[Surgical management of upper mediastinal lymph nodes metastases from thyroid carcinoma].
OBJECTIVE
To evaluate the significance of upper mediastinal lymph nodes dissection for thyroid carcinoma patients.


METHODS
The clinical data of 79 thyroid carcinoma patients who underwent the upper mediastinal lymph node dissection (between January 1984 and December 1998) were retrospectively analysed. There were 45 male and 34 female with a median age of 47 years (range 10 to 74 years). Follow-up was ended on December 31, 2003.


RESULTS
Histopathologically, there were 58 (73.4%) papillary carcinoma, 14 (17.7%) medullary carcinoma, and 7 (8.9%) follicular carcinomas. Four of them had poorly-differentiated carcinoma. Upper mediastinal lymph node dissection was carried out in 62 patients through trans-cervical approach, in 10 through an inverted T-shaped incision, and in 7 through a midline sternotomy. Seventy-six patients had 93 neck lymph node dissection procedures, and 47 patients developed paratracheal lymph node metastasis. The overall 5- and 10-year cumulative survival rate was 64.6% and 63.1%, respectively. Mediastinal lymph node recurrence developed only in 10 patients after initial upper mediastinal lymph node dissection. Nine patients died of upper mediastinal lymph node metastasis. Postoperative complications were observed in 11 patients without perioperative death.


CONCLUSIONS
Upper mediastinal lymph node metastasis is most frequently found in papillary thyroid carcinoma. Surgical dissection of upper mediastinal metastatic lymph nodes through either cervical incision or mediastinotomy is safe and effective with low rate of perioperative complications. It may improve the life quality and survival of thyroid carcinoma patients.
Li
Zheng-jiang
ZJ
Department of Head and Neck Surgical Oncology, Cancer Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China. liniulijuan1965@sina.com
Miao
Xu-xue
XX
Tang
Ping-zhang
PZ
Xu
Zhen-gang
ZG
Zhang
De-chao
DC
D000293:Adolescent; D000328:Adult; D000368:Aged; D018276:Carcinoma, Medullary / Q000556:secondary / Q000601:surgery; D002291:Carcinoma, Papillary / Q000556:secondary / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*