Individualized surgical procedures for well-differentiated thyroid cancer located in the isthmus: report of 19 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PAN Lijie ^1,2 , ZHAO Jing ¹ ,  KANG Hua ¹

1. Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;
2. Department of General Surgery, The First Affiliated Hospital of Tsinghua University, Beijing 100016, P. R. China;

Corresponding author：

KANG Hua, Email: kanghua@xwh.ccmu.edu.cn

Keywords：

well-differentiated thyroid cancer; isthmus; surgical procedure; lymph node excision

DOI：

10.7507/1007-9424.201904006

Video：

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Objective To investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.Methods Nineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.Results Among the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.Conclusions For patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.

Citation： PAN Lijie, ZHAO Jing, KANG Hua. Individualized surgical procedures for well-differentiated thyroid cancer located in the isthmus: report of 19 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 929-933. doi: 10.7507/1007-9424.201904006 Copy

1.	魏松锋, 高明, 钱碧云, 等. 1954-2009年间天津市肿瘤医院收治的甲状腺癌构成分析. 中华肿瘤杂志, 2011, 33(8): 613-615.
2.	吴毅, 孙团起. 甲状腺癌手术质量控制争议与共识. 中国实用外科杂志, 2016, 36(1): 34-37.
3.	Li G, Lei J, Peng Q, et al. Lymph node metastasis characteristics of papillary thyroid carcinoma located in the isthmus: a single-center analysis. Medicine (Baltimore), 2017, 96(24): e7143.
4.	Lee YS, Jeong JJ, Nam KH, et al. Papillary carcinoma located in the thyroid isthmus. World J Surg, 2010, 34(1): 36-39.
5.	Vasileiadis I, Boutzios G, Karalaki M, et al. Papillary thyroid carcinoma of the isthmus: total thyroidectomy or isthmusectomy? Am J Surg, 2018, 216(1): 135-139.
6.	Lei J, Zhu J, Li Z, et al. Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis. Onco Targets Ther, 2016, 9: 5209-5216.
7.	Karatzas T, Charitoudis G, Vasileiadis D, et al. Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: a case control study. Int J Surg, 2015, 18: 64-68.
8.	王梦一, 袁宏伟, 张宁, 等. 峡部甲状腺乳头状癌的诊治探讨. 中华内分泌外科杂志, 2015, 9(1): 9-12.
9.	黄辉, 徐震纲, 刘绍严, 等. 27例分化型甲状腺峡部癌患者的临床分析. 中华肿瘤杂志, 2013, 35(11): 871.
10.	Nixon IJ, Palmer FL, Whitcher MM, et al. Thyroid isthmusectomy for well-differentiated thyroid cancer. Ann Surg Oncol, 2011, 18(3): 767-770.
11.	Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. Lancet, 2016, 388(10061): 2783-2795.
12.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
13.	McLeod DS, Sawka AM, Cooper DS. Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet, 2013, 381(9871): 1046-1057.
14.	中华人民共和国国家卫生健康委员会. 甲状腺癌诊疗规范 (2018年版). 中华普通外科学文献: 电子版, 2019, 13(1): 1-15.
15.	吴昕, 徐协群, 郑朝纪, 等. 分化型甲状腺癌再次手术的临床分析. 中国普外基础与临床杂志, 2017, 24(7): 813-818.
16.	王震宇, 李锋, 张伟军. 分化型甲状腺癌再次手术临床分析. 中华耳鼻咽喉头颈外科杂志, 2010, 45(11): 951-953.
17.	Ahn D, Sohn JH, Park JY. Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma. Auris Nasus Larynx, 2014, 41(1): 63-68.
18.	Gschwandtner E, Seemann R, Bures C, et al. How many parathyroid glands can be identified during thyroidectomy? Evidence-based data for medical experts. Eur Surg, 2018, 50(1): 14-21.
19.	Sugenoya A, Shingu K, Kobayashi S, et al. Surgical strategies for differentiated carcinoma of the thyroid isthmus. Head Neck, 1993, 15(2): 158-160.
20.	Ywata de Carvalho A, Chulam TC, Kowalski LP. Long-term results of observation vs prophylactic selective level Ⅵ neck dissection for papillary thyroid carcinoma at a cancer center. JAMA Otolaryngol Head Neck Surg, 2015, 141(7): 599-606.
21.	Heaton CM, Chang JL, Orloff LA. Prognostic implications of lymph node yield in central and lateral neck dissections for well-differentiated papillary thyroid carcinoma. Thyroid, 2016, 26(3): 434-440.
22.	Ruel E, Thomas S, Perkins JM, et al. The impact of pathologically positive lymph nodes in the clinically negative neck: an analysis of 39,301 patients with papillary thyroid cancer. Ann Surg Oncol, 2017, 24(7): 1935-1942.
23.	朱一鸣, 蔺晨, 王健, 等. 甲状腺乳头状癌侧颈部淋巴结二次清扫的治疗经验. 中国医刊, 2016, 51(6): 59-63.
24.	吴红伟, 沈丰, 孙少华, 等. 全甲状腺切除+预防性中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌103例临床分析. 中国普外基础与临床杂志, 2016, 23(3): 324-327.
25.	赵菁, 凌煜玮, 韩婧, 等. 前哨淋巴结活检在分化型甲状腺癌治疗中的应用. 中国普外基础与临床杂志, 2017, 24(11): 1333-1341.
26.	许文, 费哲为. 前哨淋巴结活检术在甲状腺癌手术中的研究进展. 中国普外基础与临床杂志, 2016, 23(7): 891-894.
27.	Kaczka K, Luks B, Jasion J, et al. Sentinel lymph node in thyroid tumors-own experience. Contemp Oncol (Pozn), 2013, 17(2): 184-189.
28.	Saliba J, Payne RJ, Varshney R, et al. Sentinel lymph node biopsy status correlates with postoperative stimulated thyroglobulin levels in low-risk papillary thyroid cancer patients. Endocr Pract, 2014, 20(5): 399-404.
29.	Balasubramanian SP, Harrison BJ. Systematic review and meta-analysis of sentinel node biopsy in thyroid cancer. Br J Surg, 2011, 98(3): 334-344.

1. 魏松锋, 高明, 钱碧云, 等. 1954-2009年间天津市肿瘤医院收治的甲状腺癌构成分析. 中华肿瘤杂志, 2011, 33(8): 613-615.
2. 吴毅, 孙团起. 甲状腺癌手术质量控制争议与共识. 中国实用外科杂志, 2016, 36(1): 34-37.
3. Li G, Lei J, Peng Q, et al. Lymph node metastasis characteristics of papillary thyroid carcinoma located in the isthmus: a single-center analysis. Medicine (Baltimore), 2017, 96(24): e7143.
4. Lee YS, Jeong JJ, Nam KH, et al. Papillary carcinoma located in the thyroid isthmus. World J Surg, 2010, 34(1): 36-39.
5. Vasileiadis I, Boutzios G, Karalaki M, et al. Papillary thyroid carcinoma of the isthmus: total thyroidectomy or isthmusectomy? Am J Surg, 2018, 216(1): 135-139.
6. Lei J, Zhu J, Li Z, et al. Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis. Onco Targets Ther, 2016, 9: 5209-5216.
7. Karatzas T, Charitoudis G, Vasileiadis D, et al. Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: a case control study. Int J Surg, 2015, 18: 64-68.
8. 王梦一, 袁宏伟, 张宁, 等. 峡部甲状腺乳头状癌的诊治探讨. 中华内分泌外科杂志, 2015, 9(1): 9-12.
9. 黄辉, 徐震纲, 刘绍严, 等. 27例分化型甲状腺峡部癌患者的临床分析. 中华肿瘤杂志, 2013, 35(11): 871.
10. Nixon IJ, Palmer FL, Whitcher MM, et al. Thyroid isthmusectomy for well-differentiated thyroid cancer. Ann Surg Oncol, 2011, 18(3): 767-770.
11. Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. Lancet, 2016, 388(10061): 2783-2795.
12. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
13. McLeod DS, Sawka AM, Cooper DS. Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet, 2013, 381(9871): 1046-1057.
14. 中华人民共和国国家卫生健康委员会. 甲状腺癌诊疗规范 (2018年版). 中华普通外科学文献: 电子版, 2019, 13(1): 1-15.
15. 吴昕, 徐协群, 郑朝纪, 等. 分化型甲状腺癌再次手术的临床分析. 中国普外基础与临床杂志, 2017, 24(7): 813-818.
16. 王震宇, 李锋, 张伟军. 分化型甲状腺癌再次手术临床分析. 中华耳鼻咽喉头颈外科杂志, 2010, 45(11): 951-953.
17. Ahn D, Sohn JH, Park JY. Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma. Auris Nasus Larynx, 2014, 41(1): 63-68.
18. Gschwandtner E, Seemann R, Bures C, et al. How many parathyroid glands can be identified during thyroidectomy? Evidence-based data for medical experts. Eur Surg, 2018, 50(1): 14-21.
19. Sugenoya A, Shingu K, Kobayashi S, et al. Surgical strategies for differentiated carcinoma of the thyroid isthmus. Head Neck, 1993, 15(2): 158-160.
20. Ywata de Carvalho A, Chulam TC, Kowalski LP. Long-term results of observation vs prophylactic selective level Ⅵ neck dissection for papillary thyroid carcinoma at a cancer center. JAMA Otolaryngol Head Neck Surg, 2015, 141(7): 599-606.
21. Heaton CM, Chang JL, Orloff LA. Prognostic implications of lymph node yield in central and lateral neck dissections for well-differentiated papillary thyroid carcinoma. Thyroid, 2016, 26(3): 434-440.
22. Ruel E, Thomas S, Perkins JM, et al. The impact of pathologically positive lymph nodes in the clinically negative neck: an analysis of 39,301 patients with papillary thyroid cancer. Ann Surg Oncol, 2017, 24(7): 1935-1942.
23. 朱一鸣, 蔺晨, 王健, 等. 甲状腺乳头状癌侧颈部淋巴结二次清扫的治疗经验. 中国医刊, 2016, 51(6): 59-63.
24. 吴红伟, 沈丰, 孙少华, 等. 全甲状腺切除+预防性中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌103例临床分析. 中国普外基础与临床杂志, 2016, 23(3): 324-327.
25. 赵菁, 凌煜玮, 韩婧, 等. 前哨淋巴结活检在分化型甲状腺癌治疗中的应用. 中国普外基础与临床杂志, 2017, 24(11): 1333-1341.
26. 许文, 费哲为. 前哨淋巴结活检术在甲状腺癌手术中的研究进展. 中国普外基础与临床杂志, 2016, 23(7): 891-894.
27. Kaczka K, Luks B, Jasion J, et al. Sentinel lymph node in thyroid tumors-own experience. Contemp Oncol (Pozn), 2013, 17(2): 184-189.
28. Saliba J, Payne RJ, Varshney R, et al. Sentinel lymph node biopsy status correlates with postoperative stimulated thyroglobulin levels in low-risk papillary thyroid cancer patients. Endocr Pract, 2014, 20(5): 399-404.
29. Balasubramanian SP, Harrison BJ. Systematic review and meta-analysis of sentinel node biopsy in thyroid cancer. Br J Surg, 2011, 98(3): 334-344.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Individualized surgical procedures for well-differentiated thyroid cancer located in the isthmus: report of 19 cases

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