The Significance Of Bilateral Central Lymph Node Dissection For Unilateral Papillary Thyroid Carcinoma

Objective: To analyze the relevent factors of lymph node metastasis in the central and contralateral central regions of thyroid papillary carcinoma,then provide the evidence and determine the clinical significance and feasibility for the prevention of bilateral central lymph node dissection with thyroid papillary carcinoma.Methods: According to the inclusion criteria,chose 282 patients which with thyroid surgery underwent thyroidectomy from the same treatment group from November 2015 to December 2016 in the fujian medical university union hospital.The postoperative pathology was confirmed as unilateral thyroid papillary carcinoma.According to the patient's disease number,the tail number is numbered as matched group of 144 patients,the whole group of patients with ipsilateral glandular leaf + isthmus + ipsilateral central area lymph node dissection;the tail number is double number were set up in experimental group,a total of 138 cases,the whole group of patients with ipsilateral glandular leaf + isthmus + bilateral central lymph node dissection;All patients were treated with contralateral part or all of the lobectomy when they were with contralateral lesions.Compare the postoperative complications of the two groups,and analyze the risk factors of central metastasis and contralateral central.Result: 1.The central lymph node metastasis rate was 59.2%(167/282)in all patients.The lymph node metastasis rate in subfamily region was 12.4%(35/282)in VIa area and 32.1%(70/218)in VIb area,the lymph node metastasis rate of VIb was 31.2%(88/282),the lymph node metastasis rate in VId area was 31.7%(64/202).The All patients had no permanent hypoparathyroidism,permanent recurrent laryngeal nerve palsy and lymphatic leakage.2.There was no significant difference in the incidence of postoperative complications between the two groups.The number of lymph nodes dissected in matched group was 9.56±5.69,while the number of lymph nodes in experimental group was 11.56±6.32,and the difference between the two groups was significant(P=0.005);The average flow rate of matched group and experimental group was 49.85 ml and 60.37 ml,the difference was significant(P=0.001).3.Age<45 years(OR=2.081),tumor diameter?10mm(OR=2.012)and tumor located in the non-polar(OR=2.260)is the independent risk factors for the central area of lymph node metastasis;Tumor diameter?10mm(OR=3.784)and ipsilateral central lymph node metastasis(OR=3.409)were independent risk factors for lymph node metastasis in the contralateral central region.4.While the whole group of patients' follow-up time is short,we can not assess the incidence of recurrence now,which needs a further follow-up observation.Conclusion: 1.When thyroid foci is located in the middle or lower pole,the risk of central area lymph node metastasis would be higher.2.The papillary thyroid carcinoma in the central area of each sub-region shows a high lymph node metastasis rate.3.Compared to unilateral central area lymph node dissection,bilateral central lymph node dissection does not increase the incidence of postoperative complications.4.When a patient is with unilateral papillary thyroid carcinoma,it is recommended to prevent bilateral central area lymph node dissection.Especially for the patient who with the tumor diameter?10mm and(or)has been confirmed contralateral lymph node metastasis,bilateral central lymph node dissection would be necessary.