Right Paraesophageal Lymph Node Metastasis in Papillary Thyroid Cancer and Prophylactic Dissection: A Retrospective Study

Yun Gyoung Kim; Sun Young Min; Young Mi Lee; Ki-Wook Chung; Yuh Seok Jung; Jun Sun Ryu; Seok Won Kim

doi:10.16956/kjes.2013.13.2.77

Journal List > Korean J Endocr Surg > v.13(2) > 1060103

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Min, Lee, Chung, Jung, Ryu, and Kim: Right Paraesophageal Lymph Node Metastasis in Papillary Thyroid Cancer and Prophylactic Dissection: A Retrospective Study

Original Article

Korean J Endocrine Surg 2013;13(2):77-82.

Published online: 10 December 2013

DOI: https://doi.org/10.16956/kjes.2013.13.2.77

Right Paraesophageal Lymph Node Metastasis in Papillary Thyroid Cancer and Prophylactic Dissection: A Retrospective Study

Yun Gyoung Kim², Sun Young Min¹, Young Mi Lee¹, Ki-Wook Chung¹, Yuh Seok Jung¹, Jun Sun Ryu¹, Seok Won Kim¹

¹Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea

²Department of Surgery, Seoul National University Hospital, Seoul, Korea

Correspondence: Seok Won Kim Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, 323 (Madu-dong), Ilsan-ro, Ilsandong-gu, Goyang 410-769, Korea Tel: ＋82-2-3410-3479 Fax: ＋82-2-3410-6982 e-mail: surgeon69@gmail.com

Received 7 February 2013 Revised 6 May 2013 Accepted 16 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to determine the status of nodal disease, including the right paraesophageal node, in papillary thyroid carcinoma (PTC).

Methods

A total of 116 patients with PTC underwent total thyroidectomy and prophylactic central node dissection, including right paraesophageal lymph nodes (RPE LNs). Metastases to RPELNs were analyzed by site and clinicopathologic variables. Recurrence rate and post-operative complications were also evaluated by comparing the right paraesophageal lymph node dissection (RPE LND) with the non-RPE LND group.

Results

Central node metastases were detected in 57 (49.1%) patients; paratracheal and pre-tracheal lymph node metastases, total RPE LN metastases, and metastases only in RPE LN occurred in 50 (43.1%), 18 (15.5%), and 5 (4.3%) patients, respectively. Age, tumor size, tumor longitudinal location, extrathyroidal extension, and multicentricity were insignificant in RPE LN metastasis (P＞.05). Although there was no significant statistical difference, tumors with lymphatic invasion and larger tumors (＞1 cm) had more frequent RPE LN metastases. RPE LN metastases were frequent in deeply located tumors instead of superficially located tumors (P=0.015). Compared with the non-RPE LND group, the incidence of post-operative complications (transient hypocalcemia and vocal cord palsy) was not significantly different and there was no recurrence in both groups during the follow up period.

Conclusion

The metastatic rate of the right paraesophageal lymph nodes was 15.5%; 83.3% of these were macrometastatic. Prophylactic RPE dissection compared with the non-RPE LND group, however, did not show a survival difference for 5, years.

Keywords: Paraesophageal lymph node, Metastasis, Papillary thyroid cancer

References

1. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006; 16:109–42.

2. Machens A, Hinze R, Thomusch O, Dralle H. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002; 26:22–8.

3. Son YI, Jeong HS, Baek CH, Chung MK, Ryu J, Chung JH, et al. Extent of prophylactic lymph node dissection in the central neck area of the patients with papillary thyroid carcinoma: comparison of limited versus comprehensive lymph node dissection in a 2-year safety study. Ann Surg Oncol. 2008; 15:2020–6.

4. Kim MK, Mandel SH, Baloch Z, Livolsi VA, Langer JE, Didonato L, et al. Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg. 2004; 130:1214–6.

5. Moley JF, Lairmore TC, Doherty GM, Brunt LM, DeBenedetti MK. Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations. Surgery. 1999; 126:673–7.

6. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003; 237:399–407.

7. Gimm O, Rath FW, Dralle H. Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg. 1998; 85:252–4.

8. Henry JF, Gramatica L, Denizot A, Kvachenyuk A, Puccini M, Defechereux T. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 1998; 383:167–9.

9. Ito Y, Jikuzono T, Higashiyama T, Asahi S, Tomoda C, Takamura Y, et al. Clinical significance of lymph node metastasis of thyroid papillary carcinoma located in one lobe. World J Surg. 2006; 30:1821–8.

10. Pereira JA, Jimeno J, Miquel J, Iglesias M, Munné A, Sancho JJ, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery. 2005; 138:1095–100.

11. Shindo M, Wu JC, Park EE, Tanzella F. The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg. 2006; 132:650–4.

12. Gemsenjäger E, Perren A, Seifert B, Schüler G, Schweizer I, Heitz PU. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg. 2003; 197:182–90.

13. Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006; 140:1000–5.

14. Caron NR, Clark OH. Papillary thyroid cancer: surgical management of lymph node metastases. Curr Treat Options Oncol. 2005; 6:311–22.

15. White ML, Gauger PG, Doherty GM. Central lymph node dissection in differentiated thyroid cancer. World J Surg. 2007; 31:895–904.

16. Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol. 2008; 15:2482–6.

17. Ferlito A, Rinaldo A, Silver CE, Shaha AR, Fliss DM, Rodrigo JP, et al. Paratracheal node dissection for well-differentiated cancer of the thyroid: indications, technique and results. Auris Nasus Larynx. 2008; 35:463–8.

18. Uchino S, Noguchi S, Yamashita H, Watanabe S. Modified radical neck dissection for differentiated thyroid cancer: operative technique. World J Surg. 2004; 28:1199–203.

19. Uruno T, Miyauchi A, Shimizu K, Nakano K, Takamura Y, Ito Y, et al. Prognosis after reoperation for local recurrence of papillary thyroid carcinoma. Surg Today. 2004; 34:891–5.

20. Yun JS, Lee YS, Jung JJ, Nam KH, Chung WY, Park CS. Central neck recurrence patterns and morbidity following reoperation for recurrent papillary thyroid carcinoma. J Korean Surg Soc. 2008; 74:42–7.

21. Kim KM, Park JB, Bae KS, Kim CB, Kang DR, Kang SJ. Clinical prognostic index for recurrence of papillary thyroid carcinoma including intraoperative findings. Endocr J. 2013; 60:291–7.

22. Cheah WK, Arici C, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Complications of neck dissection for thyroid cancer. World J Surg. 2002; 26:1013–6.

23. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007; 245:604–10.

Fig. 1.

The paraesophageal node. (A) A: paratracheal lymph nodes, B: paraesophageal lymph nodes, C: pre-tracheal lymph nodes. (B) Lymph nodes of this area (paraesophageal lymph nodes) were dissected.

Table 1.

Patient demographics and clinical characteristics

Characteristics	Value
No. of patients	116
Gender Male: Female, N (%)	18 (15.5):98 (84.5)
Age (year), mean (SD), range	50.9 (10.8), 27∼78
Tumor
Size (cm), mean (SD), range	0.9 (0.6), 0.2∼4.0
Microcarcinoma, N (%)	76 (65.5)
Multicentricity, N (%)	33 (28.4)
Bilaterality, N (%)	42 (36.2)
Extrathyroidal extension,	64 (55.2)
N (%)
Lymphatic invasion, N (%)	32 (27.6)
Tumor location
Lt. lobe/Rt. lobe/isthmus, N (%)	9 (7.8)/104 (89.7)/3 (2.6)
Upper pole/mid pole/lower pole, N (%)	39 (33.6)/42 (36.2)/34 (29.3)
Anterior aspect/deep portion, N (%)	44 (37.9)/71 (61.2)
Nodal metastasis, N (%)	57 (49.1)
Paratracheal and pretracheal nodes	50 (43.1)
Rt. paraesophageal nodes	18 (15.5)
Paratracheal and pretracheal nodes only	39 (33.6)
Rt. paraesophageal nodes only	5 (4.3)
Operation method
TT with ipsilateral CLND	23 (19.8)
TT with bilateral CLND	93 (80.2)

TT = total thyroidectomy; CLND = central lymph node dissection.

Table 2.

Clinicopathologic characteristics according to right paraesophageal lymph node metastasis (N=116)

Characteristics	RPE LN (＋) (N=18)	RPE LN (－) (N=98)	P
Age (year), mean (SD)	48.6 (10.5)	51.0 (10.5)	0.988
Size (cm), mean (SD)	1.2 (0.5)	0.9 (0.7)	0.697
Tumor location
Lt. lobe/Rt. lobe, N (%)	0 (0)/18 (100)	9 (9.2)/86 (87.8)	0.590
Anterior aspect, N (%)	2 (11.1)	42 (43.3)
Deep portion, N (%)	16 (88.9)	55 (56.7)	0.015
Upper pole, N (%)	8 (44.4)	31 (32.0)	0.324
Mid pole, N (%)	6 (33.3)	36 (37.1)
Lower pole, N (%)	4 (22.2)	30 (30.9)
Extrathyroidal extension, N (%)	12 (66.7)	52 (53.1)	0.319
Lymphatic invasion, N (%)	8 (44.4)	24 (24.5)	0.106
Bilaterality, N (%)	6 (33.3)	36 (36.7)	0.483
Multicentricity, N (%)	5 (27.8)	28 (28.6)	0.141
Microcarcinoma, N (%)	8 (44.4)	68 (69.4)	0.148

RPE LN = right paraesophageal lymph node; Lt = left; Rt = right. P-value from chi-square test for parametric data, Fisher's exact test for non-parametric data and Student's t-test.

Table 3.

Clinicopathologic characteristics according to right paraesophageal lymph node metastasis in unilateral papillary thyroid cancer (N=74)

Characteristics	RPE LN (＋) (N=12)	RPE LN (－) (N=62)	P
Age (year), mean (SD)	47.6 (9.1)	51.1 (10.5)	0.148
Size (cm), mean (SD)	1.1 (0.5)	0.9 (0.6)	0.395
Tumor location
Lt. lobe/Rt. lobe, N (%)	0 (0)/12 (100) 4	(6.5)/55 (88.7)
Anterior aspect, N (%)	1 (8.3)	27 (43.5)
Deep portion, N (%)	11 (91.7)	35 (56.5)	0.024
Upper pole, N (%)	6 (50.0)	17 (27.4)	0.107
Mid pole, N (%)	2 (16.7)	28 (45.2)
Lower pole, N (%)	4 (33.3)	17 (27.4)
Extrathyroidal extension, N (%)	7 (58.3)	30 (48.4)	0.098
Lymphatic invasion, N (%)	5 (41.7)	13 (21.0)
Multicentricity, N (%)	3 (25.0)	9 (14.5)	0.116
Microcarcinoma, N (%)	6 (50.0)	42 (67.7)	0.091

RPE LN = right paraesophageal lymph node; Lt = left; Rt = right. P-value from chi-square test for parametric data, Fisher's exact test for non-parametric data and Student's t-test.

Table 4.

Recurrence rates and post-operative complication

	RPE LND group (N=116)	Non-RPE LND group (N=99)	P
Gender Male:Female, N (%)	18 (15.5):98 (84.5)	8 (8.1):91 (91.9)	0.069
Age (year), mean (SD), range	50.9 (10.8), 27∼78	49.1 (10.4), 26∼82	0.274
T-stage T1/T2/T3, N	96/8/2	91/8/0	0.392
N-stage (＋/－), N	54/54	49/50	0.527
Median f/u period (months)	54	63	＜0.01
Recurrence rate (%)	0	0	N/A
Complication Transient hypocalcemia, N (%)	30 (25.9)	28 (28.3)	0.411
Transient vocal cord palsy, N (%)	3 (2.1)	2 (2.0)	0.656

RPE LND = right paraesophageal lymph node dissection; Median F/U period = median follow-up period. P-value from chi-square test for parametric data, Fisher's exact test for non-parametric data and Student's t-test.

TOOLS

Similar articles