The Clinical Significance Of Bilateral Central Lymph Node Dissectionin Unilateral Papillary Thyroid Carcinoma

Objective:To analysis relevant factors of contralateral central lymph node metastasis, And to discuss bilateral central lymph dissection operation method and postoperative complications as well as prognosis condition in unilateral papillary thyroid carcinoma(primary tumordiameter more than 1cm). Further, To make clear the clinical value and feasibility of preventative bilateral central lymph dissection for c N0 unilateral papillary thyroid.Methods:Retrospective analysis 42 cases with c N0 unilateral papillary thyroid of Si Chuan Provincial People’S Hospital from September 2014 to March 2015.All of the patients enrolled in this study underwent a preventative bilateral central lymph dissection. The relevant factors and rate of contralateral central lymph node metastasis,as well as the rate of postoperative complications and prognosis condition were discussed. Different groups were divided for statistical analysis and comparison according to those riskt factors such as gender,age,primary tumor size,ipsilateral central lymph metastasis and ipsilateral lateral neck lymph metastasis. SPSS20.0 statistical software were applied to analyze correlative data and take Chi-aquare test and Fisher’s exact test as statistical evaluation method.Significant level was set as alpha 0.05,(P < 0.05 was thought have statistical significance)Results: In 42 PTC patients, ipsilateral central lymph metastasis was present in 30 patients(71.4%) and contralateral central lymph metastasis in 19 patients(45.2%).17 patients(40.48%) had occurred bilateral central lymph metastasis and 2 patients saltatory metastasis.Univariate analysis show that the 3 factors which are primary tumor size and ipsilateral central lymph metastasis andlateral neck lymphmetastasis have a significant influence on contralateral central lymph node metastasis(Yes or No),while the others 2 factors which are gender and age were not obviously associated with it.The statistical evaluation result between contralateral central lymph node metastasis and the 3 factors which are primary tumor size and ipsilateral central lymph metastasis were respectively c2=7.435 and P=0.006,p<0.05, c2=5.536 and P=0.019 and p<0.05,c2=5.433 and P=0.02 and p<0.05 。 While the others 2statistical evaluation result were respectively c2=0.521 and P=0.470 and p>0.05, c2=0.192 and P=1.661 and p>0.05.In the aspects of postoperative complications,there is no patients occurred following complications such as Chyle leakage, pneumothorax, pleural effusion, Tracheal fistula, esophageal fistula,voicehoarseness and Choking cough among all of 44 enrolled patients.Only 2 patients(4.5%) occurred temporary Hypocalcemia(PTH <3pg/ml) and recovery by taking a Calcium supplements treatment after 1 week. Permanent hypoparathyroidism and recurrent laryngeal nerve resection did not occurre.Conclusion: 1.The patients with primary tumor diameter over 1cm has a higher rate of contralateral central lymph node metastasis(45.2%) than those diameter less 1cm,It is seem to be a higher number. 2. The contralateral central lymph node metastasis occurre or not has a evident relationship with the primary tumor size and ipsilateral central lymph metastasis while has no obvious associated. 3.Considering the closely relationships between ipsilateral central lymph metastasis and contralateral central lymph node metastasis,It is necessary to take a ipsilateral neck lymph dissection for the patients who contralateral central lymph node metastasis is postive.4. The central lymph node metastasis rate of papillary thyroid cancer is usually high(it is up to 71.4% in this study), Those patients’ s pathological examination results postoperation are postive,but they had no evidence of central lymph node metastasis preoperation.So all papillary thyroid cancer patients should take a central lymph dissection operation.5.Although preventative bilateral central lymph dissection may lead to some complications mentioned in the above section,On the one hand those rish can be avoided by take some measures such as a experienced surgeons,fine operation,taking enough attention on the protecting of recurrent laryngeal nerve and parathyroid glands and so on,On the other hand most of those rish are temporary. So,preventative bilateral central lymph dissection maybe safe and necessary for papillary thyroid cancer patients.