title: Clinical impact of cervical lymph node involvement and central neck dissection in patients with papillary thyroid carcinoma: a retrospective analysis of 368 cases.
abstract: The impact of cervical lymph node metastases and the optimal surgical management of the neck in patients with papillary thyroid carcinoma (PTC) remain controversial. The objectives of this retrospective study were to determine, in patients with PTC, the predictive factors and the impact on tumor recurrence rate of cervical lymph node involvement, and to evaluate the oncologic results and the morbidity of central neck dissection (CND). We reviewed the records of patients who had undergone surgical treatment for PTC at our institution between 1990 and 2000. A total of 368 patients (86 men and 282 women) were included in this study. Young age (p = 0.02), tumor size (p = 0.001) and extrathyroidal tumor extension (p = 0.003) were significant predictive factors of cervical lymph node metastatic involvement (multivariate analysis). Initial metastatic cervical lymph node involvement was identified as an independent risk factor of tumor recurrence (multivariate analysis, p = 0.01). Metastatic lymph node(s) were found in prophylactic CND specimens in 31% of the patients. CND increased the risk of postoperative hypocalcemia (p = 0.008) and of permanent hypoparathyroidism (p = 0.002). In conclusion, cervical lymph node metastatic involvement at the time of initial surgery is an independent risk factor of tumor recurrence. CND provided an up-staging of more than 30% of patients with a clinically N0 neck, but was associated with significant morbidity regarding parathyroid function.
authors: Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France. alexandre.bozec@nice.fnclcc.fr.
authors: Alexandre
authors: A
authors: Bozec
authors: Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Olivier
authors: O
authors: Dassonville
authors: Département de Statistiques Médicales, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Emmanuel
authors: E
authors: Chamorey
authors: Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Gilles
authors: G
authors: Poissonnet
authors: Département d'Anatomie Pathologique, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Anne
authors: A
authors: Sudaka
authors: Département d'Anatomie Pathologique, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Isabelle
authors: I
authors: Peyrottes
authors: Département d'Anatomie Pathologique, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Francette
authors: F
authors: Ettore
authors: Département d'Anatomie Pathologique, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Juliette
authors: J
authors: Haudebourg
authors: Département de Médecine nucléaire, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Françoise
authors: F
authors: Bussière
authors: Département de Médecine nucléaire, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Danielle
authors: D
authors: Benisvy
authors: Département d'imagerie médicale, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Pierre-Yves
authors: PY
authors: Marcy
authors: Service d'endocrinologie et métabolisme, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 30 av de la voie romaine, 06002, Nice, France.
authors: Jean Louis
authors: JL
authors: Sadoul
authors: Service d'anatomie pathologique clinique et expérimentale, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 30 av de la voie romaine, 06002, Nice, France.
authors: Paul
authors: P
authors: Hofman
authors: Service d'anatomie pathologique clinique et expérimentale, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 30 av de la voie romaine, 06002, Nice, France.
authors: Sandra
authors: S
authors: Lassale
authors: Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: Jacques
authors: J
authors: Vallicioni
authors: Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: François
authors: F
authors: Demard
authors: Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189, Nice, France.
authors: José
authors: J
authors: Santini
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