Comparison of unilateral versus bilateral central neck dissection for clinically invasive papillary thyroid carcinoma

IF 2.3 3区医学 Q1 OTORHINOLARYNGOLOGY

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2024-07-09 DOI:10.1002/hed.27865

Lei Min MD, Yujing Weng MD, Yuan Li MD, Die Liu MD, Zhiheng Huang MD

{"title":"Comparison of unilateral versus bilateral central neck dissection for clinically invasive papillary thyroid carcinoma","authors":"Lei Min MD, Yujing Weng MD, Yuan Li MD, Die Liu MD, Zhiheng Huang MD","doi":"10.1002/hed.27865","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The American Thyroid Association guidelines primarily recommend central neck dissection for papillary thyroid carcinoma with advanced primary tumors or clinically positive neck nodes. However, the appropriate extent of dissection remains unclear. We aimed to compare the rate of locoregional recurrence between unilateral and bilateral central neck dissection in invasive papillary thyroid carcinoma.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Among 330 consecutive patients who underwent total thyroidectomy with central neck dissection for advanced papillary thyroid carcinoma, 212 underwent unilateral central neck dissection (UCND group) while 118 underwent bilateral central neck dissection (BCND group). We performed 1:1 propensity score matching, resulting in 99 matched pairs. Surgical outcomes and safety were compared between the two groups. Additionally, the impact of surgery on locoregional recurrence was compared using survival analysis.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>During a follow-up of 47.8 ± 20.4 months, 29 (8.8%) patients experienced locoregional recurrence within the entire study cohort. Following propensity score matching, no significant difference in recurrence-free survival was observed between the two groups (log-rank <i>p</i> = 0.516). Multivariate analysis revealed that only T4 staging was an independent risk factor for locoregional recurrence (<i>p</i> = 0.006). The mean number of total and metastatic central lymph nodes retrieved were significantly greater in BCND group (14.1 vs. 9.3, <i>p</i> < 0.001 and 6.8 vs. 4.6, <i>p</i> = 0.005, respectively). There was no significant difference in postoperative stimulated thyroglobulin levels between the two groups (0.79 ng/mL vs. 1.44 ng/mL, <i>p</i> = 0.389).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>The present study demonstrates no prognostic benefit in conducting bilateral central neck dissection. Unilateral central neck dissection may be the preferred choice for clinically invasive papillary thyroid carcinoma.</p>\n </section>\n </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hed.27865","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The American Thyroid Association guidelines primarily recommend central neck dissection for papillary thyroid carcinoma with advanced primary tumors or clinically positive neck nodes. However, the appropriate extent of dissection remains unclear. We aimed to compare the rate of locoregional recurrence between unilateral and bilateral central neck dissection in invasive papillary thyroid carcinoma.

Methods

Among 330 consecutive patients who underwent total thyroidectomy with central neck dissection for advanced papillary thyroid carcinoma, 212 underwent unilateral central neck dissection (UCND group) while 118 underwent bilateral central neck dissection (BCND group). We performed 1:1 propensity score matching, resulting in 99 matched pairs. Surgical outcomes and safety were compared between the two groups. Additionally, the impact of surgery on locoregional recurrence was compared using survival analysis.

Results

During a follow-up of 47.8 ± 20.4 months, 29 (8.8%) patients experienced locoregional recurrence within the entire study cohort. Following propensity score matching, no significant difference in recurrence-free survival was observed between the two groups (log-rank p = 0.516). Multivariate analysis revealed that only T4 staging was an independent risk factor for locoregional recurrence (p = 0.006). The mean number of total and metastatic central lymph nodes retrieved were significantly greater in BCND group (14.1 vs. 9.3, p < 0.001 and 6.8 vs. 4.6, p = 0.005, respectively). There was no significant difference in postoperative stimulated thyroglobulin levels between the two groups (0.79 ng/mL vs. 1.44 ng/mL, p = 0.389).

Conclusion

The present study demonstrates no prognostic benefit in conducting bilateral central neck dissection. Unilateral central neck dissection may be the preferred choice for clinically invasive papillary thyroid carcinoma.

查看原文本刊更多论文

临床浸润性甲状腺乳头状癌单侧与双侧颈部中央切除术的比较。

背景：美国甲状腺协会指南主要建议对原发肿瘤晚期或临床颈部结节阳性的甲状腺乳头状癌进行颈部中央切除术。然而，适当的切除范围仍不明确。我们旨在比较浸润性甲状腺乳头状癌单侧和双侧颈部中央切除术的局部复发率：在 330 例因晚期甲状腺乳头状癌接受甲状腺全切除术并进行颈部中央切除术的连续患者中，212 例接受了单侧颈部中央切除术（UCND 组），118 例接受了双侧颈部中央切除术（BCND 组）。我们进行了1:1倾向评分匹配，最终得出99对匹配结果。我们对两组患者的手术效果和安全性进行了比较。此外，我们还通过生存分析比较了手术对局部复发的影响：结果：在 47.8 ± 20.4 个月的随访期间，整个研究队列中有 29 例（8.8%）患者出现局部复发。经过倾向评分匹配后，两组患者的无复发生存率无明显差异（log-rank p = 0.516）。多变量分析显示，只有T4分期是局部复发的独立风险因素（p = 0.006）。在 BCND 组中，总淋巴结和转移性中央淋巴结的平均取材数量明显增加（14.1 对 9.3，P 结论：BCND 组的淋巴结取材数量明显增加（14.1 对 9.3，P）：本研究表明，进行双侧颈部中央清扫术对预后没有益处。单侧中央颈清扫术可能是临床浸润性甲状腺乳头状癌的首选。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.