Central neck lymphadenectomy at surgical treatment of papillary thyroid cancer.

Abstract

e18128 Background: Necessity of local forms of highly differentiated thyroid cancer preventative central neck lymphatic dissection is currently an open question. Sometimes regional metastases to lymph nodes of VI group is not determined by pre-surgical examination. The aim of the retrospective analysis is estimating the prevalence of neck central metastatic lymph nodes by the results of morphological examination after preventative central neck lymphatic dissection in patients (pts) with cN0-Nx stage. Methods: The paper includes 140 pts undergoing surgery for papillary cancer of the thyroid with the extent of tumor process cT1-T2 cN0 in 2016-2019. Proportion of men and women is 11.4% (n=16) and 88.6% (n=124). There are 47.9% (n=67) before the age of 55 and 52.1% (n=73) after the age of 55. Results: There are 130 pts who had surgical treatment by thyroidectomy with central neck lymphatic dissection: cT1 – 80% (n=104), cT2 – 20% (n=26). Results of morphological examinations shows that 18.2% (n=19) pts with cT1cN0 stage had pN1a and 23% (n=6) in cohort with cT2 cN0. From 10 patients who had surgical treatment by hemithyroidectomy with central neck lymphatic node dissection metastases in the VI group of lymphatic nodes was detected in 20% (n=2) cases. Eventually 20.7% (n=29) from all of 140 pts have metastases to the VI group of lymphatic nodes. After receiving the results of the morphological examination, it was founded that some patients’ stage had changed: pT1 was confirmed in 73.6% (n=103), pT2 was observed in 12.9% (n=18), pT3 in 13.6% (n=19). Our analysis illustrates that the detection rate pN1a correlates with the morphological stage Т: metastases to VI group lymph nodes had 12.6% (n=12) pts with pT1, 23.5% (n=4) – with pT2 and 50% (n=9) – with pT3. Conclusions: It shows a direct correlation between metastases in central compartment and morphological size of the primary tumor. Central lymph node dissection allows staging the tumor process with the determination of prognostic factors, which allows for informed planning of treatment tactics or observation.