Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma

Goepfert, Ryan P.; Liu, Chien-Ying; Ryan, William R.

doi:10.1016/j.amjoto.2015.04.011

Cited by 24 publications

(23 citation statements)

References 27 publications

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“…Patients presented with recurrent disease in RPLN can be diagnosed with either CT or magnetic resonance imaging (MRI) (3)(4)(5)(6)(7)(8)(11)(12)(13). In our case, the physical exam and the flexible laryngoscopy were able to detect the retropharyngeal mass.…”

Section: Discussionmentioning

confidence: 72%

“…Probably this occurs due to a lymphatic pathway, described by Rouviere, connecting the posterior surface of the thyroid gland to the retropharyngeal lymphatic system (15). In the second scenario, recurrence of PTC can present with retropharyngeal lymph node metastasis (4,(6)(7)(8)(9). It is proposed that the lymphatic flow direction could become retrogradely after total thyroidectomy and neck dissection, leading to the RPLN metastasis (6).…”

Section: Discussionmentioning

confidence: 99%

“…RPLN can be surgically excised via transcervical, transmandibular or transoral approaches (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The transcervical approach provides a wide exposure of the retropharyngeal space, but the morbidity of such an extensive approach is rarely justified in the treatment of a metastatic differentiated thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

“…It primarily metastasizes through the lymphatic system to the first echelon-central compartment (level VI) lymph nodes then to the lateral (levels II, III, IV, and V) neck compartments (2). PTC metastasis to the retropharyngeal space is rare with only a few reported cases (Table S1) (4,(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…High serum thyroglobulin levels in recurrent cases of RPLN metastasis can also direct the clinician towards the diagnosis of metastatic PTC. FNA of the RPLN can be done either transcervically or transorally under CT or US guidance (3,4,6,7,12). However, FNA is not always accurate: non-diagnostic samples or even benign cytology has been reported with a proven metastatic disease (3).…”

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confidence: 99%

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Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms

et al. 2017

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Papillary thyroid cancer (PTC) rarely metastasizes to the retropharyngeal lymph nodes.Managing patients with locally advanced primary PTC and metastasis located in distant anatomical areas is challenging. Herein, we report a 56-year-old patient with locally advanced asymptomatic PTC, who presented with obstructive airway symptoms due to the metastatic retropharyngeal lymph node. The patient underwent simultaneous total thyroidectomy, central lymph node dissection, en bloc resection of strap muscle and left laryngeal nerve via cervical approach and transoral resection of the metastatic retropharyngeal lymph node. Metastatic PTC should be included in the differential diagnosis of a retropharyngeal masses.Simultaneous total thyroidectomy of the primary thyroid cancer via a cervical approach and transoral resection of an isolated retropharyngeal metastasis is safe and feasible. with calcification and minimal vascularity, the mass appeared to invade the strap muscle (Figures 5,6). No discrete nodules were noted in the right thyroid lobe. Ultrasound-guided fine needle aspiration (FNA) of the left thyroid nodule was Gland Surg 2017;6(6):733-737 gs.amegroups.com positive for PTC.We decided to perform simultaneous transoral excision of the retropharyngeal mass, and total thyroidectomy via the transcervical approach. First, the parapharyngeal mass was excised through a transoral 1.5 cm vertical incision over the mass and the cystic-appearing firm lymph node was dissected circumferentially safely. Then cervical incision was performed. We identified that the strap muscle was invaded by the left thyroid mass. The left recurrent laryngeal nerve was completely encased by the mass. We performed total thyroidectomy with en bloc resection of the strap muscles and en bloc resection of the left recurrent laryngeal nerve with central lymph node dissection (level IV).Histopathology of the left thyroid lobe revealed a 2.5 cm × 2.0 cm papillary carcinoma, classic type, stage pT4aN1aM0, BRAF V600E mutant, and the left retropharyngeal lymph node was also positive for metastatic PTC. There was extrathyroidal extension present but the surgical margins were uninvolved by carcinoma. Nine of the twelve lymph nodes of the left central compartment were positive for metastatic PTC. Postoperative period was uneventful except for hoarseness. Her voice was strong subjectively and objectively. The patient received radioactive iodine postoperatively and continued to show no evidence of recurrence after 2 years of follow-up. DiscussionPapillary thyroid carcinoma is the most common and fortunately the least aggressive type of thyroid cancers. It usually grows slowly and has a favorable prognosis (14). However, PTC can be locally aggressive, and directly invading the nearby tissues. PTC most commonly metastasizes into the central compartment (level VI) lymph nodes, then the lateral (levels II, III, IV, and V) compartment nodes (2). Metastasis of PTC to the retropharyngeal lymph nodes (RPLN) is very rare and few cases are reported in the lit...

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms

et al. 2017

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Saline‐aided ultrasound‐guided transoral biopsy of retropharyngeal nodes in head and neck cancer: A feasibility study of five patients

et al. 2023

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BackgroundThe purpose of this study was to determine the feasibility of the novel technique of intra‐cavitary saline‐aided ultrasound (US) guided transoral biopsy or excision of retropharyngeal nodes.MethodsWe followed the IDEAL 2a framework to develop this technique. Procedures were performed between July 2020 and July 2022 at a tertiary head and neck center.ResultsFive patients in total underwent an ultrasound‐guided biopsy of a retropharyngeal node. They underwent seven procedures between them: three transoral robotic surgery (TORS) procedures, three fine needle aspirations (FNA) and/or core biopsy procedures, and one US assessment under general anesthetic. The six patients with histology taken (three TORS and three FNA/core biopsies) all had diagnostically adequate samples enabling appropriate treatment planning. There were no significant complications from the procedure.ConclusionSaline‐aided US‐guided biopsy of a retropharyngeal node is a safe and useful tool enabling accurate tissue sampling and tumor excision and ongoing appropriate treatment planning.

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Intraoperative Imaging and Navigation in Robotic Surgery

Liu

2017

Atlas of Head and Neck Robotic Surgery

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Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma

Abstract: Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma Permalink https://escholarship.org/uc/item/1rs008pt

Cited by 24 publications

References 27 publications

Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms

Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms

Saline‐aided ultrasound‐guided transoral biopsy of retropharyngeal nodes in head and neck cancer: A feasibility study of five patients

Intraoperative Imaging and Navigation in Robotic Surgery

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