Meena Said1, Michele Fujimoto2, Cara Franken3, Sunee Woo4, Brooke Vuong5, Philip I Haigh6. 1. General and Endocrine Surgeon at Providence Saint John's Health Center in Santa Monica, CA. mnsaid8@yahoo.com. 2. General Surgeon at the Santa Rosa Medical Center in CA. michele.a.fujimoto@kp.org. 3. General Surgeon at the Modesto Medical Center in CA. cara.franken@kp.org. 4. Former General Surgery Resident at the Los Angeles Medical Center in CA. sunee.s.woo@kp.org. 5. Former General Surgery Resident at the Los Angeles Medical Center in CA. brookevuong@gmail.com. 6. Oncologic and Endocrine Surgeon at the Los Angeles Medical Center in CA. philip.i.haigh@kp.org.
Abstract
CONTEXT: The oncologic benefit of prophylactic central lymph node dissection (pCLND) in node-negative papillary thyroid cancer has been debated. OBJECTIVE: To determine the use of pCLND in an integrated health care system and to evaluate recurrence in the cohort. DESIGN: Retrospective cohort study of patients with clinically node-negative papillary thyroid cancer who underwent total thyroidectomy with or without pCLND in Kaiser Permanente Southern California Region hospitals between January 1996 and December 2008. Chart review of all patients was performed to collect demographic data, tumor features, stage, and recurrences. MAIN OUTCOME MEASURES: Proportion undergoing pCLND and recurrence rate of papillary thyroid cancer. RESULTS: There were 864 patients identified (mean age, 46.1 years). Almost all patients had total thyroidectomy alone, and 34 (3.9%) underwent pCLND. The TNM (tumor, node, metastasis) stages for the 2 groups were not significantly different (p = 0.18). Overall recurrence was 24 (2.8%). There were 23 (2.8%) recurrences in the no-pCLND group and 1 (2.9%) recurrence in the pCLND group (p = 0.95). The rate of recurrence in the central neck compartment in those without pCLND was 1.1% and 0% in the pCLND group (p = 0.54). The recurrence rate in the lateral neck compartment in the no-pCLND group was 2.2%, and this rate was 2.9% in the pCLND group (p = 0.76). The no-pCLND group had a recurrence-free survival rate of 96.4% at 10 years vs 96.8% in the pCLND patients (p = 0.80). CONCLUSION: Presently, routine pCLND is difficult to advocate in our medical system.
CONTEXT: The oncologic benefit of prophylactic central lymph node dissection (pCLND) in node-negative papillary thyroid cancer has been debated. OBJECTIVE: To determine the use of pCLND in an integrated health care system and to evaluate recurrence in the cohort. DESIGN: Retrospective cohort study of patients with clinically node-negative papillary thyroid cancer who underwent total thyroidectomy with or without pCLND in Kaiser Permanente Southern California Region hospitals between January 1996 and December 2008. Chart review of all patients was performed to collect demographic data, tumor features, stage, and recurrences. MAIN OUTCOME MEASURES: Proportion undergoing pCLND and recurrence rate of papillary thyroid cancer. RESULTS: There were 864 patients identified (mean age, 46.1 years). Almost all patients had total thyroidectomy alone, and 34 (3.9%) underwent pCLND. The TNM (tumor, node, metastasis) stages for the 2 groups were not significantly different (p = 0.18). Overall recurrence was 24 (2.8%). There were 23 (2.8%) recurrences in the no-pCLND group and 1 (2.9%) recurrence in the pCLND group (p = 0.95). The rate of recurrence in the central neck compartment in those without pCLND was 1.1% and 0% in the pCLND group (p = 0.54). The recurrence rate in the lateral neck compartment in the no-pCLND group was 2.2%, and this rate was 2.9% in the pCLND group (p = 0.76). The no-pCLND group had a recurrence-free survival rate of 96.4% at 10 years vs 96.8% in the pCLND patients (p = 0.80). CONCLUSION: Presently, routine pCLND is difficult to advocate in our medical system.
Authors: K Thomas Robbins; Garry Clayman; Paul A Levine; Jesus Medina; Roy Sessions; Ashok Shaha; Peter Som; Gregory T Wolf Journal: Arch Otolaryngol Head Neck Surg Date: 2002-07
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