유두상 갑상선암의 중앙경부 림프절 전이

Abstract

The surgical management of papillary thyroid cancer is not only controversial with regard to the surgery of the thyroid gland itself but also with the management of regional lymph node. The presence of regional lymph node metastasis is not related to prognosis but affects the local recurrence rate and reoperation in the central neck is more technically difficult than a primary procedure.

To reduce lymph node recurrence in the central neck and avoid reoperation, the central neck lymph node dissection is mandatory at primary operation but there is question about the necessity of the lymph node dissection contralateral to primary tumor when it is confined to one lobe only.

So I analyzed the central neck lymph node metastasis of 33 patients with papillary thyroid cancer who underwent total thyroidectomy and central neck dissection.

Of 20 patients with primary tumor confined to one lobe with clear opposite lobe, the rates of contralateral paratracheal lymph node metastasis was 35%, and of 9 patients with microcarcinoma in opposite lobe, the rates of contralateral paratracheal lymph node metastasis was 67%.

However, it is difficult to identify the microcarcinoma in opposite lobe with gloss finding at operation field.

So the overall probability of contralateral lymph node metstasis is 46% when the primary tumor is confined to one lobe grossly.

The mass size was not correlated to the rates of contralateral lymph node metastasis.

The bilateral node dissection appears to be appropriate in every case of advanced papillary thyroid cancer as far as the complication rate can be maintained acceptably low.

The surgical management of papillary thyroid cancer is not only controversial with regard to the surgery of the thyroid gland itself but also with the management of regional lymph node. The presence of regional lymph node metastasis is not related to prognosis but affects the local recurrence rate and reoperation in the central neck is more technically difficult than a primary procedure.

To reduce lymph node recurrence in the central neck and avoid reoperation, the central neck lymph node dissection is mandatory at primary operation but there is question about the necessity of the lymph node dissection contralateral to primary tumor when it is confined to one lobe only.

So I analyzed the central neck lymph node metastasis of 33 patients with papillary thyroid cancer who underwent total thyroidectomy and central neck dissection.

Of 20 patients with primary tumor confined to one lobe with clear opposite lobe, the rates of contralateral paratracheal lymph node metastasis was 35%, and of 9 patients with microcarcinoma in opposite lobe, the rates of contralateral paratracheal lymph node metastasis was 67%.

However, it is difficult to identify the microcarcinoma in opposite lobe with gloss finding at operation field.

So the overall probability of contralateral lymph node metstasis is 46% when the primary tumor is confined to one lobe grossly.

The mass size was not correlated to the rates of contralateral lymph node metastasis.

The bilateral node dissection appears to be appropriate in every case of advanced papillary thyroid cancer as far as the complication rate can be maintained acceptably low.