Профилактическая центральная лимфодиссекция (VI уровня) при папиллярном раке щитовидной железы

Метастатическое поражение лимфатических узлов центральной клетчатки шеи при папиллярном раке щитовидной железы (ПРЩЖ) встречается часто, однако превентивная центральная лимфодиссекция достоверно не влияет на показатели общей и безрецидивной выживаемости пациентов. Между тем при ее рутинном выполнении ощутимо увеличивается частота послеоперационных осложнений. С точки зрения соотношения эффективность/ безопасность профилактическая центральная лимфодиссекция не может быть рекомендована в дополнение к тиреоидэктомии у всех больных ПРЩЖ.

1. So YK, Son YI, Hong SD, et al. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery. 2010;148(3):526-531. doi: 10.1016/j.surg.2010.01.003.

2. Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol. 2008;15(9): 2482-2486. doi: 10.1245/s10434-008-0044-6.

3. Robbins KT, Shaha AR, Medina JE, et al. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008;134(5): 536-538. doi: 10.1001/archotol.134.5.536.

4. American Thyroid Association Surgery Working G, American Association of Endocrine S, American Academy of O-H, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19(11):1153-1158. doi: 10.1089/thy.2009.0159.

5. American Thyroid Association Guidelines Taskforce on Thyroid N, Differentiated Thyroid C, Cooper DS, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-1214. doi: 10.1089/thy.2009.0110.

6. Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154(6):787-803. doi: 10.1530/eje.1.02158.

7. American Thyroid Association Guidelines Task F, Kloos RT, Eng C, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid. 2009;19(6):565-612. doi: 10.1089/thy.2008.0403.

8. Pilaete K, Delaere P, Decallonne B, et al. Medullary thyroid cancer: prognostic factors for survival and recurrence, recommendations for the extent of lymph node dissection and for surgical therapy in recurrent disease. B-ENT. 2012; 8(2):113-121.

9. Stamatakos M, Paraskeva P, Katsaronis P, et al. Surgical approach to the management of medullary thyroid cancer: when is lymph node dissection needed? Oncology. 2013;84(6):350-355. doi: 10.1159/000351148.

10. Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16(2):109-142. doi: 10.1089/thy.2006.16.ft-1.

11. Carling T, Carty SE, Ciarleglio MM, et al. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22(3):237-244. doi: 10.1089/thy.2011.0317.

12. Noguchi S, Murakami N. The value of lymph-node dissection in patients with differentiated thyroid cancer. Surg Clin North Am. 1987;67(2):251-261. 13. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338(5):297-306. doi: 10.1056/NEJM199801293380506.

13. Cranshaw IM, Carnaille B. Micrometastases in thyroid cancer. An important finding? Surg Oncol. 2008;17(3):253-258. doi: 10.1016/j.suronc.2008.04.005.

14. Randolph GW, Duh QY, Heller KS, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of meta-static lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22(11):1144-1152. doi: 10.1089/thy.2012.0043.

15. Hartl DM, Leboulleux S, Al Ghuzlan A, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg. 2012; 255(4):777-783. doi: 10.1097/SLA.0b013e31824b7b68.

16. Kohler HF, Kowalski LP. How many nodes are needed to stage a neck? A critical appraisal. Eur Arch Otorhinolaryngol. 2010;267(5):785-791. doi: 10.1007/s00405-009-1144-z.

17. Lundgren CI, Hall P, Dickman PW, Zedenius J. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer. 2006;106(3):524-531. doi: 10.1002/cncr.21653.

18. Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008;144(6): 1070-1077; discussion 1077-1078. doi: 10.1016/j.surg.2008.08.034.

19. Sugitani I, Kasai N, Fujimoto Y, Yanagisawa A. A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery. 2004;135(2): 139-148. doi: 10.1016/S0039.

20. Shan CX, Zhang W, Jiang DZ, et al. Routine central neck dissection in differentiated thyroid carcinoma: a systematic review and meta-analysis. Laryngoscope. 2012;122(4): 797-804. doi: 10.1002/lary.22162.

21. Wang TS, Cheung K, Farrokhyar F, et al. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol. 2013;20(11):3477-3483. doi: 10.1245/s10434-013-3125-0.

22. Румянцев П.О., Чеботарева И.В., Ильин А.А., и др. Определение содержания тиреоглобулина в биопунктате лимфоузлов шеи для диагностики метастазов папиллярного рака щитовидной железы. // Российский онологический журнал. - 1999. - №2 - С.24-29. [Rumyantsev PO, Chebotareva IV, Il'in AA, et al. Opredelenie soderzhaniya tireoglobulina v biopunktate limfouzlov shei dlya diagnostiki metastazov papillyarnogo raka shchitovidnoi zhelezy. Russian Journal of Oncology. 1999;2:24-29. (In Russ).]

23. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope. 2011;121(3):487-491. doi: 10.1002/lary.21227.

24. Morita S, Mizoguchi K, Suzuki M, Iizuka K. The accuracy of (18)[F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma. World J Surg. 2010;34(11): 2564-2569. doi: 10.1007/s00268-010-0733-8.

25. Choi JS, Kim J, Kwak JY, et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. Am J Roentgenol. 2009;193(3):871-878. doi: 10.2214/AJR.09.2386.

26. Gemsenjager E, Perren A, Seifert B, et al. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg. 2003; 197(2):182-190. doi: 10.1016/S1072-7515(03)00421-6.

27. Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140(6): 1000-1005; discussion 1005-1007. doi: 10.1016/j.surg.2006.08.001.

28. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007;245(4):604-610. doi: 10.1097/01.sla.0000250451.59685.67.

29. Besic N, Zgajnar J, Hocevar M, Petric R. Extent of thyroidectomy and lymphadenectomy in 254 patients with papillary thyroid microcarcinoma: a single-institution experience. Ann Surg Oncol. 2009;16(4):920-928. doi: 10.1245/s10434-009-0332-9.

30. Costa S, Giugliano G, Santoro L, et al. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital. 2009;29(2):61-69.

31. Roh JL, Park JY, Park CI. Prevention of postoperative hypo-calcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer. 2009;115(2):251-258. doi: 10.1002/cncr.24027.

32. Hughes DT, White ML, Miller BS, et al. Influence of prophylactic central lymph node dissection on postoperative thyro-globulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148(6):1100-1106; discussion 10061107. doi: 10.1016/j.surg.2010.09.019.

33. Moo TA, McGill J, Allendorf J, et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg. 2010;34(6): 1187-1191. doi: 10.1007/s00268-010-0418-3.

34. Lang BH, Yih PC, Shek TW, et al. Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma. J Surg Oncol. 2012;106(8):966-971. doi: 10.1002/jso.23201.

35. Moreno MA, Edeiken-Monroe BS, Siegel ER, et al. In papillary thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. Thyroid. 2012;22(4):347-355. doi: 10.1089/thy.2011.0121.

36. Barczynski M, Konturek A, Stopa M, Nowak W. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg. 2013;100(3):410-418. doi: 10.1002/bjs.8985.

37. Zetoune T, Keutgen X, Buitrago D, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol. 2010;17(12):3287-3293. doi: 10.1245/s10434-010-1137-6.

38. Yoo D, Ajmal S, Gowda S, et al. Level VI lymph node dissection does not decrease radioiodine uptake in patients undergoing radioiodine ablation for differentiated thyroid cancer. World J Surg. 2012;36(6):1255-1261. doi: 10.1007/s00268-012-1507-2.

39. Sawka AM, Rilkoff H, Tsang RW, et al. The rationale of patients with early-stage papillary thyroid cancer for accepting or rejecting radioactive iodine remnant ablation. Thyroid. 2013; 23(2):246-247. doi: 10.1089/thy.2012.0422.

40. Durante C, Haddy N, Baudin E, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin EndocrinolMetab. 2006;91(8):2892-2899. doi: 10.1210/jc.2005-2838.

41. Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 1998;383(2):167-169.

42. Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery. 2005;138(6):1095-1100, discussion 1100-1091. doi: 10.1016/j.surg.2005.09.013.

43. Bardet S, Malville E, Rame JP, et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol. 2008;158(4):551-560. doi: 10.1530/EJE-07-0603.

44. Rosenbaum MA, McHenry CR. Central neck dissection for papillary thyroid cancer. Arch Otolaryngol Head Neck Surg. 2009;135(11):1092-1097. doi: 10.1001/archoto.2009.158.

45. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. 2012;22(9):911-917. doi: 10.1089/thy.2012.0011.

46. Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg. 2010;145(3):272-275. doi: 10.1001/archsurg.2010.9.

47. Alvarado R, Sywak MS, Delbridge L, Sidhu SB. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: Is there added morbidity? Surgery. 2009;145(5):514-518. doi: 10.1016/j.surg.2009.01.013.

48. White ML, Gauger PG, Doherty GM. Central lymph node dissection in differentiated thyroid cancer. World J Surg. 2007;31(5):895-904. doi: 10.1007/s00268-006-0907-6.

49. Rondeau G, Fish S, Hann LE, et al. Ultrasonographically detected small thyroid bed nodules identified after total thyroidectomy for differentiated thyroid cancer seldom show clinically significant structural progression. Thyroid. 2011;21(8):845-853. doi: 10.1089/thy.2011.0011.