partial sternotomy (24, 12.3%). Median follow-up was 40.6 months [18.8; 64.9] with overall survival of 91.3% of the patients. In 17 (8.7%) patients, disease related death occurred. Recurrence was observed in 47 (24.1%) patients with median time to recurrence of 19 month [8.4; 31.7].
Aggressive surgical treatment for locally advanced thyroid carcinoma may offer improved local control of disease, prolonged palliation and opportunity for cure in selected patients.