Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases
Background: Lateral lymph node metastasis (LLNM) is associated with distant metastasis, locoregional recurrence and cancer-specific mortality, although the prevalence of LLNM among patients with papillary thyroid microcarcinoma (PTMC) is relatively low. The potential benefits and risks of routine la...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-08-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fendo.2019.00558/full |
| _version_ | 1811242851960356864 |
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| author | Shuai Xue Peisong Wang Qiang Zhang Yue Yin Liang Guo Ming Wang Meishan Jin Guang Chen |
| author_facet | Shuai Xue Peisong Wang Qiang Zhang Yue Yin Liang Guo Ming Wang Meishan Jin Guang Chen |
| author_sort | Shuai Xue |
| collection | DOAJ |
| description | Background: Lateral lymph node metastasis (LLNM) is associated with distant metastasis, locoregional recurrence and cancer-specific mortality, although the prevalence of LLNM among patients with papillary thyroid microcarcinoma (PTMC) is relatively low. The potential benefits and risks of routine lateral level V dissection (LVD) for PTMC with LLNM have not been previously investigated.Methods: A total of 6,880 consecutive PTMC patients who underwent initial surgery at the First Hospital of Jilin University from January 2009 to July 2017 were retrospectively analyzed. A total of 252 N1b PTMC patients were enrolled in our study.Results: The overall and occult metastasis rates in level V lymph nodes were 21.4 and 6.4%, respectively. Patients with N1b PTMC who received LVD did not show a significantly lower disease-free survival (DFS) than that of patients who did not receive LVD [hazard ratio = 1.11 (CI 0.38–3.21); p = 0.85]. Meanwhile, LVD simultaneously increased the hospital stay and cost (p = 0.03; 0.02). Multivariate logistic regression analysis revealed that 3-level simultaneous metastasis in the lateral neck was an independent risk factor for level V metastasis [odds ratio = 8.6 (CI 1.42–51.72); p = 0.02].Conclusions: Because of the low metastasis rate in level V lymph nodes, the lack of benefit for recurrence, the longer hospital stay and the higher cost associated with LVD, N1b PTMC patients without clinical level V metastasis may not need to undergo routine dissection. Prophylactic LVD may be recommended only for patients with N1b PTMC with 3-level simultaneous metastasis. |
| first_indexed | 2024-04-12T13:57:11Z |
| format | Article |
| id | doaj.art-a501bd07802f4ffaa475e93f7b933d14 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-12T13:57:11Z |
| publishDate | 2019-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-a501bd07802f4ffaa475e93f7b933d142022-12-22T03:30:20ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922019-08-011010.3389/fendo.2019.00558466850Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 CasesShuai Xue0Peisong Wang1Qiang Zhang2Yue Yin3Liang Guo4Ming Wang5Meishan Jin6Guang Chen7Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, ChinaDepartment of Thyroid Surgery, The First Hospital of Jilin University, Changchun, ChinaDepartment of Thyroid Surgery, The First Hospital of Jilin University, Changchun, ChinaDepartment of Thyroid Surgery, The First Hospital of Jilin University, Changchun, ChinaDepartment of Pathology, The First Hospital of Jilin University, Changchun, ChinaDepartment of Pathology, The First Hospital of Jilin University, Changchun, ChinaDepartment of Pathology, The First Hospital of Jilin University, Changchun, ChinaDepartment of Thyroid Surgery, The First Hospital of Jilin University, Changchun, ChinaBackground: Lateral lymph node metastasis (LLNM) is associated with distant metastasis, locoregional recurrence and cancer-specific mortality, although the prevalence of LLNM among patients with papillary thyroid microcarcinoma (PTMC) is relatively low. The potential benefits and risks of routine lateral level V dissection (LVD) for PTMC with LLNM have not been previously investigated.Methods: A total of 6,880 consecutive PTMC patients who underwent initial surgery at the First Hospital of Jilin University from January 2009 to July 2017 were retrospectively analyzed. A total of 252 N1b PTMC patients were enrolled in our study.Results: The overall and occult metastasis rates in level V lymph nodes were 21.4 and 6.4%, respectively. Patients with N1b PTMC who received LVD did not show a significantly lower disease-free survival (DFS) than that of patients who did not receive LVD [hazard ratio = 1.11 (CI 0.38–3.21); p = 0.85]. Meanwhile, LVD simultaneously increased the hospital stay and cost (p = 0.03; 0.02). Multivariate logistic regression analysis revealed that 3-level simultaneous metastasis in the lateral neck was an independent risk factor for level V metastasis [odds ratio = 8.6 (CI 1.42–51.72); p = 0.02].Conclusions: Because of the low metastasis rate in level V lymph nodes, the lack of benefit for recurrence, the longer hospital stay and the higher cost associated with LVD, N1b PTMC patients without clinical level V metastasis may not need to undergo routine dissection. Prophylactic LVD may be recommended only for patients with N1b PTMC with 3-level simultaneous metastasis.https://www.frontiersin.org/article/10.3389/fendo.2019.00558/fulllevel V dissectionpapillary thyroid microcarcinomalateral lymph node metastasislateral lymph node dissectionrecurrence |
| spellingShingle | Shuai Xue Peisong Wang Qiang Zhang Yue Yin Liang Guo Ming Wang Meishan Jin Guang Chen Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases Frontiers in Endocrinology level V dissection papillary thyroid microcarcinoma lateral lymph node metastasis lateral lymph node dissection recurrence |
| title | Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases |
| title_full | Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases |
| title_fullStr | Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases |
| title_full_unstemmed | Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases |
| title_short | Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases |
| title_sort | routine lateral level v dissection may not be necessary for papillary thyroid microcarcinoma with lateral lymph node metastasis a retrospective study of 252 cases |
| topic | level V dissection papillary thyroid microcarcinoma lateral lymph node metastasis lateral lymph node dissection recurrence |
| url | https://www.frontiersin.org/article/10.3389/fendo.2019.00558/full |
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