Influence of Prophylactic Neck Dissection on Rate of Retreatment for Papillary Thyroid Carcinoma
- PDF / 254,458 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 96 Downloads / 176 Views
Influence of Prophylactic Neck Dissection on Rate of Retreatment for Papillary Thyroid Carcinoma Dana M. Hartl • Elisabeth Mamelle • Isabelle Borget • Sophie Leboulleux • Haı¨tham Mirghani • Martin Schlumberger
Published online: 16 May 2013 Ó Socie´te´ Internationale de Chirurgie 2013
Abstract Background Prophylactic neck dissection (PND) for papillary thyroid cancer is controversial. The objective of this study was to analyze the influence of PND on the rate of retreatment. Methods In this retrospective case-control study, papillary thyroid carcinomas [10 mm without ultrasonographic evidence of nodal disease (cN0) were treated with total thyroidectomy (TT) or TT with bilateral central compartment PND. All received postoperative radioactive iodine (131I) and were followed for at least 1 year. We compared the rate of retreatment (surgery or 131I). Results Altogether, 246 patients (mean age 46 years, 78 % women) underwent TT (n = 91) or TT ? PND (n = 155). The groups were similar in age, sex, tumor size, and follow-up (median 6.3 years) (p [ 0.05). Overall, 11 (12 %) of the patients in the TT group underwent reoperation in the central compartment for recurrence versus 3 This work was included in a poster presentation at the 82nd annual meeting of the American Thyroid Association, Quebec, Canada, September 19–22, 2012. D. M. Hartl (&) E. Mamelle H. Mirghani Department of Head and Neck Oncology, Thyroid Surgery Unit, Institut Gustave Roussy and Paris-Sud University, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France e-mail: [email protected] I. Borget Department of Clinical Research, Biostatistics and Epidemiology Unit, Institut Gustave Roussy and Paris-Sud University, Villejuif, France S. Leboulleux M. Schlumberger Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and Paris-Sud University, Villejuif, France
(2 %) in the TT ? PND group (p \ 0.001). There were 1.18 administrations of 131I for the TT group versus 1.08 for the TT ? PND group (p = 0.08). The average cumulative dose of 131I was 3.9 ± 1.8 GBq for the TT group and 3.8 ± 1.3 GBq for the TT ? PND group (p = 0.52). Actuarial (Kaplan-Meier) 5-year retreatment rates were 14.7 % in the TT group and 6.5 % in the TT ? PND group (p = 0.01, log-rank). The rate of permanent recurrent nerve paralysis was 2 % for the TT group and 1 % for the TT ? PND group (p = 0.98). The rates of permanent hypoparathyroidism were 7 versus 3 %, respectively (p = 0.12). Conclusions Five-year retreatment rates were lower in patients treated with PND, with no added permanent morbidity.
Introduction Papillary thyroid carcinoma carries a high risk of occult lymph node metastases—up to 80 %—whereas follicular carcinoma is associated with a low rate of lymph node metastases—\15 % [1, 2]. Therapeutic neck dissection, performed for patients with known lymph node metastases discovered by preoperative ultrasonography (US) scanning or physical examination [3, 4], is advocated to resect all gross disease and improve regional control [5, 6]. In two large datab
Data Loading...
