The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study
The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study
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DOI：
10.1186/s12893-018-0433-0
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发表时间：
2019-04-24
期刊：
影响因子：
1.9
通讯作者：
Conzo, Giovanni
中科院分区：
文献类型：
--
作者：
Gambardella, Claudio;Patrone, Renato;Conzo, Giovanni
背景预防性颈淋巴结清扫术在文献中仍有较大争议。缺乏随机对照试验证明其应用在总生存率和局部复发方面的优势。由于近年来老年人口的迅速增加，65岁以上患者的分化型肿瘤癌诊断增加。本研究的目的是比较复发率，并发症的发生率和肿瘤的组织学特征在老年population.MethodsA回顾性研究进行了收集数据，从371例分化型甲状腺癌没有临床证据的淋巴结参与三个意大利转诊中心，从2005年至2015年。所有患者年龄均为65岁，根据手术方式分为两组（单纯甲状腺全切除术或联合中央淋巴结清扫术）。结果单纯甲状腺全切除术184例（A组），甲状腺全切除加预防性颈淋巴结清扫术187例（B组）。两组在颈部血肿（A组0.5% vs B组3.7%）、暂时性甲状旁腺功能减退（A组11.4% vs B组21.4%）和暂时性单侧返神经损伤（A组1.5% vs B组6.4%）方面的并发症存在统计学显著差异。淋巴结复发率A组为9.2%，B组为8.5%，两组比较差异无统计学意义。75岁以上患者暂时性甲状旁腺功能减退有统计学意义（A组24% vs B组11%），永久性甲状旁腺功能减退（A组2.7% vs B组0.3%）和返神经损伤（A组9.5% vs B组2%）。结论预防性中央颈清扫术的作用仍有争议，尤其是在老年患者中，积极的手术方式需要仔细评估作者报告了甲状腺全切除术与甲状腺全切除术联合预防性中央颈清扫术的复发率相似，但淋巴结切除术组和75岁以上患者的术后并发症增加，主张在老年人群中采用量身定制的手术方法。
BackgroundProphylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65years old. The aim of this study was to compare recurrence rate, complications rate and histological features of tumors in elderly population.MethodsA retrospective study was carried out collecting data from 371 patients with differentiated thyroid cancer without clinical evidence of lymph-nodes involvement in three Italian referral centers from 2005 to 2015. All patients were aged 65years and were divided in two groups based on the performed surgery (total thyroidectomy alone or associated with central lymph-nodes dissection). Moreover, patients were stratified according to the age between 65 and 74years old and over 75years old.ResultsTotal thyroidectomy alone was performed in 184 patients (group A) and total thyroidectomy with prophylactic central neck dissection was performed in 187 cases (group B). There was a statistically significant difference in complications between the groups in terms of neck hematoma (0.5% group A vs 3.7% group B), temporary hypoparathyroidism (11.4% group A vs 21.4% group B), and temporary unilateral recurrent nerve injury (1.5% group A vs 6.4% group B). Lymph nodes recurrence rate was 9.2% in group A and 8.5% in group B, with no statistically significant difference. There was a statistically significant difference in patients over 75years old in terms of temporary hypoparathyroidism (24% group A vs 11% group B), permanent hypoparathyroidism (2,7% group A vs 0,3% group B) and recurrent nerve injury (9,5% group A vs 2% group B).ConclusionsThe role of prophylactic central neck dissection is still controversial, especially in elderly patients, and an aggressive surgical approach should be carefully evaluated. The Authors reported a similar low recurrence rate between total thyroidectomy and total thyroidectomy associated with prophylactic central neck dissection, with increased postoperative complications in the lymphadenectomy group and in patients over 75years old, advocating a tailored surgical approach in elderly population.