Lateral Lymph Node Dissection As A Strategy In Treating CN0 Papillary Thyroid Carcinoma

Objective The recurrence of papillary thyroid carcinoma(PTC)is frequently correlated with Lymph node metastasis.Currently,the accuracy of the procedure for evaluating lymph node metastasis is not satisfactory.The objective of the current work is to explore the potential benefits of individualized prophylactic lateral lymph node dissection(PLLND)in cN0 PTC.Methods PTC patients underwent surgery at the First Affiliated Hospital of Chongqing Medical University from January 2013 to December2018.All PTC patients that underwent thyroid lobectomy /total thyroidectomy and ipsilateral central lymph node dissection(CLND)(level VI)were categorized into the conventional operation group and the intraoperative frozen-section group.Central lymph node frozen biopsy was routinely performed,and all PTC affected individuals were selectively subjected to prophylactic lateral lymph node dissection(PLLND)in the intraoperative frozen-section group.Univariate analysis was taken up to compare the difference among groups.Multivariate analysis was carried out to explore the elements linked to recurrence of lymph node(LN)in PTC patients within various groups.Kaplan-Meier survival curves and the log-rank analysis were employed to evaluate the lymph node recurrence-free survival(LN-RFS).Results 2365 individuals affected by PTC were made a part of this work,and there were 668 in the conventional operation group,1697 were placed in the intraoperative frozen-section group(1105 in the PLLND group).The rate of central lymph node metastatic(CLNM)was found to be52.35%(1238/2365).In the PLLND group,there were 802(72.58%)patients with CLNM and 493(44.62%)patients with lateral lymph node metastatic(LLNM),and the numbers of LLNM?5 had 99(20.08%).In the study,54.19%(362/668)PTC patients from the conventional operation group accepted RIA therapy,and 78.73%(870/1105)PTC patients in the PLLND group accepted RIA therapy,and a noteworthy statistical difference exists in this case(p(27)0.001).For LN recurrence,there were 14 and 8 PTC patients in the conventional operation group and the intraoperative frozen-section group(included 6 in the PLLND group),respectively.Most of the 22 PTC individuals with LN recurrence experienced lateral lymph node recurrence,and only 3 patients suffered from central lymph node recurrence.In comparison to the conventional operation group,significant differences were found in LN recurrence in the intraoperative frozen-section group(p(27)0.001),and LN-RFS was worse in the convention operation group compared to the intraoperative frozen-section group(p(27)0.001).Conclusion Currently,the neck ultrasound in lymph node assessment is not reliable enough and accurate.Intraoperative frozen pathological biopsy could help surgeons to accurately assess the condition of lymph node metastasis,and make reasonable intraoperative decisions for cN0 PTC patients.Some cN0 PTC patients at high and intermediate risk of recurrence were selected through selective PLLND,and clinical-stage could be accurately assessed.It helps doctors to set out a more individualized treatment in PTC patients and might reduce lymph node recurrence.It is expected that the effects of lateral lymph node metastasis on recurrence and survival of PTC will be guided by prospective research.