Transcervical superior mediastinal lymphadenectomy in the management of papillary thyroid carcinoma.
OBJECTIVE
Surgery is the treatment of choice for lymph node metastases in papillary thyroid carcinoma. When adequately treated by surgical extirpation, the presence of lymph node involvement does not seem to have a negative impact on cure rates or survival. Surgical lymphadenectomy for metastatic papillary thyroid carcinoma has been well described for both the central and the lateral compartments of the neck. Superior mediastinal lymphadenectomy, however, has only sporadically been mentioned. We describe our experience with transcervical superior mediastinal lymphadenectomy (TSML) that avoids the morbidity of the traditional sternal split.


METHODS
This retrospective analysis included 30 patients (24 women and 6 men; age range, 17-72 years) who underwent TSML by the senior author (JLF) for papillary carcinoma metastatic to the superior mediastinum between 1985 and 1999. Histopathologic examination confirmed positive nodes in all the mediastinal dissections. All patients received postoperative I(131).


RESULTS
All the patients are alive after a median follow-up of 5 years (range, 1-14 years). Twenty-nine of 30 patients remain free of disease, whereas one patient is alive with lung and bone metastases. No patient has had local or regional relapse. The only significant complication was a high incidence of temporary (70%) and later permanent (50%) hypoparathyroidism.


CONCLUSIONS
TSML is a safe and effective treatment for superior mediastinal metastases in papillary thyroid carcinoma.
Khoo
Mark L C
ML
Department of Otolaryngology, Mount Sinai Hospital, 600 University Avenue, Suite 401, Toronto, Ontario M5G 1X5, Canada.
Freeman
Jeremy L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D008482:Mediastinum / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*