Minimally Invasive Video-Assisted Surgical Management for Parapharyngeal Metastases From Papillary Thyroid Carcinoma: A Case Series Report

Abstract

Background: Papillary thyroid carcinoma (PTC) is the most prevalent cancer type in the endocrine system. Metastases to parapharyngeal lymph nodes (PPLNs) are rare. Herein, we reported a case series of PTC patients with PPLN metastases operated on by using the minimally invasive video-assisted (MIVA) technique to evaluate the safety and effectiveness of this technique.Method: In this single-institutional study, six consecutive PTC patients with PPLN metastases between January 2012 and July 2018 were enrolled. All PPLNs were managed by the MIVA technique.Result: Six patients (three women and three men) who underwent surgery were enrolled in the current study. The median age of patients was 40.5 years (39–66). Five patients (83.3%) were diagnosed with primary PTC with PPLN metastases, and one patient had PTC recurrence in the PPLNs 17 years after her first PTC surgery. Surgical treatment was successful in all patients, and the median operative time and bleeding volume were 185 (100–280) min and 85 (30–120) ml, respectively. None of the patients experienced post-operative complications except for one patient who experienced dysphagia, which resolved within 3 months. During a median follow-up of 15 months (10–31), none of the patients exhibited recurrence or persistent disease.Conclusion: The MIVA transcervical approach was technically feasible and reliable, with less invasiveness for PTC patients with PPLN metastases. Future studies are needed to accumulate more experience, investigate the indications of the technique, and determine the long-term oncological safety.

Transoral robotic surgery approach for relapse in parapharyngeal space of papillary thyroid carcinoma: Case series

“…This approach is especially useful in head and neck surgeries such as those made to treat metastases of PTC in the RPS or PPS, 9 considering that both of these complex anatomic spaces are difficult to access and that they have close proximity to vital neurovascular structures. Minimally invasive procedures allow a clear identification of critical surgical landmarks, provide an almost bloodless surgical field, reducing complications associated, 1 offer minimal facial scaring and faster rehabilitation 1 . However, TORS can be used in cases of isolated and well‐encapsulated nodes due to the limited surgical access obtained, therefore it should not be performed in cases where ENE is suspected 10 …”

“…Minimally invasive procedures allow a clear identification of critical surgical landmarks, provide an almost bloodless surgical field, reducing complications associated, 1 offer minimal facial scaring and faster rehabilitation. 1 However, TORS can be used in cases of isolated and well-encapsulated nodes due to the limited surgical access obtained, therefore it should not be performed in cases where ENE is suspected. 10…”

“…Papillary thyroid carcinoma (PTC) is the most common cancer type in the endocrine system. According to Yu et al 1 less than 100 parapharyngeal lymph node metastases cases have been reported, with rates ranging from 0.43% to 2.5%. Lymph node metastasis in the parapharyngeal space (PPS) can be classified as primary or secondary.…”

The Coexistence of Genetic Mutations in Thyroid Carcinoma Predicts Histopathological Factors Associated With a Poor Prognosis: A Systematic Review and Network Meta-Analysis

“…However, some TC (especially PTC) tumors are highly invasive, postoperative recurrence, metastasis or even death occur frequently. Therefore, novel therapeutic strategies are urgently needed (4,5).…”