Yadranko Ducic1, Lance Oxford. 1. Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern Medical Center Dallas, TX, USA. yducic@sbcglobal.net
Abstract
OBJECTIVES: To review our results with elective superior mediastinal dissections for thyroid carcinomas. STUDY DESIGN: Retrospective review. METHODS: We searched operative case logs for all patients with thyroid carcinoma treated with an elective superior mediastinal dissection by the senior author (Y.D.) during a 6-year period. Charts were reviewed for demographic information and pathologic results. Elective superior mediastinal dissections were performed when the frozen section was consistent with anaplastic or medullary carcinoma or with a well-differentiated carcinoma when there was fixation of the primary tumor to the laryngotracheal complex, there was overt clinically evident paratracheal and/or cervical adenopathy, or the primary tumor measured greater than 2.0 cm in dimension. RESULTS: Thirty-one patients meeting the above criteria were reviewed, and superior mediastinal disease was present in 19 patients (61.3%). Superior mediastinal nodes were positive in 13 (65%) of 20 patients with papillary carcinoma, 0 of 4 with follicular thyroid carcinoma, 4 of 5 patients with medullary thyroid carcinoma, and 2 of 2 patients with anaplastic thyroid carcinoma. Patients with follicular carcinoma had a lower incidence of mediastinal disease (0%) compared with nonfollicular thyroid carcinoma (70.4%), P = .02. Patients with cervical metastasis had an increased incidence of superior mediastinal disease (100% vs 53.3%). CONCLUSIONS: Elective transcervical superior mediastinal dissection was commonly positive in patients with papillary, medullary, and anaplastic thyroid carcinomas. A transcervical approach may be safely performed without sternotomy to the level of the brachiocephalic vein. Further studies are required to determine if performing elective superior mediastinal lymph node dissections will have an impact on survival.
OBJECTIVES: To review our results with elective superior mediastinal dissections for thyroid carcinomas. STUDY DESIGN: Retrospective review. METHODS: We searched operative case logs for all patients with thyroid carcinoma treated with an elective superior mediastinal dissection by the senior author (Y.D.) during a 6-year period. Charts were reviewed for demographic information and pathologic results. Elective superior mediastinal dissections were performed when the frozen section was consistent with anaplastic or medullary carcinoma or with a well-differentiated carcinoma when there was fixation of the primary tumor to the laryngotracheal complex, there was overt clinically evident paratracheal and/or cervical adenopathy, or the primary tumor measured greater than 2.0 cm in dimension. RESULTS: Thirty-one patients meeting the above criteria were reviewed, and superior mediastinal disease was present in 19 patients (61.3%). Superior mediastinal nodes were positive in 13 (65%) of 20 patients with papillary carcinoma, 0 of 4 with follicular thyroid carcinoma, 4 of 5 patients with medullary thyroid carcinoma, and 2 of 2 patients with anaplastic thyroid carcinoma. Patients with follicular carcinoma had a lower incidence of mediastinal disease (0%) compared with nonfollicular thyroid carcinoma (70.4%), P = .02. Patients with cervical metastasis had an increased incidence of superior mediastinal disease (100% vs 53.3%). CONCLUSIONS: Elective transcervical superior mediastinal dissection was commonly positive in patients with papillary, medullary, and anaplastic thyroid carcinomas. A transcervical approach may be safely performed without sternotomy to the level of the brachiocephalic vein. Further studies are required to determine if performing elective superior mediastinal lymph node dissections will have an impact on survival.