[Surgical treatment of thyroid carcinoma with the upper mediastinal metastasis].
OBJECTIVE
To study the clinical characteristics and management of thyroid cancer with the upper mediastinal metastasis.


METHODS
A retrospective study was performed to analysis the clinical characteristics, treatment and prognosis of 122 cases who underwent mediastinal dissection for thyroid cancer invasion in Cancer Hospital of Chinese Academy of Medical Science from Jan. 1985 to Oct. 2004.


RESULTS
According to postoperative pathological diagnosis, upper mediastinal(2R/2L) were the most common areas invaded, 98.4%. The incidence rate of lower mediastinal invasion was 20.5%, which often occurred in the area of lower paratracheal (4R/4L). The complication rate of the sternotomy group (38.2%)was higher than the other (28.4%), but complications associated with mediastinal operation were rare, including pleural effusion (3 cases), mediastinal infection (1 case) and superior vena cava rupture (1 case), which were all cured. After a median follow-up of 60 months (range from 12 to 249 months), 9 patients were lost in the follow-up, the follow-up rate was 92.6%. The anticipate 5-year survival rate of differentiated thyroid carcinoma and medullary carcinoma in the sternotomy group from Kaplan-Meier curve were 90.9%, 87.1% while the other group 85.4%, 92.3% (P > 0.05). Three-year and 5-year mediastinal recurrence rate of sternotomy group were 3.8%, 12.2%, while transcervical operation group 7.9%, 14.2%.


CONCLUSIONS
It is noticed that there is a big percentage of patients with lower mediastinal invasion as well as upper area lesions. Radical operation is needed via sternotomy for these patients. For those who have many lymph nodes or the condition that lymph nodes adhere to the vessels , sternotomy also should be considered.
Liu
Jie
J
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science, Beijing 100021, China.
Xu
Zhen-gang
ZG
Wang
Xiao-lei
XL
Liu
Shao-yan
SY
Qi
Yong-fa
YF
Tang
Ping-zhang
PZ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult