Aygun, Nurcihan1; Tanal, Mert2; Besler, Evren2; Makay, Özer3; Uludag, Mehmet2
1 Department of General Surgery, Siverek State Hospital, Sanl?urfa, Turkey
2 Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
3 Department of General Surgery, Faculty of Medicine, Ege University, Izm?r, Turkey
Background: The unilateral or bilateral prophylactic central dissection in papillary thyroid cancer is stil controversial. We aimed to evaluate the risk factors for paratracheal lymph node metastasis and whether the central dissection could be performed unilaterally.
Methods: Retrospective data of 57 papillary thyroid cancer patients (37 female, 20 male; mean age, 44.3±16; range, 16- 80) who underwent thyroidectomy with bilateral central lymph node and therapeutical lateral neck dissection (therapeutic for clinical positive lymph node or prophylactic for T3 tumor) were evaluated.
Results: Total thyroidectomy and bilateral central dissection were performed in 57 patients and lateral neck dissection was included in 26(45.6%). Central metastasis was detected in 43 of 57 patients(75.4%). Ipsilateral paratracheal metastasis occurred in 40 patients (70.2%); whereas prelaryngeal, pretracheal and contralateral paratracheal lymph node metastases occurred in 9(15.8%), 21(36.8%) and 9 patients(15.8%) respectively . The contralateral paratracheal metastasis was significantly revealed higher in the presence of pretracheal (38.1% vs 2.8%, p=0.001), prelaryngeal (44.4% vs 10.4%, p = 0.027) and lateral lymph node metastases (34.6% vs 0%, p <0.001). With the ROC curve, sensitivity was 88.9% and specificity was 81.2% for the prediction of contralateral paratracheal lymph node metastasis due to more than four metastatic lymph nodes in central neck dissection.
Conclusion: Therapeutic central dissection should be performed bilaterally in patients with paratracheal metastasis who have pretracheal, prelaryngeal, and lateral lymph node metastases and more than 4 metastases. Paratracheal metastases are rarely encountered in patients without pretracheal, prelaryngeal and lateral metastases, so unilateral central dissection may be considered.