Para-tracheal neck dissection - is dissection of the upper part of level Ⅵ necessary?

Papillary thyroid carcinoma (PTC) has a high propensity for regional metastases, however, the impact of such metastases on the outcome of the patients is minimal. The central compartment of the neck is considered the first and the most common echelon of metastases from thyroid carcinoma. Physical examination along with ultrasonography are the gold standard pre-operative evaluation of patients with PTC. Ultrasonography is highly sensitive in evaluating lateral neck nodes, however, its value in evaluating the central compartment is limited, resulting in a relatively high rate of occult metastases in this compartment. The main potential complications of para-tracheal neck dissection (PTND) are recurrent laryngeal nerve paralysis and hypocalcemia and these may be higher in patients undergoing PTND compared to thyroidectomy alone. New histological data is available showing no evidence of lymph nodes in the central compartment above a level parallel to the inferior border of the cricoid cartilage. These findings support withholding dissection of the upper para-tracheal region routinely as a part of PTND in patients with well-differentiated thyroid cancer. By doing that, the complications may be lower and identical to thyroidectomy alone, thus may abolish arguments against more common use of elective PTND in patients with thyroid carcinoma.     

Central compartment neck dissection for thyroid cancer. Technical considerations

The central compartment of the neck is a common site of local metastasis for thyroid carcinoma. Therefore, knowledge of the surgical techniques employed during a central compartment neck dissection is important to master for any surgeon who manages thyroid cancer patients. We review the anatomical boundaries of the central compartment of the neck as well as discuss the lymphatic drainage patterns of the thyroid gland. We advocate standardization of the surgical approach to the central compartment in order to minimize morbidity and ensure comprehensive removal of all lymph nodes when indicated, which can reduce the need for reoperative dissections.     

Sonographically-directed neck dissection for recurrent thyroid carcinoma

Objective: To determine the effectiveness of sonographically‐directed compartmental neck dissection for recurrent differentiated thyroid carcinoma as confirmed by ultrasound surveillance and thyroid‐specific biochemical markers. Study Design: Retrospective chart review. Methods: Retrospective cohort study of 18 patients with sonographically localized and pathology‐confirmed recurrent differentiated thyroid carcinoma. Fifteen patients chose to undergo compartmental neck dissection by a single surgeon. Surgery involved central compartment (level VI) or functional lateral neck dissection (level II‐IV+/‐V). Three patients declined surgery despite proven recurrent lymph node disease. Results: All 18 patients started out with sonographic evidence of recurrent lymph node disease. Preoperative thyroglobulin or thyroglobulin antibody levels were positive in 17 of 18 patients (94%). Postoperatively, all 15 patients who underwent compartmental lymph node dissections had no sonographic evidence of lymph node disease. Of the 14 patients with preoperative positive thyroglobulin or thyroglobulin antibody levels, 9 patients converted to negative levels (64%). Furthermore, two of four patients (50%) converted to thyroglobulin antibody negative status after surgery. All three patients who declined surgery had persistently detectable sonographic nodal disease in addition to positive thyroglobulin and/or thyroglobulin antibody levels (100%). Surgical complications were minimal and self‐limited as no patient experienced permanent cranial nerve deficits. Conclusion: Ultrasound‐directed cranial nerve sparing compartmental lymph node dissection results in no sonographically detectable cervical lymph node disease and undetectable basal thyroglobulin or thyroglobulin antibody levels in the majority of patients with low morbidity.     

Sentinel lymph node biopsy in thyroid tumors: a pilot study

The purpose of this study was to assess the feasibility of sentinel lymph node (SLN) biopsy in thyroid neoplasms. Ten patients with uninodular thyroid disease and no evidence of lymph node metastases were examined. Lymph node mapping was performed by preoperative lymphoscintigraphy and intraoperative use of a hand-held gammaprobe. Following thyroidectomy, the SLN(s) were selectively excised and worked-up histologically for occult metastases. Overall detection of SLNs was possible in 50% of the cases with lymphoscintigraphy and in 100% with the gammaprobe. All SLNs in the lateral compartment and upper mediastinum were accurately detected with lymphoscintigraphy. One patient with a papillary carcinoma showed a metastasis in the SLN. One patient experienced temporary lesion of the recurrent laryngeal nerve. In conclusion, sentinel lymph node biopsy is technically feasible. The combination of lymphoscintigraphy and gammaprobe accurately reveals SLNs in the central and lateral compartment and in the mediastinum. Search for SLNs in the lower central compartment enhances the risk of injuring the recurrent laryngeal nerve. The clinical relevance of SLN biopsy in papillary thyroid cancer is unclear, and the subgroup of patients benefiting from it has still to be defined.     

Tumor above the spinal accessory nerve in papillary thyroid cancer that involves lateral neck nodes: a common occurrence

OBJECTIVE: To describe the nature and extent of lateral neck node metastases from papillary thyroid cancer in relation to presenting physical examination and staging radiologic studies. DESIGN: Retrospective study. SETTING: Tertiary referral cancer center. PATIENTS: Consecutive patients who underwent comprehensive neck dissection with or without concurrent thyroidectomy for well-differentiated thyroid cancer between 1991 and 2001. Excluded were patients with well-differentiated thyroid cancer diagnosed incidentally at the time of treatment of other primary head and neck cancer, those with previous neck dissection for nonthyroid malignancies, and those undergoing surgery for medullary thyroid cancer. INTERVENTIONS: All pathology and operative and preoperative radiology reports for patients undergoing comprehensive neck dissection for well-differentiated thyroid malignancy were reviewed. Data were collected on previous procedures, preoperative evaluation, operative details, and pathologic findings. MAIN OUTCOME MEASURE: Identification of metastatic thyroid cancer in one or more nodes in anatomically defined drainage basins of the central and lateral neck. RESULTS: A total of 51 neck dissections were performed. All patients had preoperative evidence of metastatic disease. In addition to the usual comprehensive node dissection encompassing all lymphatic tissue in levels II through V, level I nodes and level II nodes above the spinal accessory nerve were labeled as distinct regions in 16 (31%) and 34 (67%) specimens, respectively. Disease was confined to a single nodal level in 20 (39%) of 51 specimens and was present in 4 or more levels in 7 (14%) of 50 neck dissections. There was cancer at 2 or 3 levels in 16 (31%) and 15 (29%) cases, respectively. Seven (21%) of the 34 patients undergoing separate analysis of nodes from above the spinal accessory nerve had cancer there. In 3 of the 34 it was the sole disease in level II. CONCLUSIONS: Tumor involvement at multiple nodal levels occurs in most cases when patients have lateral cervical node metastases. "Skip" metastases and cancer above the spinal accessory nerve are common. Neck dissections should include all node stations likely to be involved because selective node excision is likely to leave metastatic disease in situ.     

Paratracheal lymph node dissection during laryngectomy after previous (chemo)radiotherapy: a retrospective analysis of complications and histopathological results

Clin. Otolaryngol. 2011, 36 , 37–44 Objectives: To evaluate complications and histopathological results of paratracheal lymph node dissection (PTLND) at laryngectomy after (chemo)radiotherapy. Design, setting and participants: In a retrospective analysis, complications and histopathological results of paratracheal lymph node dissections were analysed in 191 patients with a recurrent or second primary laryngeal or hypopharyngeal carcinoma following radiotherapy with or without chemotherapy. Main outcome measures: The percentage of complications in patients with bilateral, unilateral or without PTLND. Results: Forty‐seven patients underwent laryngectomy with bilateral paratracheal lymph node dissection, 52 with unilateral and 92 without paratracheal lymph node dissection. Although the difference in total complications was not significant, significantly more fistulae developed in patients with bilateral paratracheal lymph node dissection (40%versus 22%; P = 0.016). In multivariate analysis, this difference maintained significant (P = 0.038). Pathological examination of the lymph node dissection specimen showed tumour in 3 of the 96 ipsilateral dissections (3%) and in 1 of the 50 contralateral dissections (2%). This suggests that if unilateral instead of a bilateral paratracheal lymph node dissection had been performed, 17% less fistulae would have occurred in this group of patients, while paratracheal lymph node (PTLN) metastases would have been missed in one patient. Three of four patients with paratracheal lymph nodeparatracheal lymph node metastases had glottic carcinoma, all with subglottic extension. Conclusion: Because of the low incidence of lymph node metastases and the increased risk of fistulae, there is a need for a strict selection of patients who need a bilateral paratracheal lymph node dissection at laryngectomy after previous (chemo)radiotherapy.     

Value of ultrasound in detecting central compartment lymph node metastases in differentiated thyroid carcinoma

The value of ultrasound in detecting central compartment lymph node metastasis in patients with well-differentiated thyroid carcinoma (WDTC) is unclear. Prospective patients with WDTC attending a university-affiliated tertiary medical center between July 2010 and June 2011 underwent neck ultrasound for detection of central compartment lymph node metastases prior to surgery. Central lymph node dissection was performed during the initial surgery regardless of ultrasound findings. The sensitivity and specificity of preoperative ultrasound in detecting central lymph node metastases were calculated according to the final histopathological results. Sixty-four patients met the study criteria. Twenty-four had pathologic central compartment lymph nodes according to preoperative ultrasound, 20 of which were confirmed by histological examination. One patient was found to have pathological central lymph nodes by histology which was not detected by US. Sensitivity of preoperative ultrasound was 95 %, specificity 90 %, and negative and positive predictive values 97 and 83 %, respectively. Preoperative ultrasound may serve as an accurate and important tool for deciding the extent of surgery in WDTC.     

侧颈部淋巴结示踪技术在甲状腺癌手术治疗中的应用

目的 探究纳米炭示踪技术在甲状腺癌侧颈部淋巴结评估中的价值。 方法 研究为前瞻性、多中心队列研究,纳入体格检查阴性、影像学怀疑侧颈部淋巴结转移的甲状腺乳头状癌患者。术中用纳米炭示踪后进行侧颈部淋巴结清扫术。根据是否炭染,将侧颈部淋巴结分区送检,统计两组淋巴结的分区以及转移情况,并根据患者的临床病理特征进行亚组分析。以颈部淋巴结清扫的结果作为金标准,计算前哨淋巴结活检的敏感度及准确率。 结果 122例患者接受示踪手术,共计颈部淋巴结125例/侧。其中有侧颈部淋巴结转移117例,有中央区淋巴结转移7例,无颈部淋巴结转移1例。炭染淋巴结的中位数为6枚,其分布为Ⅳ区>Ⅲ区>Ⅱ区>Ⅴ区,分布规律与肿瘤大小、位置、腺外侵犯无关。炭染淋巴结的转移概率在各个淋巴结分区中均显著高于非炭染淋巴结(Ⅱ区:19.9%比5.6%,P<0.001;Ⅲ区:35.0%比18.3%,P<0.001;Ⅳ区:37.1%比15.2%,P<0.001;Ⅴ区:14.8%比3.7%,P<0.05)。侧颈部前哨淋巴结活检的敏感度为89.5%,准确率为91.8%。 结论 侧颈部淋巴结的炭染规律与甲状腺癌淋巴引流的规律基本一致,炭染淋巴结的转移概率显著高于非炭染淋巴结,是潜在侧颈部前哨淋巴结活检的示踪方法。     

Operative Behandlung des differenzierten Schilddrüsenkarzinoms Technik und Morbidität der paratrachealen Lymphadenektomie

Background. The extent of cervical lymphadenectomy in treatment of differentiated thyroid cancer is controversial. Technique and results of paratracheal lymphadenectomy are presented to demonstrate safety of cervical lymphadenectomy procedures. Patients and methods. 68 Patients with differentiated thyroid cancer underwent total thyroidectomy and extended lymphadenectomy in a standardized technique. The pre- and paratracheal and the lateral lymphnode compartments were cleared. Results. Permanent pareses of recurrent laryngeal nerve or permanent hypocalcaemias were not observed. 3 patients developed transient recurrent nerve palsy, 26 patients transient hypocalcaemia (Ca²⁺ >1,7 and <2,2 mmol/l). In 3 patients mild voice disturbances, probably due to superior laryngeal nerve dysfunction were observed. In 1 patient shorttime tracheotomy was performed. 1 patients showed permanent Horner's syndrome. Conclusions. Thyroidectomy with extended lymphadenectomy achieves removal of all cervical tumor masses without relevant morbidity. The distribution of metastatic lymph nodes underlines the necessity of extended lymphadenectomy.     

甲状腺外科专业化的临床资料分析

目的 评价耳鼻咽喉头颈外科医师手术治疗甲状腺良性疾病的结果。方法回顾性分析北京朝阳医院耳鼻咽喉头颈外科2001年1月-2004年4月手术治疗496例甲状腺良性疾病的方式、术后并发症的发生、手术耗时、颈部切口长度、住院时间和术后复发的情况。结果甲状腺一侧腺叶加对侧腺叶部分切除314例，甲状腺一侧腺叶加峡部切除76例，甲状腺双侧腺叶次全切除29例，单纯甲状腺峡部切除3例，甲状腺全切除46例，颈部低位领式切口入路切除胸骨后结节性甲状腺肿28例。术后一侧喉返神经损伤发生率为0．2％(1／496)，无双侧喉返神经损伤。术后暂时性低钙血症发生率为1．8％(9／496)，无永久性低钙血症。术后出血发生率为0．6％(3／496)，无切口感染。手术耗时平均为66min，颈部切口长度平均为5．2cm，住院时间平均为6．3d。术后复发率0．2％(1／496)。结论受过严格头颈外科培训的耳鼻咽喉科医师行甲状腺良性疾病手术可降低喉返神经损伤的发生。     

喉癌颈部转移淋巴结分布研究

目的 :回顾分析我院 1990年 4月～ 2 0 0 0年 4月收治的喉癌患者 2 89例颈部转移淋巴结的分布情况 ,指导颈清扫手术。方法 :将 2 89例分为 3组 :第 1组 :颈清扫术后有转移淋巴结的分布 (181例 ) ;第 2组 :术后病理诊断阴性淋巴结的免疫组化研究 (71例 ) ;第 3组 :未清扫者随访中再转移淋巴结的分布研究 (37例 )。结果 :第 1组清扫 2 4 2侧 ,颈部Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区转移率分别为 2 .8%、98.3%、32 .6 %、15 .0 %、13.0 %、2 1.4 % ;第 2组 71例 ,其中 4 6例 (5 0侧 )免疫组化研究发现 13个淋巴结内有微灶转移 ,分布于 11例患者中 ,所有转移淋巴结均分布在Ⅱ区 ;第 3组 37例 ,施行挽救性手术共 4 5侧 ,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区转移率分别为 2 .2 %、10 0 %、4 8.9%、2 6 .7%、13.3%。结论 :喉癌首先转移和主要转移部位为Ⅱ区 ,其次为Ⅲ区 ;Ⅳ、Ⅴ区发生率则较低 ,颌下区几乎不发生转移。喉癌患者的颈清扫应在常规清扫颈侧Ⅱ～Ⅳ区淋巴结的同时 ,根据病变范围情况行Ⅳ区的清扫 ,对颌下三角和颈后三角 (Ⅴ区 )在无影像学和术中证实的条件下 ,应予以保留 ,以缩短手术操作时间和减少术后并发症的发生     

Risk factors for permanent laryngeal nerve paralysis in patients with thyroid carcinoma.

OBJECTIVES: This study investigated the incidence of and risk factors for permanent recurrent laryngeal nerve paralysis for patients with thyroid malignancy. DESIGN: Retrospective chart review. SETTING: Tertiary oncology referral centre. PARTICIPANTS: Records of 290 consecutive patients treated between 1997 and 2001 were reviewed. All patients who have had one or more operations. Patients with preoperative recurrent laryngeal nerve paralysis and patients who underwent thyroidectomy in conjunction with laryngectomy were excluded. The incidence of postoperative permanent cord palsy was calculated in relation to the number of patients. MAIN OUTCOME MEASURES: Age, gender, thyroid functions, tumour localisations and size, multicentricity, thyroid capsule invasion, extrathyroidal soft tissue invasion, differentiation, histological type, co-existence of lymphocytic thyroiditis, total number of dissected and metastatic nodes, type of surgery, the place of surgery and number of operations were the risk factors investigated for permanent recurrent laryngeal nerve paralysis. Univariate and multivariate analyses were performed. RESULTS: Permanent recurrent laryngeal nerve paralysis developed in 27 (9%) of 290 patients with thyroid carcinoma. Transient and permanent paralysis rates in total or subtotal thyroidectomy, completion thyroidectomy and neck dissection groups were 5/3%, 7/3% and 24/17% respectively. Cox regression analysis identified the type of surgery [adjusted relative risk (RR) = 2.1, 95% confidence interval (CI) = 1.1-4.0, P = 0.01], extrathyroidal soft tissue invasion (RR = 5.7, 95% CI = 2.0-15.7, P = 0.001) and number of metastatic nodes (RR = 1.6, 95% CI = 1.1-2.5 P = 0.01). CONCLUSIONS: The factors related with recurrent laryngeal nerve paralysis post-thyroid carcinoma surgery are linked to special features of the tumour and to the type of surgery.     

Postoperative complications of thyroidectomy for differentiated thyroid carcinoma

OBJECTIVE: This study evaluates the incidence and risk factors of complications in patients submitted to thyroidectomy for differentiated thyroid carcinoma in a cancer hospital with residency training. STUDY DESIGN: A retrospective chart and complications review of 316 consecutive patients who underwent thyroidectomy for differentiated thyroid carcinoma. RESULTS: Of the 316 patients, the main postoperative complications were transient hypocalcemia in 87 (27.5%), permanent hypocalcemia in 16 (5.1%), transient vocal cord palsy in 4 (1.2%), and permanent vocal cord palsy in 2 (0.6%). Neck dissection and paratracheal lymph node dissection when associated with total thyroidectomy were significantly related to transitory and permanent hypocalcemia. CONCLUSION: Thyroid surgery can be performed safely in a hospital with medical residency training program under direct supervision of an experienced surgeon with acceptable morbidity. Hypocalcemia is the most significant complication. Neck and paratracheal lymph node dissections were the most significant predictors of hypocalcemia in patients submitted to total thyroidectomy.     

Level IIb lymph node metastasis in laryngeal squamous cell carcinoma

OBJECTIVES: Selective neck dissection, despite preservation of the spinal accessory nerve, can lead to some degree of postoperative shoulder dysfunction as a result of removal of level IIb lymph nodes. The aim of this study was to determine whether level IIb lymph nodes can be preserved in elective or therapeutic neck dissection as a treatment for patients with laryngeal squamous cell carcinoma (SCC). STUDY DESIGN: This was a prospective analysis of a case series. METHODS: A prospective analysis of 65 patients with laryngeal SCC who underwent surgical treatment of the primary lesion with simultaneous neck dissection from January 1999 to December 2002 was performed. During the neck dissection, the contents of the level IIb lymph nodes were dissected, labeled, and processed separately from the remainder of level II nodes and the main neck dissection specimen. The incidence of pathologic metastasis to level IIb lymph nodes and the regional recurrence within this area were evaluated. In addition, several potential risk factors for metastatic disease in the level IIb lymph nodes such as sex, age, cT stage, cN stage, and the presence of other positive lymph nodes were also evaluated. RESULTS: A total of 125 neck dissections were performed in this series. Of these dissections, 102 (82%) were elective and 23 (18%) were therapeutic. The prevalence of metastases in the level IIb lymph nodes was 1% (one of 46) and 0% (zero of 56) in clinically node-negative (N0) ipsilateral and contralateral necks, respectively, and 37% (seven of 19) and 0% (zero of four) in clinically node-positive ipsilateral and contralateral necks, respectively. There was a statistically significant association between level IIb metastases and clinically positive N stage (P<.001). The presence of other positive lymph nodes was also shown to have a statistically significant association with metastasis in the level IIb lymph nodes (P=.001). Only two of 46 patients (4%) with clinically N0 necks developed a regional recurrence. However, three of eight cases (38%) with positive pathologic level IIb lymph nodes developed regional recurrence. CONCLUSION: Level IIb lymph node pads may be preserved in elective neck dissection in patients with laryngeal SCC. However, this area should be removed thoroughly during therapeutic neck dissection in the treatment of clinically node-positive necks.     

Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients

OBJECTIVES/HYPOTHESIS: The objectives were to quantify the incidence of clinically unsuspected thyroid tissue in cervical lymph nodes encountered during neck dissection in patients with head and neck carcinoma, to describe the location and histological aspect of these inclusions, and to assess their clinical significance. STUDY DESIGN: Retrospective study. METHODS: The histological records of 1123 neck dissections in 752 patients with head and neck carcinoma were reviewed. In cases with thyroid inclusions, the pathological diagnosis was reviewed and an immunohistochemical study against thyroglobulin and calcitonin was carried out. RESULTS: Clinically unsuspected thyroid tissue was found in lymph nodes in 11 of the 752 patients with head and neck carcinoma treated with neck dissection. In five cases, the thyroid inclusion was compatible with a metastases of an occult papillary thyroid carcinoma. In the other six cases, a collection of thyroid follicles without malignant characteristics was found beneath the lymph node capsule. These latter cases were considered benign thyroid inclusions. A thyroidectomy was performed in three of the patients with lymph node metastases of the papillary carcinoma. An occult papillary carcinoma was found in only one case. The other two patients had been treated previously with radiotherapy for an early-stage glottic carcinoma. Immunohistochemical study did not find calcitonin-positive cells within the benign thyroid inclusions. After a follow-up period ranging from 1.2 to 8.2 years, no patient had any kind of local, regional, or distant relapse related to the thyroid disease. CONCLUSION: The incidence of unsuspected thyroid tissue in lymph nodes of patients with head and neck carcinoma treated with neck dissection was 1.5%. Both lymph node metastases of a papillary carcinoma and benign thyroid inclusions were found. The study results suggest that the incidental finding of thyroid tissue in the lymph nodes during a neck dissection in patients with head and neck carcinoma does not necessarily indicate the need for aggressive therapy.     

Paratracheal node dissection for well-differentiated cancer of the thyroid: indications, technique and results

Metastases to regional lymphatics are common in patients with well-differentiated thyroid cancer (WDTC) but the treatment of paratracheal adenopathy remains an issue of controversy among head and neck surgeons. The purpose of the current study was to review the indications for paratracheal neck dissection (PTND) in patients with WDTC. Most of the studies published in the English literature and examining PTND for WDTC were reviewed. No prospective randomized studies exist and thus this review examined the best available data. The occurrence of regional metastases in the paratracheal region is common in patients with WDTC and PTND is a safe and effective treatment for such metastases. Therapeutic PTND is the standard of care in patients with proven metastases to the paratracheal region. Elective PTND seems to be indicated in several groups of patients such as patients with clinically proven metastases in the lateral neck, even if the paratracheal region seems free of metastases on preoperative imaging studies. Male patients older than 45 years of age with thyroid cancer may also be candidates for this procedure. PTND may be indicated in several groups of patients with WDTC either as an elective or therapeutic procedure. Modern imaging and cytopathologic procedures may reveal suspected or proven metastatic disease in the paratracheal lymph nodes, particularly after previous surgery. However, the impact of such disease on the patients survival is questionable. More data regarding the benefit from this procedure in terms of regional control and long-term survival are needed.     

Completion thyroidectomy for initially misdiagnosed thyroid cancer

Intraoperative frozen sections fails to diagnose thyroid carcinoma accurately in 16% of cases. In such instances, we recommend that completion thyroidectomy be performed in the patient who has invasive carcinoma, is less than 70 years old, and has a reasonable life expectancy. The procedure should be carried out immediately if the error in diagnosis is discovered within a week; otherwise the procedure should be delayed until 3 to 4 months later. At that time, the recurrent laryngeal nerves and at least two parathyroid glands should be dissected and preserved. A paratracheal lymph node dissection should also be performed and the lower jugular lymph nodes should be sampled. If these jugular lymph nodes are found to be positive, a modified radical neck dissection should be added. The morbidity associated with the completion thyroidectomy is minimal. Postoperatively, a 131I scan of the neck should be carried out and ablative doses of radioactive iodine can be given if the uptake in the thyroid bed is greater than 1.5%. Subsequently, all patients are given thyroid suppressive therapy and are monitored closely. This approach will reduce the local recurrence rate and improve the long-term survival.     

Importance of routine evaluation of the thyroid gland prior to open partial laryngectomy

OBJECTIVES: To determine the incidence and presentation of synchronous thyroid lesions in a patient population undergoing open partial laryngectomy (OPL), and to determine whether routine preoperative evaluation of the thyroid gland prior to OPL is useful to identify synchronous thyroid lesions in order to reduce the need for reoperation in this complex patient population. DESIGN: Retrospective medical chart review. SETTING: Academic institution. PATIENTS: Sixty-seven consecutive patients with laryngeal tumors who had undergone OPL from 1996 to 2005. INTERVENTIONS: Charts of 67 consecutive patients with laryngeal tumors who underwent OPL in 1996 to 2005 have been reviewed for synchronous thyroid lesions. For all patients, reports of (1) complete preoperative examination findings, (2) inpatient course, (3) postoperative follow-up, and (4) postoperative final histopathologic findings were reviewed. For patients with synchronous thyroid lesions, reports of (1) thyroid evaluation and imaging and (2) preoperative (fine-needle aspiration), (3) intraoperative (frozen section), and (4) postoperative (final) histopathologic results for the thyroid lesions were reviewed. MAIN OUTCOME MEASURES: Incidence of synchronous thyroid lesions and laryngeal cancer in patients undergoing OPL. RESULTS: Eight (11.9%) of 67 (95% confidence interval, 5.3%-22.2%) patients with laryngeal tumors who underwent OPL had evidence of synchronous thyroid lesions. All 8 patients had squamous cell carcinoma of the larynx and underwent either supracricoid or supraglottic laryngectomy. In these 8 patients, synchronous thyroid lesions were incidentally detected. Four patients had papillary thyroid carcinoma, 1 had squamous metaplasia, and 3 had follicular thyroid tissue that was negative for malignancy on final pathologic examination. In 2 patients, the thyroid lesions were detected preoperatively (prior to OPL); in another 2 patients, thyroid masses were detected intraoperatively; and in 4 patients, the thyroid disease was identified postoperatively on histopathologic examination of excised cervical lymph nodes. In 2 patients, thyroidectomy was performed as a second operation after the OPL, and 1 of them had transient vocal fold paralysis for 2 months. Thyroid ultrasonography was performed in 4 patients. In 3 patients, the ultrasonography was performed after the OPL final pathologic findings indicated the presence of metastatic thyroid disease in cervical lymph nodes. Ultrasonography revealed intrathyroidal lesions in all 3 patients. CONCLUSIONS: Patients with laryngeal tumors who will be undergoing OPL might have occult synchronous thyroid lesions. Thyroid surgery in patients with previous OPL may have an increased potential for complication owing to postsurgical changes in the central neck region. Routine preoperative evaluation of the thyroid gland, especially with ultrasonography, to screen for occult synchronous thyroid lesions is recommended for all patients with laryngeal tumors who will be undergoing OPL. Eradication of any thyroid cancer detected preoperatively by fine-needle aspiration should be performed at the same time as OPL. Pros and cons of total thyroidectomy for indeterminate thyroid nodules should be discussed with this patient population.     

头颈部鳞癌颈淋巴结隐匿性转移

目的 探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法 对111例头颈部鳞癌N_0M_0患者的颈淋巴结清扫标本进行切片观察。结果 隐匿性转移总体发生率为26.12％(29/111)。其中口腔癌18.75％(15/80),口咽癌25.00％(1/4),下咽癌54.54％(6/11),喉癌43.75％(7/16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N_0M_0患者5年生存率为66.7％,其中pN~-为74.39％(61/82),pN~ 为44.82％(13/29)。结论 对临床T_3和T_4期、癌组织分化程度低和深度浸润的cN_0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。     

喉癌临床N0患者颈淋巴结转移的病理研究

目的 探讨喉癌临床Ｎ０患者颈淋巴结转移特点,为颈淋巴结处理方式选择提供根据。方法 ４０例临床Ｎ０喉癌患者被随机为选择性根治性颈廓清术及功能性颈廓清术两组。分别完成１３及２７例。将获得淋结逐一行病理检查,以确定转移情况。结果 ＲＮＤ组平均每侧获淋巴结３４．２枚,ＦＮＤ组为２７．４枚,差异无显著性。两组颈淋巴结转移率分别为３０．８％及３３．３％,总转移率为３２．５％。１３例颈淋巴结转移阳性病例中１２列