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Tae K, Choi HW, Ji YB, Song CM, Park JH, Kim DS. Feasibility of transoral robotic selective neck dissection with or without a postauricular incision for papillary thyroid carcinoma: A pilot study. Front Surg 2022; 9:985097. [PMID: 36303854 PMCID: PMC9592833 DOI: 10.3389/fsurg.2022.985097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Background The study aimed to evaluate the feasibility of transoral robotic selective neck dissection (SND) with or without a postauricular incision for papillary thyroid carcinoma (PTC). Methods We studied 14 patients with PTC who underwent robotic SND via the transoral or combined transoral and postauricular approaches. Results The transoral approach was performed on 10 patients for dissection of levels III and IV. An additional postauricular incision was made on 4 patients for dissection of level II in addition to levels III, IV, and V. The operation was completed successfully in 13 patients, except 1 patient with the procedure conversion due to uncontrolled bleeding from the internal jugular vein. The mean numbers of removed lymph nodes in the lateral compartment were 23.1 ± 9.4 and 38.3 ± 8.5 in the transoral and combined groups. Transient recurrent laryngeal nerve palsy occurred in 1 patient, transient hypoparathyroidism in 3 patients, and chyle leakage in 1 patient. There were no hematomas, mental nerve injuries, surgical space infections, or CO2 embolisms. Conclusion Transoral robotic SND is feasible with or without a postauricular incision.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea,Correspondence: Kyung Tae
| | - Hae Won Choi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jung Hwan Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Dong Sun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
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Liu WQ, Yang JY, Wang XH, Cai W, Li F. Analysis of factors influencing cervical lymph node metastasis of papillary thyroid carcinoma at each lateral level. BMC Surg 2022; 22:228. [PMID: 35701785 PMCID: PMC9199251 DOI: 10.1186/s12893-022-01678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze the clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) and its influence on the distribution of lymph node metastasis at each lateral level of the neck to guide precise treatment of the lateral area. METHODS The clinicopathological data of patients with PTC initially diagnosed and treated at our hospital from February 2014 to September 2021 were collected; the metastatic status of each lateral level was recorded, and correlations were analyzed. RESULTS A total of 203 patients were enrolled in this study. There were 67 males and 136 females, with an average age of 41.1 years. In the lateral cervical area, lymph node metastasis was found at level IIa in 81 patients (39.9%); level III, 171 patients (84.2%); level IV, 122 patients (60%); and level Vb, 18 patients (8.9%). Correlation analysis showed that age (r = 0.198, P < 0.01) and sex (r = 0.196, P < 0.01) were weakly correlated with the number of positive lymph nodes in the central region. The tumor size (r = 0.164, P < 0.05) was weakly correlated with lymph node metastasis at level IV. The presence of multiple tumor foci was weakly correlated with lymph node metastasis at level IIa (r = 0.163, P < 0.05) and Vb (r = 0.143, P < 0.05). The tumor location (r = - 0.168, P < 0.05) was weakly correlated with lymph node metastasis at level III. The number of positive lymph nodes in the central region (r = 0.189, P < 0.01) was weakly correlated with lymph node metastasis at level IV. Binary logistic regression analysis showed that the risk of metastasis of multifocal tumors was higher than that of unifocal tumors by 1.958 times at level IIa (P = 0.021, OR = 1.958) and 2.929 times at level Vb (P = 0.049, OR = 2.929). The higher the tumor was located, the higher the risk of metastasis at level III (P = 0.014, OR = 0.563). Every additional positive lymph node in the central region increased the risk of metastasis at level IV by 1.126 times (P = 0.009, OR = 1.126). CONCLUSIONS For patients with pathological evidence of lateral metastasis, standard dissection of level IIa through Vb is recommended; selective dissection requires careful consideration. Patients with multifocal tumors have a high risk of metastasis at levels IIa and Vb, which requires special attention during the operation.
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Affiliation(s)
- Wen-Qing Liu
- Xuan Wu Hospital of The Capital Medical University, Beijing, China
| | | | - Xiao-Hui Wang
- Xuan Wu Hospital of The Capital Medical University, Beijing, China
| | - Wei Cai
- Xuan Wu Hospital of The Capital Medical University, Beijing, China
| | - Fei Li
- Xuan Wu Hospital of The Capital Medical University, Beijing, China.
- General Surgery Department, Xuanwu Hospital, No. 45 Changchun Street, Xicheng District, 100053, Beijing, China.
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Song Y, Xu G, Wang T, Zhang Y, Zhang B. Indications of Superselective Neck Dissection in Patients With Lateral Node Metastasis of Papillary Thyroid Carcinoma. Otolaryngol Head Neck Surg 2021; 166:832-839. [PMID: 34488520 DOI: 10.1177/01945998211038318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The extent of neck dissection in papillary thyroid carcinoma (PTC) patients with lateral neck metastasis is controversial. This work aims to screen the patients suitable for superselective neck dissections including only levels III-IV. STUDY DESIGN Prospective observational cohort study. SETTING The study was conducted in a high-volume tertiary care setting. METHODS A total of 134 consecutive previously untreated PTC patients with lateral neck metastases and subjected to 154 therapeutic lateral neck dissections (including levels II, III, IV, and VB) between June 2018 and March 2021 were enrolled. Fine-needle aspiration was performed preoperatively at each suspicious neck level. Clinical predictors were analyzed for occult lymph node metastases at levels II and VB. RESULTS As a result, 44.8% and 5.8% of neck specimens exhibited metastatic lymph nodes at levels II and VB. In addition, univariate and multivariate analyses showed that the primary tumor in the ipsilateral thyroid upper lobe (P = .016, odds ratio = 3.528) and clinically multiple metastatic lymph nodes in level III-IV (P = .005, odds ratio = 6.414) were independent predictive factors for occult level II metastases. All 3 (1.9%) occult metastases at level VB were found in necks with preoperative multiple lymph node metastases. CONCLUSIONS A superselective lateral neck dissection including levels III to IV may be considered in patients with PTC when the preoperative evaluation identifies a single lymph node metastasis located at levels III to IV and the primary tumor is not in the upper lobe of the ipsilateral thyroid.
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Affiliation(s)
- Yuntao Song
- Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Guohui Xu
- Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Tianxiao Wang
- Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Yabing Zhang
- Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Bin Zhang
- Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
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Piccin O, D'Alessio P, Cavicchi O. Transoral robotic selective neck dissection for papillary thyroid carcinoma: Is it appropriate? Head Neck 2020; 42:3795-3796. [PMID: 32888216 DOI: 10.1002/hed.26447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ottavio Piccin
- Department of Otolaryngology Head and Neck Surgery, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Pasquale D'Alessio
- Department of Otolaryngology Head and Neck Surgery, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ottavio Cavicchi
- Department of Otolaryngology Head and Neck Surgery, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Tae K. Reply to Letter to the Editor: Transoral robotic selective neck dissection for papillary thyroid carcinoma: Is it appropriate? Head Neck 2020; 42:3797-3798. [PMID: 32888240 DOI: 10.1002/hed.26449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Verma A, Chen AY. Indications and outcomes of superselective neck dissection: A review and analysis of the literature. Laryngoscope Investig Otolaryngol 2020; 5:672-676. [PMID: 32864437 PMCID: PMC7444773 DOI: 10.1002/lio2.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/23/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022] Open
Abstract
Superselective neck dissection, defined as dissection of two or less contiguous neck levels, has recently been introduced to reduce surgical morbidity of neck dissection while maintaining favorable oncologic outcomes. The purpose of this review is to report the results of superselective neck dissection when applied to specific settings: the management of regional disease after chemoradiation, head and neck squamous cell carcinoma with clinical N0 necks, and high risk papillary thyroid carcinoma.
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Affiliation(s)
- Avanti Verma
- Department of Otolaryngology‐Head and Neck SurgeryEmory UniversityAtlantaGeorgiaUSA
| | - Amy Y. Chen
- Department of Otolaryngology‐Head and Neck SurgeryEmory UniversityAtlantaGeorgiaUSA
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Tae K, Kim KH. Transoral robotic selective neck dissection for papillary thyroid carcinoma: Dissection of Levels III and IV. Head Neck 2020; 42:3084-3088. [PMID: 32794247 DOI: 10.1002/hed.26379] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 12/21/2022] Open
Abstract
We present the operative procedure of transoral robotic selective neck dissection for papillary thyroid carcinoma. A 28-year-old woman, diagnosed with papillary thyroid carcinoma and lymph node metastasis at right level IV, underwent total thyroidectomy, central neck dissection, and selective neck dissection involving levels III and IV via the transoral robotic approach. A 1.5-2-cm central incision was made near the base of the lower lip frenulum, and two lateral incisions were made close to the oral commissure. An additional right axillary port was made to place a third robotic instrument for counter-traction. The operation was completed successfully without conversion to the conventional transcervical approach. The working space and surgical view were enough to perform selective neck dissection of levels III and IV. There were no major postoperative complications. Transoral robotic selective neck dissection of levels III and IV is feasible and safe in selected patients.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Keon-Ho Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Added Value of Computed Tomography to Ultrasonography for Assessing LN Metastasis in Preoperative Patients with Thyroid Cancer: Node-By-Node Correlation. Cancers (Basel) 2020; 12:cancers12051190. [PMID: 32397148 PMCID: PMC7281101 DOI: 10.3390/cancers12051190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Diagnostic accuracy of US in the evaluation of lymph node (LN) metastasis for thyroid cancer patients is limited. We investigated the value of CT added to US for characterizing LNs in preoperative thyroid cancer patients by node-by-node correlation. A total of 225 primary thyroid cancer patients who underwent LN biopsy were included. Based on node-by-node correlation, 274 LNs were classified into probably benign, indeterminate, and suspicious categories on US, CT, and combined US/CT. Malignancy risks were calculated for each category and were compared between US/CT concordant and discordant cases. On US, CT, and combined US/CT, malignancy risks were 1.7%, 8.7%, and 0% in the probably benign category, 22.4%, 5.9%, and 8.0% in the indeterminate category, and 77.2%, 82.0%, and 75.6% in the suspicious category, respectively. Malignancy risk of the concordant suspicious category was higher than that of the discordant suspicious category (84.7% vs. 43.2%, p < 0.001). The addition of CT helped correctly detect additional metastasis in 16.4% of the US indeterminate LNs and in 1.7% of the US probably benign LNs. CT may complement US for LN characterization in thyroid cancer patients by suggesting the diagnostic confidence level for the suspicious category and helping correctly detect metastasis in US indeterminate LNs.
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Tan Y, Guo B, Deng X, Ding Z, Wu B, Niu Y, Hou J, Zhang Y, Fan Y. Transoral endoscopic selective lateral neck dissection for papillary thyroid carcinoma: a pilot study. Surg Endosc 2019; 34:5274-5282. [PMID: 31834511 DOI: 10.1007/s00464-019-07314-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transoral endoscopic thyroid surgery via the vestibular approach (TOETVA) has been gradually accepted worldwide due to its scar-free effect on the neck. Even central cervical lymphadenectomy has been performed in some cases of papillary thyroid carcinoma (PTC). However, there are few reports involving lateral neck dissection with TOETVA. In this study, we attempted to perform selective lateral neck dissection (SLND) for PTC via a transoral vestibular approach. METHODS This prospective study was conducted from January 2016 to December 2018 in twenty PTC patients with unilateral T1 tumors without capsular invasion and patients with abnormal level III and IV lymph nodes who underwent SLND via a transoral vestibular approach. RESULTS Endoscopic surgery was successfully accomplished in all 20 PTC patients. The mean age was 29.2 ± 5.5 (20-41) years. The mean operation time was 146.0 ± 18.7 (114-193) min. The average postoperative hospital stay was 6.8 ± 1.3 (5-10) days. The mean number of removed nodes was 7.4 ± 2.5 (4-12) in the central neck and 10.9 ± 2.8 (6-16) in the lateral neck, and the positive yield amounts were 2.0 ± 1.2 (0-4) and 2.7 ± 1.9 (0-6), respectively. No major complications occurred except for 1 case of transient unilateral recurrent laryngeal nerve palsy and two cases of effusion in the operative area. No evidence of persistent or recurrent disease was observed in these patients during a mean follow-up of 24.3 ± 9.1 (6-36) months. The cosmetic results and protection of personal privacy of this procedure were excellent. CONCLUSION Endoscopic SLND via the transoral vestibular approach is feasible, safe, and effective for selected PTCs. A multicenter large comparative study is necessary.
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Affiliation(s)
- YuYan Tan
- Department of Thyroid and Breast Surgery, The First College of Clinical Science of Three Gorges University, Yiling Road 183, Yichang, Hubei, 443003, China.,Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - BoMin Guo
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - XianZhao Deng
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - Zheng Ding
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - Bo Wu
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - YiQi Niu
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - JianZhong Hou
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - YinChao Zhang
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - YouBen Fan
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.
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Kim MS, Kim BH, Han YE, Nam DW, Hah JH. Clinical outcomes after local anesthesia with monitored anesthesia care during thyroidectomy and selective neck dissection: a randomized study. Eur Arch Otorhinolaryngol 2017; 274:3789-3794. [DOI: 10.1007/s00405-017-4707-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
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An C, Zhang X, Wang S, Zhang Z, Yin Y, Xu Z, Tang P, Li Z. Efficacy of Superselective Neck Dissection in Detecting Metastasis in Patients with cN0 Papillary Thyroid Carcinoma at High Risk of Lateral Neck Metastasis. Med Sci Monit 2017; 23:2118-2126. [PMID: 28469126 PMCID: PMC5426385 DOI: 10.12659/msm.900273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background This study aimed to evaluate superselective neck dissection (SSND) in patients with cN0 papillary thyroid carcinoma (PTC) at high risk of lateral cervical lymph node (LN) metastasis. Material/Methods This study enrolled 138 patients with PTC who underwent SSND. These patients were at high risk for LN metastasis and the rate of cervical LN metastasis was recorded. Results In all, 146 lateral neck dissections were performed in 138 patients. Intraoperative pathological data revealed LN metastasis from 55 cases, for which Level II and V dissection were performed. Ninety SSNDs were performed in the other 83 patients without metastasis identified in frozen sections. Occult lymph node metastasis (OLNM) rates were 56.8% and 43.5% in the central compartment and lateral neck, respectively. OLNM rates of Level II–VI were 17.8%, 31.5%, 36.3%, 1.4%, and 56.8%, respectively. Level VI metastasis (p<0.001), extra thyroidal extension (p=0.003), and tumor size (p=0.011) were significant factors for lateral neck LN metastasis. Conclusions SSND might be effective for early diagnosis of lateral neck metastases of PTC. Patients with OLNM should receive level II, III, and IV dissection, but level V dissection could be omitted.
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Affiliation(s)
- Changming An
- Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland)
| | - Xiwei Zhang
- Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland)
| | - Shixu Wang
- Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland)
| | - Zongmin Zhang
- Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland)
| | - Yulin Yin
- Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland)
| | - Zhengang Xu
- Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland)
| | - Pingzhang Tang
- Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland)
| | - Zhengjiang Li
- Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Science (CAMS), Peking Union Medical College (PUMC), Beijing, China (mainland)
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