Unnecessity of Routine Dissection of Right Central Lymph Nodes in cN0 Papillary Thyroid Carcinoma Located at the Left Thyroid Lobe

• Published in: Frontiers in oncology Vol. 11; p. 685708
• Main Authors: Zhang, Songtao, Zhang, Runfang, Wang, Chao, Gong, Wenbo, Zheng, Chen, Fang, Qigen, Dai, Liyuan
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 01-07-2021
• Subjects: cN0; left thyroid lobe; LN-prRLN; lymph node metastasis; Oncology; papillary thyroid carcinoma; cN0; papillary thyroid carcinoma; left thyroid lobe; LN-prRLN; lymph node metastasis
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2021.685708

The lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) is an important part of the central lymph nodes (LNs). We aimed to explore the rate and predictors of LN-prRLN metastasis in cN0 papillary thyroid carcinoma (PTC) located at the left thyroid lobe.
Patients with surgically treated primary left lobe PTC were retrospectively enrolled. The metastatic distribution of LN-prRLN and postoperative complications were assessed. The association between LN-prRLN metastasis and clinicopathological variables was evaluated by univariate and multivariate analyses.
A total of 857 patients were included for the analysis. Central LN metastasis was noted in 310 (35.3%) cases. The most (27.6%) and least (1.7%) commonly involved LNs were the left paratracheal LN and the LN-prRLN. In the univariate analysis, the tumor size, multifocality, the extent of extrathyroidal extension (none
macroscopic
macroscopic maximal), and perineural invasion were associated with positive LN-prRLN. In the multivariate analysis, tumor size of >40.0 mm and macroscopic maximal invasion were found as the only two independent predictors. Transient and permanent hypoparathyroidism were noted in 90 (10.2%) and 13 (1.5%) patients, respectively. Voice change was noted in 40 (4.6%) patients, and 20 patients recovered.
In cN0 PTC located at the left lobe, LN-prRLN metastasis was very uncommon. We found that LN-prRLN dissection is not required routinely, but should be performed if the tumor size is >40.0 mm and macroscopic maximal extrathyroidal extension is present.