Clinical Analysis Of Lateral Cervical Lymph Node Recurrence In Papillary Thyroid Carcinoma

Objective:In order to analysis the rate of postoperative papillary thyroid carcinomas recurrence in each cervical lymph nodes level,post-reoperative outcome and the complication.To research the recurrent rate in previously dissected areas.Methods:A retrospective cohort study of patients undergoing lymph node dissection for PTC relapse was taken in our hospital from 2010-01 to 2011-06.We statistically analyzed the distribution of lymph node metastasis in each region,the incidence of postoperative complications and follow up Tg to predict the therapeutic effect.Three hundred thirty-six PTC patients who need reoperation in a previously dissected area for recurrence had included in this retrospective analysis at our hospital during 2000-2016.A total of 360 side lateral cervical lymph nodes were dissected.The operative interval which was 6 months or less was divided into subgroups for analysis.The lymph node metastasis rate of each level,the number of positive lymph nodes and the total lymph nodes were counted.Results:Lymph node metastasis was found in 259 cases,lymph node metastasis rates in levels ?,?,?,? and ? were 43.2%,50.2%,45.6%,8.1%and 59.1%respectively.44 cases which took the level ? dissection were divided into ?A and ?B according to the accessory nerve,the metastasis rates were 52.27%and 18.18%(P=0.887),respectively.Recurrence in unilateral lateral neck is more common than bilateral lateral neck(73.1%vs 20.6%,P<0.001).The lateral neck lymph nodes was more likely to metastasize than the central region(80.7%vs 59.1%,P<0.001).There were 47 cases(18.1%)had postoperative complications,including 10 cases of permanent hypocalcemia.The rate of recurrence in unilateral lateral neck is 92.9%(312/336).Multiple level metastases,two or more levels were identified recurrence,were 47.5%(171/360).The recurrence rates of level ?,?,? and V were 55.6%(200/360),44.2%(156/360),59.7%(215/360)and 10.3%(37/360)respectively.Positive lymph nodes were mainly located in level ?(33.6%)and ?(35.8%).The group of operative interval less than or equal to 6 months had more number of positive lymph nodes(4.37 VS 3.2,P=0.001)and the total lymph nodes(26.56 VS 16.8,P<0.001)than the group of more than 6 months.Conclusions:The re-operation for papillary thyroid carcinomas which were recurrent in neck region was generally recommended levels ?-? and ? dissection.The incidence of postoperative complications of re-surgery is high,the treatment should be operated by experienced surgeon.Lymph node metastasis,maybe residual,is more common in level? and level ? in previously dissected area.Multi-level metastasis is not rare,these areas need to pay attention when the first operation.Most of the patients underwent reoperation because of residual lymph nodes from the previous treatment.In order to reduce lymph node remnant,normalization and completeness of the initial operation is particularly important.