A Case Report Of 295 Differential Thyroid Carcinoma Patients

Objective:To evaluate reasonable extent of lymph node dissection of differentiated thyroid carcinoma (DTC), post-operational recurrence-related factors, the sentinel lymph node (SLN) region and regulate the significance of SLN. Material and Methods:From Nov. 2003 to Apr. 2009, consecutive 295 patients with DTC being performed surgical operation, were concluded retrospectively. We analyze the significance between the prognosis-related factors (sex,age,cN0 or cN1 and extent of lymph node dissection) and the recurrence rates, and then discuss the region of SLN.Results:In the 295 patients with DTC, 157 cases metastasised to lymph node, the rate is 53.2%. 51 cases(32.5%) metastasised to lymph node levelⅥ, 29 cases (18.5%) metastasised to lymph node levelⅣ, 77 cases (49%) metastasised to lymph node levelⅡ~Ⅵ. The incidence of metastasition to lymph node levelⅥis higher than lymph node levelⅣ. The recrudescent incidence between man and woman is not different. The recrudescent incidence of the patients who are older than 45y is higher than the incidence of the ones who are younger. For the patients in clinically negative node (cN0) stage, the incidence of recrudescent cases with R0 (near-total thyroidectomy without node dissection) is higher than R1 (near-total thyroidectomy with prophylactic (levelⅥ) lymph node dissection)(P<0.05); the incidecence of recrudescent cases with R1,R2 (near-total thyroidectomy with modified radical lymph node dissection) and R3 (near-total thyroidectomy with comprehensive lymph node dissection) is no difference (P>0.05); For the patients in cN1 stage, the difference of recrudescent incidence cases with R2 and R3 is not statistically significant (P>0.05). In one sentence, the recurrent rate of DTC is closely related with age, clinical node stage, and the extent of lymph nodes dissection.Conclusion:Lymph node levelⅥbelongs to SLN. The higher recurrence rate of DTC is closely related with age≥45, clinically positive node stage, and operation without node dissection. From our study, we found that the optimized prognosis of the patients whose preoperative diagnosis was cN0 stage had signficant relationship with near-total thyroidectomy procedure with prophy- lactic (levelⅥ) node dissection. The patients that preoperative diagnosis was cN1 stage got benefits from the thyroidectomy procedure simultaneously with the modified radical lymph node dissection.