title: Risk factors and indication for dissection of right paraesophageal lymph node metastasis in papillary thyroid carcinoma.
abstract: BACKGROUND
  Right paraesophageal lymph nodes (RPELNs) are located behind right recurrent laryngeal nerve which often ignored in central compartment lymph nodes (LNs) dissection of papillary thyroid carcinoma (PTC) patients. The aim of this study was to identify the risk factors for RPELN metastasis and indications for RPELN dissection.
  
  
  METHODS
  Medical record of 246 consecutive PTC patients (194 female, 52 male), who underwent total thyroidectomy (244 patients) or right lobectomy (2 patients) with central compartment LN dissection (13 ipsilateral and 233 bilateral), were reviewed. The RPELNs were kept separately during the operation. The clinical pathology data was collected and analyzed.
  
  
  RESULTS
  RPELN metastasis was confirmed in 33 patients (13.4%) and were discovered in 18.5% (31/168) of right lesion, 34.4% (31/90) of right central group LN (rCLN) metastasis, 33.3% (18/54) of lateral compartment LN (LLN) metastasis, 25.7% (9/35) of local recurrent patients respectively. The ultrasound suspected metastatic LNs, tumor diameter, tumor number, tumor location, and numbers of metastatic Delphian LNs, central group LNs (CLNs), rCLNs, and LLNs between patients with and without RPELN metastasis showed significant differences in univariate analysis (P < 0.05). In multivariate analysis, number of metastatic rCLNs (1-2: OR 13.6, 95% CI, 2.7-67.5; ≧3: OR39.4, 95% CI, 7.7-200.9), right side tumor (OR 6.4, 95% CI, 1.1-35.6), and three or more metastatic LLNs (OR 3.5, 95% CI, 1.2-10.2) were independent risk factors for RPELN metastasis.
  
  
  CONCLUSIONS
  PTC patients with right lobe lesions, especially with potential rCLN metastasis, are at considerable risk of RPELN metastasis. RPELN dissection should be considered in these patients.
authors.affiliation: General Surgery Department, Peking Union Medical College Hospital, Beijing, 100730, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: General Surgery Department, Peking Union Medical College Hospital, Beijing, 100730, China.
authors.forename: Hongfeng
authors.initials: H
authors.lastname: Liu
authors.affiliation: General Surgery Department, Peking Union Medical College Hospital, Beijing, 100730, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Ultrasonography Department, Peking Union Medical College Hospital, Beijing, 100730, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Xia
authors.affiliation: Ultrasonography Department, Peking Union Medical College Hospital, Beijing, 100730, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Institute of Basic Medical Sciences, Chinese Academy of Medical Science, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
authors.forename: Guangliang
authors.initials: G
authors.lastname: Shan
authors.affiliation: General Surgery Department, Peking Union Medical College Hospital, Beijing, 100730, China. Electronic address: li.xiaoyi@263.net.
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary; D002681:China; D015331:Cohort Studies; D004210:Dissection / Q000379:methods; D004947:Esophagus; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Papillary thyroid carcinoma (PTC); Right paraesophageal lymph node (RPELN)