The Role of Prophylactic Cervical Lymph Node Dissection with Total Thyroidectomy in Prevention Recurrence of Papillary Thyroid Carcinoma

Salah Hadi Kadhim; Karrar Ibrahim Mahmood; Mohammed Mohammud Habash

doi:10.3889/oamjms.2022.9436

Authors

Salah Hadi Kadhim Department of Surgery
Karrar Ibrahim Mahmood Department of Surgery, Hammurabi College of Medicine, University of Babylon, Hillah, Iraq
Mohammed Mohammud Habash Department of Surgery, College of Medicine, University of Diyala, Baqubah, Iraq

DOI:

https://doi.org/10.3889/oamjms.2022.9436

Keywords:

Papillary thyroid cancer, Lateral and central cervical lymph nodes, Risk factors

Abstract

AIM: It is assess benefit prophylactic selective unilateral cervical lymph node (LN) dissection with total thyroidectomy for patients who have papillary thyroid carcinoma (PTC) and negative cervical lymph nodes metastasis and determination recommended risk factors for such surgery.

METHODS: This was a prospective study, 60 patients with PTC investigated by Fine needle aspiration, ultrasonography to support diagnosis patients with PTC, and negative lymph node metastasis. Nineteen patients are excluded from the entire 60 patients; remaining 41 patients are submitted to a total thyroidectomy and prophylactic selective one side ipsilateral lateral and central lymph nodes dissection (level II, III, IV, and V). Then, follow-up 2 years for all patients, postoperatively, for detection PTC recurrence.

RESULTS: The result shows that from the total 41 patients, two groups are positive and negative lymph nodes metastasis 24.4% (10) and 75.6% (31), respectively, positive lymph nodes metastasis is presented more in male 7 (70%) with significant difference (p = 0.03) and age groups <55 years old 6 (60%) with insignificant association (p = 0.413). Thyroid nodular size (>1 cm) and multiple nodules presented more in positive lymph nodes metastasis with significant difference in both. Multivariate binary logistic regression, sex, thyroid multinodularity, and thyroid nodule size were insignificant relationship of prediction of lymph nodes metastasis.

CONCLUSION: Prophylactic cervical LN dissection with total thyroidectomy for patients with PTC and negative cervical lymph nodes metastasis has beneficial role in preventing recurrence of PTC. Risk factors such as male gender, thyroid multinodularity (multiple nodule), and their size (>1 cm) have role in increasing chance of occurrence of cervical LN metastasis.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Murray SE, Schneider DF, Bauer PS, Sippel RS, Chen H. Synchronous and antecedent nonthyroidal malignancies in patients with papillary thyroid carcinoma. J Am Coll Surg. 2013;216(6):1174-80. https://doi.org/10.1016/j.jamcollsurg.2013.02.007 Mid:23522438 DOI: https://doi.org/10.1016/j.jamcollsurg.2013.02.007

Wu X, Li BL, Zheng CJ, He XD. Predictive factors for central lymph node metastases in papillary thyroid microcarcinoma. World J Clin Cases. 2020;8(8):1350-60. https://doi.org/10.12998/wjcc.v8.i8.1350 PMid:32368529 DOI: https://doi.org/10.12998/wjcc.v8.i8.1350

Sciuto R, Romano L, Rea S, Marandino F, Sperduti I, Maini CL. Natural history and clinical outcome of differentiated thyroid carcinoma: A retrospective analysis of 1503 patients treated at a single institution. Ann Oncol. 2009;20(10):1728-35. https://doi.org/10.1093/annonc/mdp050 PMid:19773250 DOI: https://doi.org/10.1093/annonc/mdp050

Toniato A, Boschin I, Casara D, Mazzarotto R, Rubello D, Pelizzo M. Papillary thyroid carcinoma: Factors influencing recurrence and survival. Ann Surg Oncol. 2008;15(5):1518-22. https://doi.org/10.1245/s10434-008-9859-4 PMid:18324441 DOI: https://doi.org/10.1245/s10434-008-9859-4

Gillanders SL, O’Neill JP. Prognostic markers in well differentiated papillary and follicular thyroid cancer (WDTC). Eur J Surg Oncol. 2018;44(3):286-96. https://doi.org/10.1016/j.ejso.2017.07.013 PMid:28801060 DOI: https://doi.org/10.1016/j.ejso.2017.07.013

Siironen P, Louhimo J, Nordling S, Ristimäki A, Mäenpää H, Haapiainen R, et al. Prognostic factors in papillary thyroid cancer: An evaluation of 601 consecutive patients. Tumor Biol. 2005;26(2):57-64. https://doi.org/10.1159/000085586 PMid:15870511 DOI: https://doi.org/10.1159/000085586

Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005;71(9):731-4. https://doi.org/10.1177/000313480507100907 PMid:16468507 DOI: https://doi.org/10.1177/000313480507100907

Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214. https://doi.org/10.1089/thy.2009.0110 PMid:19860577 DOI: https://doi.org/10.1089/thy.2009.0110

Xu B, Tallini G, Scognamiglio T, Roman BR, Tuttle RM, Ghossein RA. Outcome of large noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Thyroid. 2017;27(4):512-7. https://doi.org/10.1089/thy.2016.0649 PMid:28136139 DOI: https://doi.org/10.1089/thy.2016.0649

Bruno OD, Ase E, García Del Río H, Mezzadri NA. Long-term survival after small doses of radioiodine therapy for brain metastases of thyroid cancer. Medicina (B Aires). 2020;80(5):560-2. PMid:33048803

Grogan RH, Kaplan SP, Cao H, Weiss RE, Degroot LJ, Simon CA, et al. A study of recurrence and death from papillary thyroid cancer with 27 years of median follow-up. Surgery. 2013;154(6):1436-46. https://doi.org/10.1016/j.surg.2013.07.008 PMid:24075674 DOI: https://doi.org/10.1016/j.surg.2013.07.008

Wiltshire JJ, Drake TM, Uttley L, Balasubramanian SP. Systematic review of trends in the incidence rates of thyroid cancer. Thyroid. 2016;26(11):1541-52. https://doi.org/10.1089/thy.2016.0100 PMid:27571228 DOI: https://doi.org/10.1089/thy.2016.0100

Ryu YJ, Kwon SY, Lim SY, Na YM, Park MH. Predictive factors for skip lymph node metastasis and their implication on recurrence in papillary thyroid carcinoma. Biomedicines. 2022;10(1):179. https://doi.org/10.3390/biomedicines10010179 PMid:35052858 DOI: https://doi.org/10.3390/biomedicines10010179

Leboulleux S, Rubino C, Baudin E, Caillou B, Hartl DM, Bidart JM, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 2005;90(10):5723-9. https://doi.org/10.1210/jc.2005-0285 PMid:16030160 DOI: https://doi.org/10.1210/jc.2005-0285

Adam MA, Pura J, Goffredo P, Dinan MA, Reed SD, Sosa JA, et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. J Clin Oncol. 2015;33(21):2370-5. https://doi.org/10.1200/jco.2014.59.8391 PMid:26077238 DOI: https://doi.org/10.1200/JCO.2014.59.8391

De Meer SG, Dauwan M, De Keizer B, Valk GD, Borel Rinkes IH, Vriens MR. Not the number but the location of lymph nodes matters for recurrence rate and disease-free survival in patients with differentiated thyroid cancer. World J Surg. 2012;36(6):1262-7. https://doi.org/10.1007/s00268-012-1427-1 PMid:22270993 DOI: https://doi.org/10.1007/s00268-012-1427-1

Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26(1):1-133. https://doi.org/10.1089/thy.2015.0020 PMid:26462967 DOI: https://doi.org/10.1089/thy.2015.0020

Lang BH, Ng SH, Lau LL, Cowling BJ, Wong KP, Wan KY. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid. 2013;23(9):1087-98. https://doi.org/10.1089/thy.2012.0608 PMid:23402640 DOI: https://doi.org/10.1089/thy.2012.0608

Yang P, Li J, Jing H, Chen Q, Song X, Qian L. Effect of prophylactic central lymph node dissection on locoregional recurrence in patients with papillary thyroid microcarcinoma. Int J Endocrinol. 2021;2021:8270622. https://doi.org/10.1155/2021/8270622 PMid:34819955 DOI: https://doi.org/10.1155/2021/8270622

Li C, Meng ZZ, Qin JW, Qiu XG. Analysis of risk factors of level V lymphatic metastasis for papillary thyroid carcinoma with pN1b. J Oncol. 2021;2021:5562065. https://doi.org/10.1155/2021/5562065 PMid:34457005 DOI: https://doi.org/10.1155/2021/5562065

Sippel RS, Robbins SE, Poehls JL, Pitt SC, Chen H, Leverson G, et al. A randomized controlled clinical trial: No clear benefit to prophylactic central neck dissection in patients with clinically node negative papillary thyroid cancer. Ann Surg. 2020;272(3):496-503. https://doi.org/10.1097/sla.0000000000004345 PMid:33759836 DOI: https://doi.org/10.1097/SLA.0000000000004345

Viola D, Materazzi G, Valerio L, Molinaro E, Agate L, Faviana P, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: Clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab. 2015;100(4):1316-24. https://doi.org/10.1210/jc.2014-3825 PMid:25590215 DOI: https://doi.org/10.1210/jc.2014-3825

Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: Update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212. https://doi.org/10.1155/2013/965212 PMid:23737785 DOI: https://doi.org/10.1155/2013/965212

Zhang X, Chen W, Fang Q, Fan J, Feng L, Guo L, et al. lateral lymph node metastases in t1a papillary thyroid carcinoma: stratification by tumor location and size. Front Endocrinol (Lausanne). 2021;12:716082. https://doi.org/10.3389/fendo.2021.716082 PMid:34335480 DOI: https://doi.org/10.3389/fendo.2021.716082

Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg. 2006;30(1):91-9. https://doi.org/10.1007/s00268-005-0113-y PMid:16369721 DOI: https://doi.org/10.1007/s00268-005-0113-y

Ito Y, Fukushima M, Higashiyama T, Kihara M, Takamura Y, Kobayashi K, et al. Incidence and predictors of right paraesophageal lymph node metastasis of N0 papillary thyroid carcinoma located in the right lobe. Endocr J. 2013;60(3):389-92. https://doi.org/10.1507/endocrj.ej12-0362 PMid:23182918 DOI: https://doi.org/10.1507/endocrj.EJ12-0362

Salter KD, Andersen PE, Cohen JI, Schuff KG, Lester L, Shindo ML, et al. Central nodal metastases in papillary thyroid carcinoma based on tumor histologic type and focality. Arch Otolaryngol Head Neck Surg. 2010;136(7):692-6. https://doi.org/10.1001/archoto.2010.112 PMid:20644065 DOI: https://doi.org/10.1001/archoto.2010.112

Qu N, Zhang L, Ji QH, Chen JY, Zhu YX, Cao YM, et al. Risk factors for central compartment lymph node metastasis in papillary thyroid microcarcinoma: A meta-analysis. World J Surg. 2015;39(10):2459-70. DOI: https://doi.org/10.1007/s00268-015-3108-3

Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: Pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007;245(4):604-10. https://doi.org/10.1097/01.sla.0000250451.59685.67 PMid:17414610 DOI: https://doi.org/10.1097/01.sla.0000250451.59685.67

Zuniga S, Sanabria A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2009;135(11):1087-91. https://doi.org/10.1001/archoto.2009.163 PMid:19917919 DOI: https://doi.org/10.1001/archoto.2009.163