PDF(Sci-hub)
Abstract：
UNASSIGNED: The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disease, the prognostic benefit of level V prophylactic ND remains debatable.
UNASSIGNED: All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database.
UNASSIGNED: A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P = .648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk.
UNASSIGNED: There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study\'s findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients.
UNASSIGNED: All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database.
UNASSIGNED: A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P = .648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk.
UNASSIGNED: There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study\'s findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients.
摘要：
■在颈外侧存在临床可检测的甲状腺乳头状癌（PTC）转移是颈淋巴结清扫（ND）和甲状腺切除术的适应症。尽管对于临床上明显的局部区域转移性疾病患者中II至IV级的治疗选择性ND的重要性存在共识，V级预防性ND的预后益处仍有争议。
■在2006年至2019年期间因转移性PTC接受ND甲状腺切除术的所有患者均纳入单机构回顾性研究。初次演示时的术前特征，成像检查,术中发现,最终的组织病理学报告从机构数据库中检索。
■共发现189例局部晚期PTC患者，其中22例（11.6％）患者因临床受累而接受了II至IV级选择性ND和V级解剖。在V级手术的患者与未发现的患者的比较没有显着差异。平均随访5.1±3.1年，复发率为20.1%。在接受和未接受VND水平的患者之间，复发率没有显着差异（22.7％vs19.8％，P=.648）。随访期间未检测到切除水平V的复发，而在未进行V级解剖的4例（2.1％）患者中发现了V级复发。宏观和微观甲状腺外扩展的证据是疾病复发风险的重要预测因素。
■V级夹层与复发风险之间没有显著关联。V级复发罕见(4/189名患者，2.1%）。我们的研究结果表明，选择性水平VND的预防益处较低。在指示横向ND时，不应常规进行选择性VND水平，而应在对高危患者进行仔细评估后考虑。
■在2006年至2019年期间因转移性PTC接受ND甲状腺切除术的所有患者均纳入单机构回顾性研究。初次演示时的术前特征，成像检查,术中发现,最终的组织病理学报告从机构数据库中检索。
■共发现189例局部晚期PTC患者，其中22例（11.6％）患者因临床受累而接受了II至IV级选择性ND和V级解剖。在V级手术的患者与未发现的患者的比较没有显着差异。平均随访5.1±3.1年，复发率为20.1%。在接受和未接受VND水平的患者之间，复发率没有显着差异（22.7％vs19.8％，P=.648）。随访期间未检测到切除水平V的复发，而在未进行V级解剖的4例（2.1％）患者中发现了V级复发。宏观和微观甲状腺外扩展的证据是疾病复发风险的重要预测因素。
■V级夹层与复发风险之间没有显著关联。V级复发罕见(4/189名患者，2.1%）。我们的研究结果表明，选择性水平VND的预防益处较低。在指示横向ND时，不应常规进行选择性VND水平，而应在对高危患者进行仔细评估后考虑。
