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Is the Internal Jugular Node Dissection without Level V Sufficient in Patients with Papillary Thyroid Carcinoma with Lateral Neck Node Metastasis?

Journal of Endocrine Surgery 2020년 20권 3호 p.31 ~ 40
이초록, 김진경, 강상욱, 이잔디, 정종주, 남기현, 정웅윤,
소속 상세정보
이초록 ( Lee Cho-Rok ) - Yonsei University College of Medicine Department of Surgery
김진경 ( Kim Jin-Kyong ) - Yonsei University College of Medicine Department of Surgery
강상욱 ( Kang Sang-Wook ) - Yonsei University College of Medicine Department of Surgery
이잔디 ( Lee Jan-Dee ) - Yonsei University College of Medicine Department of Surgery
정종주 ( Jeong Jong-Ju ) - Yonsei University College of Medicine Department of Surgery
남기현 ( Nam Kee-Hyun ) - Yonsei University College of Medicine Department of Surgery
정웅윤 ( Chung Woong-Youn ) - Yonsei University College of Medicine Department of Surgery

Abstract


Purpose: Papillary thyroid carcinoma (PTC) has a high rate of lateral neck node metastases, and completeness of surgical resection is an important determinant of outcomes. The appropriate extent of therapeutic lateral neck dissection remains controversial. This study aims to access the impact of lateral neck node dissection of levels II to V in a large patient series.

Methods: A retrospective review of the clinical charts and hospital records of 778 consecutive patients who had metastatic PTC and who underwent unilateral cervical lymph node dissection at a single institution between 1999 January and 2009 December.

Results: A total of 489 modified radical neck dissection (MRND) (levels II?V) and 289 internal jugular node dissection (IJND) (levels II?IV) were performed in 778 patients. There were no differences in clinicopathological findings except for the retrieved and metastatic lateral lymph nodes (LLNs). The multiple-level lymph node (LN) metastasis was more prevalent in the MRND group, and the distribution of metastasis lymph node levels was significantly different in both group. The recurrence rate and disease-free survival were similar in the 2 groups. In multivariate analysis, female sex, tumor size, and multi-level LLN metastasis were independent predictors recurrence. Postoperative complications were similar in MRND and IJND group.

Conclusion: IJND achieves favorable postoperative results in PTC with lateral neck node metastasis patients, and level V metastasis/recurrence incidence is low. Therefore, the extent of lateral neck node dissection, whether IJND or MRND, can be considered for patients according to the simultaneous metastasis level and the tumor size.

키워드

Thyroid carcinoma; Neck dissection; Recurrence

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