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Профилактическая центральная лимфодиссекция (VI уровня) при папиллярном раке щитовидной железы

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Метастатическое поражение лимфатических узлов центральной клетчатки шеи при папиллярном раке щитовидной железы (ПРЩЖ) встречается часто, однако превентивная центральная лимфодиссекция достоверно не влияет на показатели общей и безрецидивной выживаемости пациентов. Между тем при ее рутинном выполнении ощутимо увеличивается частота послеоперационных осложнений. С точки зрения соотношения эффективность/ безопасность профилактическая центральная лимфодиссекция не может быть рекомендована в дополнение к тиреоидэктомии у всех больных ПРЩЖ.

Ключевые слова:
папиллярный рак щитовидной железы, профилактическая центральная лимфодиссекция, эффективность, осложнения, papillary thyroid cancer, prophylactic central neck dissection, efficacy, complications

Литература:
1.So Y.K., Son Y.I., Hong S.D., et al. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. // Surgery. 2010;148(3):526-531. doi: 10.1016/j.surg.2010.01.003.
2.Roh J.L., Kim J.M., Park C.I. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. // Ann Surg Oncol. 2008;15(9): 2482-2486. doi: 10.1245/s10434-008-0044-6.
3.Robbins K.T., Shaha A.R., Medina J.E., et al. Consensus statement on the classification and terminology of neck dissection. // Arch Otolaryngol Head Neck Surg. 2008;134(5): 536-538. doi: 10.1001/archotol.134.5.536.
4.American Thyroid Association Surgery Working G, American Association of Endocrine S, American Academy of O-H, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. // Thyroid. 2009;19(11):1153-1158. doi: 10.1089/thy.2009.0159.
5.American Thyroid Association Guidelines Taskforce on Thyroid N, Differentiated Thyroid C, Cooper D.S., et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. // Thyroid. 2009;19(11):1167-1214. doi: 10.1089/thy.2009.0110.
6.Pacini F., Schlumberger M., Dralle H., et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. // Eur J Endocrinol. 2006;154(6):787-803. doi: 10.1530/eje.1.02158.
7.American Thyroid Association Guidelines Task F, Kloos R.T., Eng C., et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. // Thyroid. 2009;19(6):565-612. doi: 10.1089/thy.2008.0403.
8.Pilaete K., Delaere P., Decallonne B., et al. Medullary thyroid cancer: prognostic factors for survival and recurrence, recommendations for the extent of lymph node dissection and for surgical therapy in recurrent disease. // B-ENT. 2012; 8(2):113-121.
9.Stamatakos M., Paraskeva P., Katsaronis P., et al. Surgical approach to the management of medullary thyroid cancer: when is lymph node dissection needed? // Oncology. 2013;84(6):350-355. doi: 10.1159/000351148.
10.Cooper D.S., Doherty G.M., Haugen B.R., et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. // Thyroid. 2006;16(2):109-142. doi: 10.1089/thy.2006.16.ft-1.
11.Carling T., Carty S.E., Ciarleglio M.M., et al. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. // Thyroid. 2012;22(3):237-244. doi: 10.1089/thy.2011.0317.
12.Noguchi S., Murakami N. The value of lymph-node dissection in patients with differentiated thyroid cancer. // Surg Clin North Am. 1987;67(2):251-261. 13.
13.Schlumberger M.J. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338(5):297-306. doi: 10.1056/NEJM199801293380506.
14.Cranshaw I.M., Carnaille B. Micrometastases in thyroid cancer. An important finding? // Surg Oncol. 2008;17(3):253-258. doi: 10.1016/j.suronc.2008.04.005.
15.Randolph G.W., Duh Q.Y., Heller K.S., et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. // Thyroid. 2012;22(11):1144-1152. doi: 10.1089/thy.2012.0043.
16.Hartl D.M., Leboulleux S., Al Ghuzlan A., et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. // Ann Surg. 2012; 255(4):777-783. doi: 10.1097/SLA.0b013e31824b7b68.
17.Kohler H.F., Kowalski L.P. How many nodes are needed to stage a neck? A critical appraisal. // Eur Arch Otorhinolaryngol. 2010;267(5):785-791. doi: 10.1007/s00405-009-1144-z.
18.Lundgren C.I., Hall P., Dickman P.W., Zedenius J. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. // Cancer. 2006;106(3):524-531. doi: 10.1002/cncr.21653.
19.Zaydfudim V., Feurer I.D., Griffin M.R., Phay J.E. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. // Surgery. 2008;144(6): 1070-1077; discussion 1077-1078. doi: 10.1016/j.surg.2008.08.034.
20.Sugitani I., Kasai N., Fujimoto Y., Yanagisawa A. A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. // Surgery. 2004;135(2): 139-148. doi: 10.1016/S0039.
21.Shan C.X., Zhang W., Jiang D.Z., et al. Routine central neck dissection in differentiated thyroid carcinoma: a systematic review and meta-analysis. // Laryngoscope. 2012;122(4): 797-804. doi: 10.1002/lary.22162.
22.Wang T.S., Cheung K., Farrokhyar F., et al. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. // Ann Surg Oncol. 2013;20(11):3477-3483. doi: 10.1245/s10434-013-3125-0.
23.Румянцев П.О., Чеботарева И.В., Ильин А.А., и др. Определение содержания тиреоглобулина в биопунктате лимфоузлов шеи для диагностики метастазов папиллярного рака щитовидной железы. // Российский онологический журнал. - 1999. - №2 - С.24-29.
24.Hwang H.S., Orloff L.A. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. // Laryngoscope. 2011;121(3):487-491. doi: 10.1002/lary.21227.
25.Morita S., Mizoguchi K., Suzuki M., Iizuka K. The accuracy of (18)[F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma. // World J Surg. 2010;34(11): 2564-2569. doi: 10.1007/s00268-010-0733-8.
26.Choi J.S., Kim J., Kwak J.Y., et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. // Am J Roentgenol. 2009;193(3):871-878. doi: 10.2214/AJR.09.2386.
27.Gemsenjager E., Perren A., Seifert B., et al. Lymph node surgery in papillary thyroid carcinoma. // J Am Coll Surg. 2003; 197(2):182-190. doi: 10.1016/S1072-7515(03)00421-6.
28.Sywak M., Cornford L., Roach P., et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. // Surgery. 2006;140(6): 1000-1005; discussion 1005-1007. doi: 10.1016/j.surg.2006.08.001.
29.Roh J.L., Park J.Y., Park C.I. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. // Ann Surg. 2007;245(4):604-610. doi: 10.1097/01.sla.0000250451.59685.67.
30.Besic N., Zgajnar J., Hocevar M., Petric R. Extent of thyroidectomy and lymphadenectomy in 254 patients with papillary thyroid microcarcinoma: a single-institution experience. // Ann Surg Oncol. 2009;16(4):920-928. doi: 10.1245/s10434-009-0332-9.
31.Costa S., Giugliano G., Santoro L., et al. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. // Acta Otorhinolaryngol Ital. 2009;29(2):61-69.
32.Roh J.L., Park J.Y., Park C.I. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. // Cancer. 2009;115(2):251-258. doi: 10.1002/cncr.24027.
33.Hughes D.T., White M.L., Miller B.S., et al. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. // Surgery. 2010;148(6):1100-1106; discussion 10061107. doi: 10.1016/j.surg.2010.09.019.
34.Moo T.A., McGill J., Allendorf J., et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. // World J Surg. 2010;34(6): 1187-1191. doi: 10.1007/s00268-010-0418-3.
35.Lang B.H., Yih P.C., Shek T.W., et al. Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma. // J Surg Oncol. 2012;106(8):966-971. doi: 10.1002/jso.23201.
36.Moreno M.A., Edeiken-Monroe B.S., Siegel E.R., et al. In papillary thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. // Thyroid. 2012;22(4):347-355. doi: 10.1089/thy.2011.0121.
37.Barczynski M., Konturek A., Stopa M., Nowak W. Prophylactic central neck dissection for papillary thyroid cancer. // Br J Surg. 2013;100(3):410-418. doi: 10.1002/bjs.8985.
38.Zetoune T., Keutgen X., Buitrago D., et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. // Ann Surg Oncol. 2010;17(12):3287-3293. doi: 10.1245/s10434-010-1137-6.
39.Yoo D., Ajmal .S, Gowda S., et al. Level VI lymph node dissection does not decrease radioiodine uptake in patients undergoing radioiodine ablation for differentiated thyroid cancer. // World J Surg. 2012;36(6):1255-1261. doi: 10.1007/s00268-012-1507-2.
40.Sawka A.M., Rilkoff H., Tsang R.W., et al. The rationale of patients with early-stage papillary thyroid cancer for accepting or rejecting radioactive iodine remnant ablation. // Thyroid. 2013; 23(2):246-247. doi: 10.1089/thy.2012.0422.
41.Durante C., Haddy N., Baudin E., et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. // J Clin EndocrinolMetab. 2006;91(8):2892-2899. doi: 10.1210/jc.2005-2838.
42.Henry J.F., Gramatica L., Denizot A., et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. // Langenbecks Arch Surg. 1998;383(2):167-169.
43.Pereira J.A., Jimeno J., Miquel J., et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. // Surgery. 2005;138(6):1095-1100, discussion 1100-1091. doi: 10.1016/j.surg.2005.09.013.
44.Bardet S., Malville E., Rame J.P., et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. // Eur J Endocrinol. 2008;158(4):551-560. doi: 10.1530/EJE-07-0603.
45.Rosenbaum M.A., McHenry C.R. Central neck dissection for papillary thyroid cancer. // Arch Otolaryngol Head Neck Surg. 2009;135(11):1092-1097. doi: 10.1001/archoto.2009.158.
46.Giordano D., Valcavi R., Thompson G.B., et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. // Thyroid. 2012;22(9):911-917. doi: 10.1089/thy.2012.0011.
47.Shen W.T., Ogawa L., Ruan D., et al. Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. // Arch Surg. 2010;145(3):272-275. doi: 10.1001/archsurg.2010.9.
48.Alvarado R., Sywak M.S., Delbridge L., Sidhu S.B. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: Is there added morbidity? //Surgery. 2009;145(5):514-518. doi: 10.1016/j.surg.2009.01.013.
49.White M.L., Gauger P.G., Doherty G.M. Central lymph node dissection in differentiated thyroid cancer. // World J Surg. 2007;31(5):895-904. doi: 10.1007/s00268-006-0907-6.
50.Rondeau G., Fish S., Hann L.E., et al. Ultrasonographically detected small thyroid bed nodules identified after total thyroidectomy for differentiated thyroid cancer seldom show clinically significant structural progression. // Thyroid. 2011;21(8):845-853. doi: 10.1089/thy.2011.0011.

Prophylactic central lymph nodes dissection (VI level) in papillary thyroid cancer

Metastatic involvement of central lymph nodes in patients with papillary thyroid cancer (PTC) is very common. However, prophylactic central lymph nodes dissection additionally to thyroidectomy does not significantly affect disease-free and overall survival of PTC patients. Meanwhile its routine conduction is tangibly increase postsurgical complications. From efficacy/safety point of view prophylactic central lymph nodes dissection couldn''t be recommended as substantiated in all PTC patients.

Keywords:
папиллярный рак щитовидной железы, профилактическая центральная лимфодиссекция, эффективность, осложнения, papillary thyroid cancer, prophylactic central neck dissection, efficacy, complications