Clinical evaluation of upper mediastinal dissection for differentiated thyroid carcinoma.
BACKGROUND
An extensive upper mediastinal dissection in advanced differentiated thyroid carcinoma is occasionally required. This investigation was undertaken to clarify the indications for mediastinal lymph node dissection and the route of upper mediastinal metastases.


METHODS
Twenty-one patients with differentiated thyroid cancer, who underwent their first radical operations with mediastinal dissection through a partial midline sternotomy, were enrolled in this study. Of 21 patients, 10 (48%) were found to have mediastinal lymph node metastases.


RESULTS
The tumor size in the group with metastatic disease was much bigger than that in the group without metastatic disease. Histologic type and age were similar between the two groups. The extent of cervical lymph node metastases was more significant in the group with metastatic disease; in particular, all 10 patients showed more than two metastatic nodes along the internal jugular vein of the tumor-free side.


CONCLUSIONS
This study indicates that metastases to the internal jugular chain on the side contralateral to the primary tumor would be an extremely important factor for indication of extensive upper mediastinal lymph node dissection after median partial sternotomy in patients with differentiated thyroid carcinoma.
Sugenoya
A
A
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Asanuma
K
K
Shingu
K
K
Onuma
H
H
Shimizu
T
T
Masuda
H
H
Kasuga
Y
Y
Kobayashi
S
S
Iida
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000556:secondary* / Q000601:surgery; D008482:Mediastinum / Q000601:surgery*; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*