Clinical value and indication for the dissection of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma

Abstract

// Ding-Cun Luo 1 , Xiao-Cheng Xu 2 , Jin-Wang Ding 1 , Yu Zhang 1 , You Peng 1 , Gang Pan 1 and Wo Zhang 1 1 Department of Surgical Oncology, Hangzhou First People’s Hospital, Nanjing Medical University, Zhejiang, China 2 Department of Surgery of Thyroid and Breast, Wujiang District of Suzhou First People’s Hospital, Jiangsu, China Correspondence to: Ding-Cun Luo, email: ldc65@163.com Keywords: lymph node posterior to right recurrent laryngeal nerve, neck dissection, PTC, risk factors, metastasis Received: January 12, 2017      Accepted: August 06, 2017      Published: August 16, 2017 ABSTRACT Lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) are common sites of nodal recurrence after the resection of papillary thyroid carcinoma (PTC). However, the indication for LN-prRLN dissection remains debatable. We therefore studied the relationships between LN-prRLN metastasis and the clinicopathological characteristics in 306 patients with right or bilateral PTC who underwent LN-prRLN dissection. We found that LN-prRLN metastasis occurred in 16.67% of PTC and was associated with a number of the clinicopathological features. The receiver-operator characteristic (ROC) analysis showed that the areas under the ROC curves for the prediction of LN-prRLN metastasis by the risk factors age < 35.5 years, right tumor size > 0.85 cm, lymph node (right cervical central VI-1) number > 1.5, metastatic lymph node (right cervical central VI-1) size > 0.45 cm, and lymph node number in the right cervical lateral compartment > 0.5 were 0.601, 0.815, 0.813, 0.725, and 0.743, respectively. In conclusion, the risk factors for LN-prRLN metastasis in patients suffering right thyroid lobe or bilateral PTC include age ≤ 35.5 years, right tumor size ≥ 0.85 cm, capsular invasion, metastatic lymph node (right cervical central VI-1) number ≥ 2, metastatic lymph node (right cervical central VI-1) size ≥ 0.45 cm, and metastatic lymph node number in the right cervical lateral compartment ≥ 1. In patients whose risk factors can be identified pre-operatively or intraoperatively, the dissection of LN-pr-RLN should be considered during right cervical central compartment dissection.