[The role of lymphadenectomy in the treatment of differentiated thyroid cancer].
Papillary and follicular carcinoma represent almost 90% of the thyroid malignancies, being responsible for 70% of the mortality generated by thyroid cancer. Lymph node involvement, far more significant in the papillary form, increases the risk of local recurrence and affects long-term survival. Due to the lack of prospective randomised studies to assess the benefit of lymph node dissection in addition to total thyroidectomy, there is no consensus regarding the need of routine vs elective central compartment lymphadenectomy. Routine lymph node dissection of the central compartment is supported by the argument that it reduces the amount of neoplastic thyroid tissue and, therefore, optimises the effectiveness of radioiodine in DTC patients. Moreover, it provides an accurate staging by the detailed histopathological analysis and allows an optimal postoperative thyroid scanning. No additional morbidity of central lymphadenectomy is reported, compared to total thyroidectomy alone, if performed by a specialised surgeon. However, reinterventions for recurrence in the central compartment, carry a significantly higher risk of recurrent nerve and parathyroids damage. Unlike central compartment, it is generally agreed that lymphadenectomy of the lateral neck, as modified radical neck dissection, is employed when there is evidence of neoplastic lymph node involvement, wether macroscopic, imaging or by pathological data.
Dănilă
R
R
Clinica a III-a Chirurgie, Facultatea de Medicină, Universitatea de Medicină si Farmacie "Gr. T. Popa", Iaşi.
Popovici
Ramona
R
Andriescu
Lidia
L
Timofte
D
D
Ungureanu
Maria Christina
MC
Găluşcă
B
B
Dragomir
Cr
C
D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018265:Carcinoma, Papillary, Follicular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome