MANAGEMENT OF LYMPH NODE METASTASES IN WELL-DIFFERENTIATED AND MEDULLARY THY ROID CANCER: RETROSPECTIVE STUDY ON 52 CASES
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Abstract
Objective: To define the surgical principles of neck dissections as applied to the head and neck squamous cell carcinomas, extending their rationale to treatment of lymph nodes metastases from thyroid carcinomas.
Materials and methods: Between January 1994 and June 2002, 52 patients affected by well-differentiated thyroid cancers (1 follicular, 9 medullary, and 42 papillary cancers) underwent uni- or bilateral neck dissections at our Department, for a total of 73 neck dissections. Patients were subdivided into 2 groups: 37 simultaneously treated on the thyroid and the neck (Group A), and 15 operated elsewhere on the thyroid and for a neck recurrence and/or persistence at our Department (Group B).
Results: 48 patients underwent a regular follow-up (range: 3-86 months, mean: 38). Among patients alive with disease, 5 in Group A and 4 in Group B had a localregional recurrence. In particular, 2 patients for each group (2 medullary and 2 papillary cancers) had a regional recurrence on the N site, at the level of one or more lymph nodes "in field" as regards the neck dissection previously performed. Moreover, in all these patients a local recurrence on the T site has been observed.
Discussion: Lymph nodes metastases have a minor prognostic impact in well-differentiated thyroid cancers in respect of the rest of head and neck cancers. Nonetheless, when performing a cura t i ve or elective neck dissection, the gold standard surgical principles must be the same. As a matter of fact, a 20% o incidence of lymph nodes metastases at the V level, often not specifically addressed in neck dissections for thyroid cancers, it is noteworthy. Aim of such an aggressive surgical approach of the neck is to obtain a low incidence of “in field” regional recurrences, which become no more amenable of a subsequent surgical salvage.
Conclusion: Surgical techniques as lymphadenectomy or “pick-berry procedure” must be abandoned because they do not respect the basic anatomic, physiopathologic, and oncologic principles of neck dissections along cervical fasciae and spaces.