Impact of Routine Unilateral Central Neck Dissection on Preablative and Postablative Stimulated Thyroglobulin Levels after Total Thyroidectomy in Papillary Thyroid Carcinoma
详细信息 查看全文
- 作者：Brian Hung-Hin Lang MS (1)
Kai Pun Wong MBBS (1)
Koon Yat Wan MBBS (2)
Chung Yau Lo MS (1) - 刊名：Annals of Surgical Oncology
- 出版年：2012
- 出版时间：January 2012
- 年：2012
- 卷：19
- 期：1
- 页码：60-67
- 全文大小：225KB
- 参考文献：1. Cancer incidence and mortality in Hong Kong, 1983-006. Hong Kong Cancer Registry, Hong Kong. http://www3.ha.org.hk/cancereg/e_stat.asp.
2. Lang BH, Lo CY, Chan WF, Lam KY, Wan KY. Prognostic factors in papillary and follicular thyroid carcinoma: implications for cancer staging. / Ann Surg Oncol. 2007;14:730-. CrossRef
3. Machens A, Hauptmann S, Dralle H. Lymph node dissection in the lateral neck for completion in central node-positive papillary thyroid cancer. / Surgery. 2009;145:176-1. CrossRef
4. Cooper DS, Doherty GM, Hauger BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. / Thyroid. 2009;19:1167-14. CrossRef
5. Zetoune T, Keutgen X, Buitrago D, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. / Ann Surg Oncol. 2010;17:3287-3. CrossRef
6. Hughes DT, White ML, Miller BS, Gauger PG, Burney RE, Doherty GM. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. / Surgery. 2010;148:1100-. CrossRef
7. Moo TA, McGill J, Allendorf J, Lee J, Fahey T, Zarnegar R. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. / World J Surg. 2010;34:1187-1. CrossRef
8. Bonnet S, Hartl D, Leboulleux S, et al. Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. / J Clin Endocrinol Metab. 2009;94:1162-. CrossRef
9. Forest VI, Clark JR, Ebrahimi A, et al. Central compartment dissection in thyroid papillary carcinoma. / Ann Surg. 2011;253:123-0. CrossRef
10. Carling T, Long WD, Udelsman R. Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer. / Curr Opin Oncol. 2010;22:30-. CrossRef
11. 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. 2006;30:91-. CrossRef
12. Shen WT, Ogawa L, Ruan D, Suh I, Duh QY, Clark OH. Central neck lymph node dissection for papillary thyroid cancer: the reliability of surgeon judgment in predicting which patients will benefit. / Surgery. 2010;148:398-03. CrossRef
13. Rosenbaum MA, McHenry CR. Central neck dissection for papillary thyroid cancer. / Arch Otolaryngol Head Neck Surg. 2009;135:1092-. CrossRef
14. Roh JL, Park JY, Park CI. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. / Cancer. 2009;115:251-. CrossRef
15. Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid carcinoma. / Surgery. 2006;140:1000-. CrossRef
16. Low TH, Delbridge L, Sidhu S, et al. Lymph node status influences follow-up thyroglobulin levels in papillary thyroid cancer. / Ann Surg Oncol. 2008;15:2827-2. CrossRef
17. Kim TY, Kim WB, Kim ES, et al. Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. / J Clin Endocrinol Metab. 2005;90:1440-. CrossRef
18. Heemstra KA, Liu YY, Stokkel M, et al. Serum thyroglobulin concentrations predict disease-free remission and death in differentiated thyroid carcinoma. / Clin Endocrinol (Oxf). 2007;66:58-4.
19. Giovanella L, Ceriani L, Suriano S, Ghelfo A, Maffioli M. Thyroglobulin measurement before rh-TSH-aided 131I ablation in detecting metastases form differentiated thyroid carcinoma. / Clin Endocrinol (Oxf). 2008;69:659-3. CrossRef
20. So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. / Surgery. doi:10.1016/j.surg.2011.02.004 .
21. Lang BH, Lo CY, Chan WF, Lam KY, Wan KY. Staging systems for papillary thyroid carcinoma: a review and comparison. / Ann Surg. 2007;245:366-8. CrossRef
22. Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. / Surgery. 2006;140:866-3. CrossRef
23. Sackett WR, Reeve TS, Barraclough B, Delbridge L. Thyrothymic thyroid rest: incidence and relationship to the thyroid gland. / J Am Coll Surg. 2002;195:635-0. CrossRef
24. Lang B, Lo CY, Chan WF, Lam KY, Wan KY. Restaging of differentiated thyroid carcinoma by the sixth edition AJCC/UICC TNM staging system: stage migration and predictability. / Ann Surg Oncol. 2007;14:1551-. CrossRef
25. Lo CY. Parathyroid autotransplantation during thyroidectomy. / ANZ J Surg. 2002;72:902-. CrossRef
26. So YK, Son YI, Hong SD, et al. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. / Surgery. 2010;148:526-1. CrossRef
27. Smallridge RC, Meek SE, Morgan MA, et al. Monitoring thyroglobulin in a sensitive immunoassay has comparable sensitivity to recombinant human TSH-stimulated thyroglobulin in follow-up of thyroid cancer patients. / J Clin Endocrinol Metab. 2007;92:82-. CrossRef
28. Kloos RT, Mazzaferri EL. A single recombinant human thyrotrophin–stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later. / J Clin Endocrinol Metab. 2005;90:5047-7. CrossRef - 作者单位：Brian Hung-Hin Lang MS (1)
Kai Pun Wong MBBS (1)
Koon Yat Wan MBBS (2)
Chung Yau Lo MS (1)
1. Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
2. Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
文摘
Background Prophylactic central neck dissection (CND) remains controversial in papillary thyroid carcinoma (PTC). Because postsurgical stimulated thyroglobulin (sTg) level is a good surrogate for recurrence, the study aimed to evaluate the impact of prophylactic CND on preablative and postablative sTg levels after total thyroidectomy. Methods Of the 185 patients retrospectively analyzed, 82 (44.3%) underwent a total thyroidectomy and prophylactic CND (CND-positive group) while 103 (55.7%) underwent total thyroidectomy only (CND-negative group). All patients had no preoperative or intraoperative evidence of lymph node metastases. Clinicopathological characteristics, postoperative outcomes, and preablative and postablative sTg levels were compared between the two groups. Preablative sTg level was taken at the time of radioiodine ablation, while postablative sTg level was taken 6?months after ablation. A multivariable analysis was conducted to identify factors for preablative athyroglobulinemia (sTg?<?0.5?μg/L). Results Relative to the CND-negative group, the CND-positive group had larger tumors (15?mm vs. 10?mm, P?<?0.005), more extrathyroidal extension (26.8% vs. 14.6%, P?<?0.003), more tumor, node, metastasis system stage III disease (32.9% vs. 9.7%, P?<?0.001), and more temporary hypoparathyroidism (18.3% vs. 8.7%, P?=?0.017). Fourteen patients (17.1%) in the CND-positive group were upstaged from stages I/II to III as a result of prophylactic CND. The CND-positive group experienced lower median preablative sTg (<0.5?μg/L vs. 6.7?μg/L, P?<?0.001) and a higher rate of preablative athyroglobulinemia (51.2% vs. 22.3%, P?=?0.024), but these differences were not observed 6?months after ablation. Prophylactic CND was the only independent factor for preablative athyroglobulinemia. Conclusions Although performing prophylactic CND in total thyroidectomy may offer a more complete initial tumor resection than total thyroidectomy alone by minimizing any residual microscopic disease, such a difference becomes less noticeable 6?months after ablation.