American Association of Endocrine SurgeonNodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma
Section snippets
Patients and methods
The surgical and pathology prospective protocols of a series of patients undergoing total thyroidectomy and CND for papillary thyroid cancer between 1995 and 2003 were reviewed. Patients were excluded from the study if (1) papillary cancer was diagnosed after operation (microcarcinoma or missed initial diagnosis), (2) they were undergoing completion thyroidectomy, (3) they had recurrent cancer (local or nodal metastasis), or (4) they were referred for neck dissection after thyroidectomy.
Results
Demographic and tumor characteristics of the series are shown in Table I. The surgical procedures performed and the intraoperative findings are shown in Table II. In 4 patients, section of the inferior laryngeal nerve was carried out to assure the complete resection of tumors and/or nodal metastasis invading the nerve. In 2 of these 4 patients, a tracheal sleeve resection also was performed. In addition, 1 patient required resection of the internal jugular vein, which was invaded in continuity
Discussion
The rationale for introducing CND in papillary cancer was similar to that emphasized for treating medullary carcinoma: preventing local recurrences in the central compartment where reoperation is difficult and, eventually, reducing the mortality rate, particularly in the high-risk patients. In addition, all studies on lymph node metastasis of papillary cancer agree in that the central neck compartment, particularly the region ipsilateral to the tumor, is involved most frequently. In our study,
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Presented at the 26th Annual Meeting of the American Association of Endocrine Surgeons, Cancun, Mexico, April 3-5, 2005.