title: Clinicopathological pattern of lymph node recurrence of papillary thyroid cancer. Implications for surgery.
abstract: BACKGROUND
  Lymph nodal involvement in papillary thyroid cancers is very common, but the role of lymph node dissection is still controversial. Surgeons are consequently divided between opposed to and in favor of routine central neck dissection associated with total thyroidectomy.
  
  
  METHODS
  Clinical records of 210 patients undergoing from January 2000 to December 2006 total thyroidectomy without routine lymph node dissection were retrospectively evaluated. One hundred and ninety eight patients (94.2%) underwent radioiodine ablation as well, followed by Thyroid Stimulating Hormone suppression therapy. In patients with loco regional lymph nodal recurrence, central (VI) and ipsilateral (III-IV) lymph node dissection was performed.
  
  
  RESULTS
  Incidence of permanent hypoparathyroidism (iPTH < 10 pg/ml) and permanent vocal fold paralysis were respectively 1.4% and 1.9%. After an 8-year mean follow-up, the rate of loco regional recurrence was 4.2%-9/210 patients. In these cases selective lymph node dissection was carried out without complications.
  
  
  CONCLUSIONS
  The role of neck dissection in papillary thyroid cancer management, is still subject of research and controversial regarding routine or therapeutic indications, surgical extension, its impact on local recurrence and survival.
  
  
  CONCLUSIONS
  A low loco regional recurrence rate may be observed after total thyroidectomy without prophylactic lymph node dissection. Lymph nodal recurrences were more frequent in young male patients, sometime affected by follicular variant, in each case less than 2 cm. There is a general agreement about the extension of therapeutic lymph node dissection, while routine central neck dissection is still controversial and may be indicated in high risk patients.
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: giovanni.conzo@unina2.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mauriello
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gambardella
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cavallo
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Tartaglia
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Napolitano
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Roerto
authors.initials: R
authors.lastname: Varriale
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rossetti
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Landino
authors.initials: L
authors.lastname: Fei
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D002291:Carcinoma, Papillary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult
keywords: Lymph node neck dissection; Lymph node recurrence; Papillary thyroid cancer; Radioactive iodine ablation; Routine central lymph node dissection; Total thyroidectomy