Total Thyroidectomy plus Prophylactic Central Lymph Node Dissection in Treatment of Multifocal Papillary Thyroid Carcinoma: A Clinical Analysis of 103 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WUHong-wei , SHENFeng ,  SUNShao-hua , HUHong-sheng , ZHOUWen-bo

Department of Thyroid Surgery, Affliated Dongfeng Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China;

Corresponding author：

SUNShao-hua, Email: sysunshaohua@126.com

Keywords：

Multifocal papillary thyroid carcinoma; Central lymph node dissection; Efficacy

DOI：

10.7507/1007-9424.20160086

Video：

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Objective To analyze the clinical and pathological features of multifocal papillary thyroid carcinoma, and to assess the value and safety of total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma. Methods Clinical data of 103 patients with multifocal papillary thyroid carcinoma, who underwent total thyroidectomy plus prophylactic central lymph node dissection in Affliated Dongfeng Hospital from June 2011 to February 2015 were collected retrospectively. Preoperative ultrasound showed that all patients didn't suffered from cervical lymph node metastasis. Results Among 103 patients who underwent total thyroidectomy plus central lymph node dissection, the unilateral multiple lesions were found in 55 patients (53.40%), and the bilateral multiple lesions were found in 48 patients (46.60%). A total of 31 patients (30.10%) were confirmed to have central lymph node metastasis after operation, central lymph node metastasis only located in the same side of multifocal papillary thyroid carcinoma in 16 patients (29.10%), but of 15 patients (31.25%) with 2-side of multifocal papillary thyroid carcinoma, 7 patients suffered from 2-side central lymph node metastasis and 8 patients suffered from 1-side central lymph node metastasis. Thirty patients (12.62%) suffered from transient postoperative hypocalcemia after operation, and returned to normal for longest of 2 weeks; 1 patient (0.97%) suffered from parathyroid permanent damage; 18 patients (17.48%) suffered from transient recurrent laryngeal nerve palsy, no one suffered from permanent recurrent laryngeal nerve injury; 3 patients (2.91%) suffered from postoperative transient drinking cough. All of 103 patients were followed up for 5 months to 4 years, and the postoperative follow-up rate was 100%. During the follow-up period, 3 patients (2.91%) suffered from cervical lymph node metastasis in side region of neck. Conclusion Total thyroidectomy plus prophylactic central lymph node dissection plays an important role in the treatment of multifocal papillary thyroid carcinoma.

Citation： WUHong-wei, SHENFeng, SUNShao-hua, HUHong-sheng, ZHOUWen-bo. Total Thyroidectomy plus Prophylactic Central Lymph Node Dissection in Treatment of Multifocal Papillary Thyroid Carcinoma: A Clinical Analysis of 103 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(3): 324-326. doi: 10.7507/1007-9424.20160086 Copy

1.	向俊, 吴毅. 甲状腺癌临床诊治新特点(附572例临床分析). 中国实用外科杂志, 2008, 28(5): 365-367.
2.	张磊, 王洋, 李新喜, 等. 预防性颈中央区淋巴结清扫术与传统甲状腺全切除术治疗cN0期甲状腺乳头状癌安全性及有效性的meta分析. 中国普外基础与临床杂志, 2015, 22(12): 1487-1494.
3.	崔鹏, 徐德全, 殷越, 等. cN0期甲状腺微小乳头状癌颈部淋巴结处理的研究进展. 中国普外基础与临床杂志,2015, 22(11): 1405-1409.
4.	吴红伟, 王飞, 胡洪生, 等. 甲状腺全切除术技术改进临床应用分析. 中国普通外科杂志, 2011, 20(5): 523-525.
5.	吴高松, 马小鹏, 刘岩岩, 等. 甲状腺全切除术的技术改进(附252例报告). 华中科技大学学报: 医学版, 2009, 38(6): 829-831.
6.	李加涌, 桑剑锋, 姚永忠, 等. 双极电凝镊在开放性甲状腺手术中的临床应用. 中国普外基础与临床杂志, 2016, 23(1): 75-78.
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8.	林琳, 郑向前, 刘磊, 等. 多灶性甲状腺乳头状癌的生物学特性及治疗分析. 中华普通外科杂志, 2010, 25(8): 621-623.
9.	林益凯, 盛建明, 赵文和, 等. 多灶性甲状腺乳头状癌168例临床研究. 中华外科杂志, 2009, 47(6): 450-453.
10.	李治, 刘春萍, 石岚, 等. 546例分化型甲状腺癌手术治疗分析. 中华外科杂志, 2008, 46(5): 375-377.
11.	石岚, 黄韬. 甲状腺乳头状癌淋巴结转移规律的研究. 中华普通外科杂志, 2007, 22(7): 524-526.
12.	中华医学会内分泌学分会, 中华医学会外科学分会内分泌外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
13.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
14.	NCCN. NCCN clinical practice guidelines in oncology. Thyroid carcinoma. Version 1. 2011-04-25. http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.
15.	Pacini F, Castagna MG, Brilli L, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v214-v219.
16.	田文. 应重视甲状腺全切除术中并发症的预防. 中华外科杂志, 2015, 53(3): 161-163.
17.	田文, 姚京. 重视甲状腺结节规范化诊治. 中国实用外科杂志, 2015, 35(6): 579-583.
18.	吴红伟, 王飞, 胡洪生, 等. 甲状腺全切除术治疗甲状腺微小癌128例临床分析. 中国普通外科杂志, 2014, 23(5): 609-611.
19.	Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2005, 30(1): 91-99.
20.	Moo TA, McGill J, Allendorf J, et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg, 2010, 34(6): 1187-1191.
21.	黄韬. ATA、NCCN及欧洲分化型甲状腺癌临床指南异同点和国内应用探讨. 中国实用外科杂志, 2011, 31(5): 407-410.

1. 向俊, 吴毅. 甲状腺癌临床诊治新特点(附572例临床分析). 中国实用外科杂志, 2008, 28(5): 365-367.
2. 张磊, 王洋, 李新喜, 等. 预防性颈中央区淋巴结清扫术与传统甲状腺全切除术治疗cN0期甲状腺乳头状癌安全性及有效性的meta分析. 中国普外基础与临床杂志, 2015, 22(12): 1487-1494.
3. 崔鹏, 徐德全, 殷越, 等. cN0期甲状腺微小乳头状癌颈部淋巴结处理的研究进展. 中国普外基础与临床杂志,2015, 22(11): 1405-1409.
4. 吴红伟, 王飞, 胡洪生, 等. 甲状腺全切除术技术改进临床应用分析. 中国普通外科杂志, 2011, 20(5): 523-525.
5. 吴高松, 马小鹏, 刘岩岩, 等. 甲状腺全切除术的技术改进(附252例报告). 华中科技大学学报: 医学版, 2009, 38(6): 829-831.
6. 李加涌, 桑剑锋, 姚永忠, 等. 双极电凝镊在开放性甲状腺手术中的临床应用. 中国普外基础与临床杂志, 2016, 23(1): 75-78.
7. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59(4): 225-249.
8. 林琳, 郑向前, 刘磊, 等. 多灶性甲状腺乳头状癌的生物学特性及治疗分析. 中华普通外科杂志, 2010, 25(8): 621-623.
9. 林益凯, 盛建明, 赵文和, 等. 多灶性甲状腺乳头状癌168例临床研究. 中华外科杂志, 2009, 47(6): 450-453.
10. 李治, 刘春萍, 石岚, 等. 546例分化型甲状腺癌手术治疗分析. 中华外科杂志, 2008, 46(5): 375-377.
11. 石岚, 黄韬. 甲状腺乳头状癌淋巴结转移规律的研究. 中华普通外科杂志, 2007, 22(7): 524-526.
12. 中华医学会内分泌学分会, 中华医学会外科学分会内分泌外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
13. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer; Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
14. NCCN. NCCN clinical practice guidelines in oncology. Thyroid carcinoma. Version 1. 2011-04-25. http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.
15. Pacini F, Castagna MG, Brilli L, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v214-v219.
16. 田文. 应重视甲状腺全切除术中并发症的预防. 中华外科杂志, 2015, 53(3): 161-163.
17. 田文, 姚京. 重视甲状腺结节规范化诊治. 中国实用外科杂志, 2015, 35(6): 579-583.
18. 吴红伟, 王飞, 胡洪生, 等. 甲状腺全切除术治疗甲状腺微小癌128例临床分析. 中国普通外科杂志, 2014, 23(5): 609-611.
19. Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2005, 30(1): 91-99.
20. Moo TA, McGill J, Allendorf J, et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg, 2010, 34(6): 1187-1191.
21. 黄韬. ATA、NCCN及欧洲分化型甲状腺癌临床指南异同点和国内应用探讨. 中国实用外科杂志, 2011, 31(5): 407-410.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Total Thyroidectomy plus Prophylactic Central Lymph Node Dissection in Treatment of Multifocal Papillary Thyroid Carcinoma: A Clinical Analysis of 103 Cases

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