Transoral robotic selective neck dissection for papillary thyroid carcinoma: Is it appropriate?

Piccin, Ottavio; D'Alessio, Pasquale; Cavicchi, Ottavio

doi:10.1002/hed.26447

Cited by 1 publication

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“…Some researchers believe that super-selective lymph node dissection is feasible, especially in robot-assisted and endoscopic surgery [ 16 , 18 ], while other researchers doubt the safety of this approach. Doctor Piccin [ 19 ] suggests that patients with preoperatively proven PTC LLN metastasis should undergo dissection including levels II to V and that the transoral robotic approach may not be the ideal surgical technique for neck dissection. In a study conducted by Doctor Zhao [ 16 ], the experimental group underwent selective dissection at levels III and IV, and the control group underwent standardized dissection at levels II through V. The rate of lymph node metastasis at level II in the control group was 33% (42/147).…”

Section: Discussionmentioning

confidence: 99%

Analysis of factors influencing cervical lymph node metastasis of papillary thyroid carcinoma at each lateral level

et al. 2022

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Objective To analyze the clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) and its influence on the distribution of lymph node metastasis at each lateral level of the neck to guide precise treatment of the lateral area. Methods The clinicopathological data of patients with PTC initially diagnosed and treated at our hospital from February 2014 to September 2021 were collected; the metastatic status of each lateral level was recorded, and correlations were analyzed. Results A total of 203 patients were enrolled in this study. There were 67 males and 136 females, with an average age of 41.1 years. In the lateral cervical area, lymph node metastasis was found at level IIa in 81 patients (39.9%); level III, 171 patients (84.2%); level IV, 122 patients (60%); and level Vb, 18 patients (8.9%). Correlation analysis showed that age (r = 0.198, P < 0.01) and sex (r = 0.196, P < 0.01) were weakly correlated with the number of positive lymph nodes in the central region. The tumor size (r = 0.164, P < 0.05) was weakly correlated with lymph node metastasis at level IV. The presence of multiple tumor foci was weakly correlated with lymph node metastasis at level IIa (r = 0.163, P < 0.05) and Vb (r = 0.143, P < 0.05). The tumor location (r = − 0.168, P < 0.05) was weakly correlated with lymph node metastasis at level III. The number of positive lymph nodes in the central region (r = 0.189, P < 0.01) was weakly correlated with lymph node metastasis at level IV. Binary logistic regression analysis showed that the risk of metastasis of multifocal tumors was higher than that of unifocal tumors by 1.958 times at level IIa (P = 0.021, OR = 1.958) and 2.929 times at level Vb (P = 0.049, OR = 2.929). The higher the tumor was located, the higher the risk of metastasis at level III (P = 0.014, OR = 0.563). Every additional positive lymph node in the central region increased the risk of metastasis at level IV by 1.126 times (P = 0.009, OR = 1.126). Conclusions For patients with pathological evidence of lateral metastasis, standard dissection of level IIa through Vb is recommended; selective dissection requires careful consideration. Patients with multifocal tumors have a high risk of metastasis at levels IIa and Vb, which requires special attention during the operation.

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