Surgical treatment of cervical nodal metastases in patients with papillary thyroid carcinoma.
OBJECTIVE
To determine if more extensive neck dissection in patients with papillary carcinoma of the thyroid affords a survival benefit vs limited lymphadenectomy of positive nodal disease.


METHODS
Survey analysis of a national cancer database.


METHODS
Cases of papillary thyroid carcinoma were extracted from the Surveillance, Epidemiology, and End Results database for January 1, 1988, to December 31, 1999, along with demographic, staging, and treatment variables. Cases were limited to patients who underwent total thyroidectomy and postoperative radioactive iodine treatment along with excision of 1 or more positive cervical nodes. Patients were divided into 2 groups: those undergoing limited lymphadenectomy of only positive nodes and those undergoing more extensive neck dissection with removal of positive and negative nodes.


RESULTS
Among 2097 patients with papillary carcinoma meeting treatment criteria, 880 underwent limited lymphadenectomy and 1217 underwent neck dissection. The mean age, sex distribution, primary tumor extent and size, and follow-up duration were not different between these 2 groups (P>.05 for all). The mean survival for patients undergoing limited lymphadenectomy was 135 months, vs 136 months for patients undergoing neck dissection. Actuarial 5-year (10-year) survival rates were 94.4% (91.3%) and 95.9% (92.4%), respectively. Kaplan-Meier survival was not different between groups (P =.40, log-rank test).


CONCLUSIONS
Limited lymphadenectomy of positive nodal disease in patients with papillary carcinoma affords survival similar to that of patients undergoing more extensive neck dissections. Therefore, a formal neck dissection may not be required for the effective treatment of cervical nodal metastases in patients with papillary carcinoma of the thyroid.
Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Neil
N
Bhattacharyya
D000328:Adult; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009333:Neck / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection; D012189:Retrospective Studies; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*