World Journal of Endocrine Surgery

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VOLUME 8 , ISSUE 1 ( January-April, 2016 ) > List of Articles

RESEARCH ARTICLE

Oral Presentation IV

Jin-Seong Cho, Min-Ho Park, Jung-Han Yoon

Citation Information : Cho J, Park M, Yoon J. Oral Presentation IV. World J Endoc Surg 2016; 8 (1):21-27.

DOI: 10.5005/wjoes-8-1-21

License: CC BY-NC 4.0

Published Online: 01-04-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

BACKGROUND AND AIMS

Prophylactic central lymph node dissection with total thyroidectomy (TT) for the treatment of papillary thyroid cancer (PTC) is controversial because of the possibility of increased morbidity with uncertain benefit. We evaluated the changing trends of lymph node ratio (LNR), recurrence, and radioablation therapy. Also, we evaluated the safety of omitting radioablation after TT with PTC, especially on low PNR (positive node ratio) N1a patients compared with high PNR N1a patients.

METHODS

Consecutive 147 N1a and 216 N0 patients who underwent TT with central neck dissection were enrolled. We divided 147 N1a patients into two groups: 96 high-PNR vs 51 low-PNR group according to 50% of PNR, and compared three groups including N0 group.

RESULTS

There were 21/147 (14.3%) recurrences on N1a intermediate-risk patients and 5/216 (2.3%) on N0 low-risk patients. Of these 21 recurrences, 20 (95.2%) occurred in the high-PNR group and only 1 (4.8%) was in the low-PNR group. The recurrence in low-PNR group (Graph 1; green line) was significantly lower than in high-PNR group (red line; log-rank p value = 0.003), but significantly not different from the N0 group (blue line; log-rank p-value = 0.889). Although this study was a retrospective nonrandomized trial with less number of patients, the 10-year recurrence of omitting RAI in low-PNR intermediate-risk N1a patients with less than 50% of PNR was shown to be comparable with 216 N0 low-risk patients.

CONCLUSION

Prophylactic central neck dissection may lead to upstaging and low recurrence, but also to overuse of radioablation. Lymph node ratio could be a useful predictor of recurrence and useful guidance in radioablation therapy.


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