변형 근치 경부 림프절 절제술시 Iron-Intern 사용의 초기 경험
Early Experience of Iron-Intern Usage during Modified Radical Neck Dissection
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Purpose: Modified radical neck dissections (MRND) in papillary thyroid cancer surgery usually leave a long incision in the neck, causing cosmetic problems. We introduce a new surgical approach to MRND, with minimal lateral extension of transverse collar incisions, using the Iron-Intern. Methods: Between Jan 2008 and Dec 2008, 135 patients with papillary thyroid cancer who had undergone MRND were enrolled in this study. Total thyroidectomy and central node dissection with Kocker transverse collar incision with minimal additional lateral extension were performed before MRND. MRND were performed including level II, III, IV and V. Among 135 patients, we performed MRND with the Iron-Intern in 70 patients (Group I) and 65 patients who had MRND performed without the Iron-Intern (Group II) were included as a control group. In Group I, the Iron-Intern, with some modifications, was applied during the dissection of the level II area. The postoperative outcomes of the patients were analyzed and compared retrospectively. Results: The median hospital stay was significantly lower in Group I compared to Group II (P=0.003). The median operation time was significantly higher in Group I than Group II (P=0.002). The median numbers of harvested central and lateral lymph nodes were 10, 29 (group I) and 8, 23 (group II), respectively (P=0.073, P=0.148). Median levothyroxine off thyroglobulin levels were 1.2 and 1.8 in Group I and II, respectively (P=0.110). Conclusion: MRND, with minimal lateral extension using the Iron-Intern, can be easily and safely performed, leaving only minor scars in the neck.
Abstract
Purpose: Modified radical neck dissections (MRND) in papillary thyroid cancer surgery usually leave a long incision in the neck, causing cosmetic problems. We introduce a new surgical approach to MRND, with minimal lateral extension of transverse collar incisions, using the Iron-Intern. Methods: Between Jan 2008 and Dec 2008, 135 patients with papillary thyroid cancer who had undergone MRND were enrolled in this study. Total thyroidectomy and central node dissection with Kocker transverse collar incision with minimal additional lateral extension were performed before MRND. MRND were performed including level II, III, IV and V. Among 135 patients, we performed MRND with the Iron-Intern in 70 patients (Group I) and 65 patients who had MRND performed without the Iron-Intern (Group II) were included as a control group. In Group I, the Iron-Intern, with some modifications, was applied during the dissection of the level II area. The postoperative outcomes of the patients were analyzed and compared retrospectively. Results: The median hospital stay was significantly lower in Group I compared to Group II (P=0.003). The median operation time was significantly higher in Group I than Group II (P=0.002). The median numbers of harvested central and lateral lymph nodes were 10, 29 (group I) and 8, 23 (group II), respectively (P=0.073, P=0.148). Median levothyroxine off thyroglobulin levels were 1.2 and 1.8 in Group I and II, respectively (P=0.110). Conclusion: MRND, with minimal lateral extension using the Iron-Intern, can be easily and safely performed, leaving only minor scars in the neck.
참고문헌 (15)
- Slough CM, "History of thyroid and parathyroid surgery, Surgery of the Thyroid and Parathyroid Glands", pp.3~11 (2003), Saunders
- Ohgami M, "Scarless endoscopic thyroidectomy: breast approach for better cosmesis", Surg Laparosc Endosc Percutan Tech, 10, pp.1~4 (2000)
- Miccoli P, "Minimally invasive video-assisted surgery of the thyroid: a preliminary report", Langenbecks Arch Surg, 385, pp.261~264 (2000)
- Kang SW, "Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients", Endocr J, 56, pp.361~369 (2009)
- Tae K, "Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences", Surg Endosc, 25, pp.221~228 (2011)
- Kitano H, "Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation", Surg Endosc, 16, pp.88~91 (2002)
- Schlumberger MJ, "Nontoxic goiter and thyroid neoplasia, Williams Textbook of Endocrinology.", pp.469~473 (2002), Saunders
- 신선혜, "크기 1.5 cm 이하의 작은 갑상선 유두암의 예후를 고려한 조직학적 고찰", 대한내과학회지, 73(1), pp.44~49 (2007), 대한내과학회
- Ministry of Health and Welfare, "2002 Annual Report of the Korea Central Cancer Registry", ~ (2003)
- Akslen LA, "Prognostic significance of histologic grading compared with subclassification of papillary thyroid carcinoma", Cancer, 88, pp.1902~1908 (2000)
- DeGroot LJ, "Natural history, treatment, and course of papillary thyroid carcinoma", J Clin Endocrinol Metab, 71, pp.414~424 (1990)
- Hay ID, "Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989", Surgery, 114, pp.1050~1057 (1993)
- Mazzaferri EL, "Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer", Am J Med, 97, pp.418~428 (1994)
- Sherman SI, "Prospective multicenter study of thyroiscarcinoma treatment: initial analysis of staging and outcome. National Thyroid Cancer Treatment Cooperative Study Registry Group", Cancer, 83, pp.1012~1021 (1998)
- Greene FL, "The American Joint Committee on Cancer: updating the strategies in cancer staging", Bull Am Coll Surg, 87, pp.13~15 (2002)