Abstract:
OBJECTIVE:The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC. STUDY DESIGN:Observational retrospective controlled study. METHODS:Clinical records of patients (n=610) surgically treated for cN0-PTC at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008, were retrospectively reviewed. Study population was divided into three groups according to surgical treatment: Group A, total thyroidectomy (n=205); Group B, total thyroidectomy and elective ipsilateral CND (n=281); Group C, total thyroidectomy and bilateral CND (n=124). RESULTS:Of a total of 610 patients, 305 (50%) were classified as low-risk, 278 (45.57%) as intermediate-risk, and 27 (4.43%) as high-risk. Response to initial therapy was excellent in 567 patients (92.95%), acceptable in 21 (3.44%), and incomplete in 22 (3.61%), with no significant differences among groups. Locoregional recurrence was detected in 32 (5.2%) out of 610 patients. Distant metastasis was found in 15 patients (2.5%). Statistical analysis showed no significant differences in the rates of locoregional recurrence (p=0.890) or distant metastasis (p=0.538) among groups. Disease-specific mortality and overall survival did not significantly differ among groups (p=0.248 and 0.223, respectively). Rate of permanent hypoparathyroidism was significantly higher in Group C patients compared to those in Groups A and B. CONCLUSION:CND does not confer any clear advantage in the treatment of low-risk patients, regardless of surgical procedure. Instead, bilateral CND may be effective in limiting disease relapse and/or progression in patients at higher prognostic risk. Our data indicate that elective CND does not confer any clear advantage in terms of locoregional recurrence and long-term survival, as demonstrated by outcomes of the study Groups, regardless of their different prognostic risk. Elective CND allows a more accurate pathologic staging of central neck lymph nodes, despite its increasing the risk of permanent hypoparathyroidism. Intraoperative pathologic staging is a valuable tool to assess the risk of controlateral lymph node metastasis in the central neck compartment and to limit more aggressive surgery only to cases, otherwise understaged, with lymph node metastasis.
journal_name
Am J Otolaryngoljournal_title
American journal of otolaryngologyauthors
Giordano D,Frasoldati A,Gabrielli E,Pernice C,Zini M,Castellucci A,Piana S,Ciarrocchi A,Cavuto S,Barbieri Vdoi
10.1016/j.amjoto.2017.06.004subject
Has Abstractpub_date
2017-01-01 00:00:00pages
576-581issue
5eissn
0196-0709issn
1532-818Xpii
S0196-0709(17)30279-Xjournal_volume
38pub_type
杂志文章abstract::We report a case of chondrosarcoma of the larynx, diagnosed by a percutaneous core-needle biopsy (CNB). Cartilaginous tumors of the larynx are usually diagnosed by biopsy with direct laryngomicroscopy under general anesthesia. However, patients find it difficult to undergo a biopsy under general anesthesia, for physic...
journal_title:American journal of otolaryngology
pub_type: 杂志文章
doi:10.1016/j.amjoto.2014.03.013
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abstract:OBJECTIVES:We aim to present two cases of a retained insertion stylet from nasal feeding tube bridle systems. STUDY DESIGN:Case series of two patients. METHODS:Patients were evaluated from 8/2012 to 9/2013 for retained bridle system insertion stylet. RESULTS:Two patients presented with a retained stylet from nasal t...
journal_title:American journal of otolaryngology
pub_type: 杂志文章
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更新日期:2015-03-01 00:00:00
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journal_title:American journal of otolaryngology
pub_type: 杂志文章
doi:10.1016/0196-0709(89)90064-1
更新日期:1989-05-01 00:00:00
abstract::Starting eight days after hatching, chicks received daily subcutaneous injections of streptomycin sulfate, either 400 mg/kg for 30 days or 1,200 mg/kg for 15 days. Randomly selected chicks from each group were killed at intervals during the injection period, and the ampullae were examined for signs of vestibulotoxicit...
journal_title:American journal of otolaryngology
pub_type: 杂志文章
doi:10.1016/s0196-0709(84)80053-8
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abstract::A diagnosis of natural killer (NK)/T-cell lymphoma was clarified after repeated deep neck abscess in a 63-year-old man. The absolute number of lymphocytes was mildly decreased. Lymphopenia induced by latent malignant lymphoma in this case likely caused the immunodeficiency, which induced repeated infection in the head...
journal_title:American journal of otolaryngology
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doi:10.1016/j.amjoto.2008.05.004
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abstract::A procedure for laryngotracheal separation was performed on 5 elderly patients in poor general condition to prevent habitual aspiration pneumonia. Intractable aspiration was relieved in all the patients with no major postoperative complications. In this intervention, a modification of the procedure previously reported...
journal_title:American journal of otolaryngology
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journal_title:American journal of otolaryngology
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doi:10.1016/j.amjoto.2004.03.002
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Pigmented villonodular synovitis (PVNS) is a rare/benign condition of the synovial joint lining. It most commonly presents in the knee but has also been reported to occur in the temporomandibular joint (TMJ). Although there are several series reporting the use of postoperative radiotherapy (PORT) for extremi...
journal_title:American journal of otolaryngology
pub_type: 杂志文章,评审
doi:10.1016/j.amjoto.2014.10.017
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pub_type: 杂志文章
doi:10.1016/j.amjoto.2009.11.009
更新日期:2011-03-01 00:00:00
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更新日期:1994-11-01 00:00:00
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journal_title:American journal of otolaryngology
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doi:10.1016/j.amjoto.2015.10.010
更新日期:2016-03-01 00:00:00
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journal_title:American journal of otolaryngology
pub_type: 杂志文章,评审
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更新日期:2021-01-01 00:00:00
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更新日期:2015-01-01 00:00:00
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journal_title:American journal of otolaryngology
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doi:10.1016/j.amjoto.2012.09.011
更新日期:2013-03-01 00:00:00
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journal_title:American journal of otolaryngology
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doi:10.1016/j.amjoto.2008.04.006
更新日期:2009-05-01 00:00:00
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journal_title:American journal of otolaryngology
pub_type: 杂志文章
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更新日期:2020-01-01 00:00:00
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journal_title:American journal of otolaryngology
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更新日期:2017-01-01 00:00:00
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更新日期:2009-03-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:2015-11-01 00:00:00
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journal_title:American journal of otolaryngology
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更新日期:1991-01-01 00:00:00
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更新日期:2016-01-01 00:00:00
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journal_title:American journal of otolaryngology
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更新日期:1982-09-01 00:00:00