Elsevier

Surgery

Volume 140, Issue 6, December 2006, Pages 1000-1007
Surgery

American Association of Endocrine Surgeons
Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer

Presented at the 27th Annual Meeting of the American Association of Endocrine Surgeons, New York, New York, May, 2006.
https://doi.org/10.1016/j.surg.2006.08.001Get rights and content

Background

Lymphadenectomy in clinically node-negative papillary thyroid cancer (PTC) is controversial. The aim of this study is to determine whether routine ipsilateral level VI lymphadenectomy (LNDVI) has advantages over total thyroidectomy (TT) alone.

Methods

A retrospective cohort study was performed. Patients undergoing surgery for clinically node-negative PTC >1 cm were included. Group A had TT and LNDVI. Group B had TT alone. The number of radioiodine treatments and postablative stimulated serum thyroglobulin (TG) levels were compared.

Results

From 1995 to 2005, 447 patients with clinically node-negative PTC underwent surgery. Group A (n = 56) had TT and LNDVI. Group B (n = 391) had TT alone. Tumor size was equivalent (group A, 20 mm; group B, 23 mm; P = .14) as were MACIS (metastasis, age, completeness of resection, invasion, and size) scores (group A, 4.70; confidence interval, 4.23-5.17; group B, 4.73; confidence interval, 4.4-5.05). Serum postablative TG levels were lower in group A (0.4 μg/L) compared with group B (9.3 μg/L), P = .02. More patients had undetectable TG levels in group A (72%) than in group B (43%) (P < .001). Long-term complications rates were the same.

Conclusions

In PTC the addition of routine LNDVI results in lower postablation levels of TG and higher rates of athyroglobulinemia when compared with TT alone.

Section snippets

Patients and methods

A retrospective cohort study of all patients undergoing surgical intervention for PTC at the University of Sydney Endocrine Unit was undertaken. Data were retrieved from prospectively maintained surgical and nuclear medicine databases.

Results

In the period December 1995 to April 2005, 594 patients underwent surgical intervention for PTC within the University of Sydney Endocrine Surgery Unit. Of these, 447 had no preoperative evidence of lymph node metastases either in the central or lateral compartments on the basis of physical examination and sonography. Fifty-six patients underwent TT in combination with ipsilateral LNDVI and were designated as group A. Three hundred ninety-one patients in group B underwent TT alone. As shown in

Discussion

The role of routine surgery for the management of apparently normal regional lymph nodes continues to be enthusiastically debated. This is true for PTC and other surgically treated malignancies. Some groups have argued that lymph node metastasis, in general, are an indicator of prognosis rather than the determining factor of prognosis; as a result the treatment of regional lymph nodes and metastasis does not effect the outcome of cancer cases.10, 11 It has generally been accepted in the past

Conclusion

Total thyroidectomy performed in conjunction with ipsilateral LNDVI in patients with PTC and no apparent lymphadenopathy results in significantly lower levels of serum TG and higher rates of athyroglobulinemia.

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