Central cervical lymph node dissection in the treatment of papillary thyroid cancer

Abstract

Background. The need to perform prophylactic central cervical lymph node dissection in localized forms of highly differentiated thyroid cancer remains open at the moment. Preoperative examination does not always allow to reliably determine the presence of regional metastasis in the lymph nodes of the VI group.Aim. Evaluation of the neck central lymphatic collector damage frequency in clinical N0-Nx based on the results of a morphological study after performing a preventive central cervical lymph node dissection.Materials and methods. The study involved 295 patients operated on in 2016-2022 for papillary thyroid cancer with the prevalence of the tumor process — cT1-T2, N0-Nx. The ratio of men and women is 11.5% (n=34) and 88.5% (n=261). Of these, 40.7% (n=120) were less than 55 years old, 59.3% were more than 55 years old (n=175). All patients underwent surgical treatment in the amount of thyroidectomy and hemithyroidectomy with central cervical lymph node dissection.Results. In a morphological study, in some patients there was a change in the clinical stage from T1-T2 to T3: pT1 was found in 80.3% (n=237); рТ2 — in 9.2% (n=27); рТ3 — in 10.5% (n=31). In 77 (26.1%) of 295 patients, metastases were found in the lymph nodes of the central tissue of the neck. Primary surgical treatment — thyroidectomy with central cervical lymph node dissection —was performed in 295 patients, of which tumors corresponding to the cT1 — 247 (83.7%), cT2 — 48 (16.3%). According to the results of pathomorphological examination of the tissue of the neck after prophylactic lymph node dissection, pN1a was detected in 57 (23.1%) and 20 (41.7%) patients, respectively.When assessing the frequency of damage to the regional lymph collector of group VI after performing a morphological study of the removed tissue, it was revealed that with pT1 the frequency of damage to the lymph nodes was 22.8% (n54); at рТ2 — 33.3% (n9); and at pT3 this figure increases to 45.2% (n14).Conclusion. According to the results of the study, it was revealed that there is a clear dependence of the defeat of regional lymph nodes of the central tissue of the neck on the size of the primary tumor from 22.8% with pT1 to 33.3% with pT2 and 45.2% with pT3. Thus, the implementation of prophylactic central cervical lymphadenectomy for papillary thyroid cancer is an important component of surgical treatment.