[Lymph node dissection in non-medullary differentiated thyroid carcinoma].
Papillary and follicular thyroid carcinomas are the most common form of endocrine carcinomas. Lymph node involvement seems to be a low risk factor for death, but it increases the risk for loco-regional recurrences and distant metastasis. The limits and the key points of the cervical lymph node dissection are described. The sentinel lymph node is used to rarely, so it could limit the lymph dissection. Node-picking has to be avoided. Central lymph node resection is recommended for high-risk patients, as male, patients more than 45 or less than 21 years old, papillary carcinomas greater than 1 cm or follicular carcinoma more than 2 cm in diameter. Lateral lymph node resection is performed when the lymph nodes of the central compartment are involved, more than 3 cm in diameter, and bulked. Prophylactic lymphadenectomy is useless. When thyroid carcinoma is known postoperatively, re-operation depends of the cervical mass and of the results of the radioactive iodine treatment.
Mathonnet
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M
Service de Chirurgie Digestive, Générale et Endocrinienne, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France. mathonnet@unilim.fr
D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy