갑상선 유두암의 측경부 재발에서 포괄적 경부 림프절절제술과 비교한 제한적 경부 림프절절제술의 치료 성적
Is Comprehensive Neck Dissection a Sole Choice for the Treatment of Recurrent Papillary Thyroid Carcinoma in the Lateral Neck?
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Background and Objectives Therapeutic comprehensive neck dissection has been recommended for the patients with recurrent papillary thyroid carcinoma (PTC) confined to the neck after initial total thyroidectomy. However, the benefit of comprehensive neck dissection to remove asymptomatic metastatic lymph node towards improving clinical recurrences or survival is largely unproven. We analyzed the pattern of recurrence in the lateral compartment of neck and evaluated the possible application of limited lymph node dissection against comprehensive neck dissection. Subjects and Method A retrospective review was carried out for 43 patients who underwent surgical treatment for recurrent PTC in the lateral neck from 2000 to 2005, and their clinicopathological results were stratified according to the extent of surgery into two groups, the limited surgery group and the comprehensive surgery group. Results Recurrence rate in lateral neck after initial total thyroidectomy was 14.5% (43/ 296), and the most common level of recurrence was level IV (50.9%). Although limited surgery group showed a tendency toward more frequent recurrence after treatment of the first recurrence than did the comprehensive surgery group, this tendency had no statistical significance. Moreover, no patients in either group have died of PTC during over a mean follow-up period of 80 months. In the aspect of factors associated with surgical morbidity, such as operating time, duration of admission, and complication, the limited surgery group had superior results when compared to the comprehensive group. Conclusion The benefit of comprehensive neck dissection concerning recurrence and survival was not verified in the present study hence a more preservative approach could be applied to selective patients with recurrent PTC in the lateral compartment of neck.
Abstract
Background and Objectives Therapeutic comprehensive neck dissection has been recommended for the patients with recurrent papillary thyroid carcinoma (PTC) confined to the neck after initial total thyroidectomy. However, the benefit of comprehensive neck dissection to remove asymptomatic metastatic lymph node towards improving clinical recurrences or survival is largely unproven. We analyzed the pattern of recurrence in the lateral compartment of neck and evaluated the possible application of limited lymph node dissection against comprehensive neck dissection. Subjects and Method A retrospective review was carried out for 43 patients who underwent surgical treatment for recurrent PTC in the lateral neck from 2000 to 2005, and their clinicopathological results were stratified according to the extent of surgery into two groups, the limited surgery group and the comprehensive surgery group. Results Recurrence rate in lateral neck after initial total thyroidectomy was 14.5% (43/ 296), and the most common level of recurrence was level IV (50.9%). Although limited surgery group showed a tendency toward more frequent recurrence after treatment of the first recurrence than did the comprehensive surgery group, this tendency had no statistical significance. Moreover, no patients in either group have died of PTC during over a mean follow-up period of 80 months. In the aspect of factors associated with surgical morbidity, such as operating time, duration of admission, and complication, the limited surgery group had superior results when compared to the comprehensive group. Conclusion The benefit of comprehensive neck dissection concerning recurrence and survival was not verified in the present study hence a more preservative approach could be applied to selective patients with recurrent PTC in the lateral compartment of neck.
참고문헌 (22)
- 김은중, "갑상선 유두상 암종에 대한 임상적 고찰", 대한이비인후과학회지 두경부외과학, 47(4), pp.354~361 (2004), 대한이비인후과학회
- 안순현, "갑상선암의 유전자 이상", 대한이비인후과학회지 두경부외과학, 51(6), pp.502~507 (2008), 대한이비인후과학회
- Ross DS, "Recurrence after treatment of micropapillary thyroid cancer", Thyroid, 19(10), pp.1043~1048 (2009)
- Baudin E, "Microcarcinoma of the thyroid gland:the Gustave-Roussy Institute experience", Cancer, 83(3), pp.553~559 (1998)
- Cooper DS, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 19(11), pp.1167~1214 (2009)
- Caron NR, "Selective modified radical neck dissection for papillary thyroid cancer-is level I, II and V dissection always necessary", World J Surg, 30(5), pp.833~840 (2006)
- Sato N, "Do the level of nodal disease according to the TNM classification and the number of involved cervical nodes reflect prognosis in patients with differentiated carcinoma of the thyroid gland? J Surg", Oncol, 69(3), pp.151~155 (1998)
- Shaha AR, "Risk group stratification and prognostic factors in papillary carcinoma of thyroid", Ann Surg Oncol, 3(6), pp.534~538 (1996)
- Lundgren CI, "Clinically significant prognostic factors for differentiated thyroid carcinoma:a population-based,nested case-control study", Cancer, 106(3), pp.524~531 (2006)
- Noguchi S, "The value of lymph-node dissection in patients with differentiated thyroid cancer", Surg Clin North Am, 67(2), pp.251~261 (1987)
- 태경, "유두상 갑상선 암종에서 경부 림프절 전이의 양상 및 치료", 대한이비인후과학회지 두경부외과학, 48(12), pp.1506~1511 (2005), 대한이비인후과학회
- Sivanandan R, "Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid", Br J Surg, 88(9), pp.1241~1244 (2001)
- Pingpank JF Jr, "Tumor above the spinal accessory nerve in papillary thyroid cancer that involves lateral neck nodes:a common occurrence", Arch Otolaryngol Head Neck Surg, 128(11), pp.1275~1278 (2002)
- Frankenthaler RA, "Lymph node metastasis from papillary-follicular thyroid carcinoma in young patients", Am J Surg, 160(4), pp.341~343 (1990)
- Roh JL, "Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma", Head Neck, 29(10), pp.901~906 (2007)
- Wong KT, "Ultrasound of thyroid cancer", Cancer Imaging, 5, pp.157~166 (2005)
- Schoder H, "Positron emission imaging of head and neck cancer,including thyroid carcinoma", Semin Nucl Med, 34(3), pp.180~197 (2004)
- Bardet S, "Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma", Eur J Endocrinol, 158(4), pp.551~560 (2008)
- Bhattacharyya N, "Surgical treatment of cervical nodal metastases in patients with papillary thyroid carcinoma", Arch Otolaryngol Head Neck Surg, 129(10), pp.1101~1104 (2003)
- Shen WT, "Central neck lymph node dissection for papillary thyroid cancer:the reliability of surgeon judgment in predicting which patients will benefit", Surgery, 148(2), pp.398~403 (2010)
- Turanli S, "Is the type of dissection in lateral neck metastasis for differentiated thyroid carcinoma important", Otolaryngol Head Neck Surg, 136(6), pp.957~960 (2007)
- 김원배, "갑상선결절 및 암 진료 권고안", 대한내분비학회지, 22(3), pp.157~187 (2007), 대한내분비학회