tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2024-14-1-39-46tumors-1292Research ArticleСОБСТВЕННЫЕ ИССЛЕДОВАНИЯ. ВОПРОСЫ ОНКОХИРУРГИИOWN RESEARCH. ONCOSURGERY ISSUESПрофилактическая центральная шейная лимфодиссекция как этап в лечении папиллярного рака щитовидной железыPreventive central neck lymph node dissection as a stage in the treatment of papillary thyroid cancerhttps://orcid.org/0000-0002-0855-6527ТигровМ. С.TigrovМ. S.

Тигров Михаил Сергеевич

111123 Москва, Новогиреевская ул., 1, корп. 1

Tigrov Mikhail Sergeevich

Build. 1, 1 Novogireevskaya St., Moscow 111123

tigrov.92@mail.ruЯковлеваЛ. П.YakovlevaL. P.

Яковлева Лилия Павловна

111123 Москва, Новогиреевская ул., 1, корп. 1

Yakovleva Liliya Pavlovna

Build. 1, 1 Novogireevskaya St., Moscow 111123

https://orcid.org/0000-0002-9132-3416КропотовМ. А.KropotovМ. А.

Кропотов Михаил Алексеевич

15478 Москва, Каширское шоссе, 23

Kropotov Mikhail Alekseevich

23 Kashirskoe Shosse, Moscow 115478

https://orcid.org/0000-0002-4706-0276МеньшиковаС. С.MenshikovaS. S.

Меньшикова Светлана Сергеевна

111123 Москва, Новогиреевская ул., 1, корп. 1

Menshikova Svetlana Sergeevna

Build. 1, 1 Novogireevskaya St., Moscow 111123

ГБУЗ г. Москвы «Московский клинический научно-практический центр им. А.С. Логинова Департамента здравоохранения г. Москвы»РоссияA. S. Loginov Moscow Clinical Scientific Center, Moscow Healthcare DepartmentRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава РоссииРоссияN. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaRussian Federation2024150320241413946Copyright © Тигров М.С., Яковлева Л.П., Кропотов М.А., Меньшикова С.С., 20242024Тигров М.С., Яковлева Л.П., Кропотов М.А., Меньшикова С.С.Tigrov М.S., Yakovleva L.P., Kropotov М.А., Menshikova S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/1292Актуальность

Актуальность: Вопрос о необходимости выполнения профилактической центральной шейной лимфодиссекции в лечении локализованных форм высокодифференцированного рака щитовидной железы остается открытым, так как дооперационное обследование не всегда позволяет достоверно определить наличие поражения регионарного лимфоколлектора VI группы.

Цель

Цель: Оценка частоты поражения центрального лимфатического коллектора шеи при клиническом N0–Nx по результатам морфологического исследования после выполнения превентивной центральной шейной лимфодиссекции.

Материалы и методы

Материалы и методы: Пациенты оперированы в период с 2016–2022 гг. по поводу папиллярного рака щитовидной железы — сТ1–2N0–x. Соотношение мужчин и женщин — 11,5% (n = 34) и 88,5% (n = 261) соответственно. Из них в возрасте менее 55 лет — 40,7% (n = 120), более 55 лет — 59,3% (n = 175). Всем пациентам выполнено хирургическое лечение в объеме тиреоидэктомии или гемитиреоидэктомии с центральной шейной лимфодиссекцией.

Результаты

Результаты: В исследование включено 295 пациентов: сT1–247 (83,7%) и сT2–48 (16,3%). По результатам морфологического исследования у части пациентов отмечено изменение стадии опухолевого процесса: стадия pT1 установлена в 80,3% (n = 237), рТ2 — в 9,2% (n = 27), рТ3 — в 10,5% (n = 31). У 77 (26,1%) из 295 больных выявлены метастазы в лимфатических узлах центральной клетчатки шеи. Отмечена корреляция частоты метастазирования с размером первичной опухоли, соответствующей рТ1 в 22,8% случаев (n = 54), рТ2 — в 33,3% (n = 9), рТ3 — 45,2% (n = 14). Транзиторная гипокальциемия была выявлена у 32% пациентов при рТ1, 69% — при рТ2 и у 84% — при рТ3. У двух пациентов был отмечен односторонний транзиторный парез гортани.

Выводы

Выводы: Проведенный анализ позволяет сказать, что выполнение профилактической центральной шейной лимфодиссекции при высокодифференцированном раке щитовидной железы является необходимым компонентом хирургического лечения, позволяющим повысить радикальность лечения с последующим снижением риска прогрессирования основного заболевания вследствие уточненного стадирования заболевания. В ходе исследования у 77 (26,1%) из 295 пациентов выявлены метастазы в лимфатических узлах центральной клетчатки шеи. Отмечена корреляция частоты метастазирования с размером первичной опухоли, а также зависимость количества пораженных лимфатических узлов от распространенности первичной опухоли. Частота послеоперационных осложнений, влияющих на качество жизни пациентов, приемлема. В период лечения отмечено 0,67% парезов гортани и 39% гипокальциемий легкой степени тяжести.

Relevance

Relevance: The need of prophylactic cervical lymph node dissection for the detection of low grade thyroid cancer remains debatable since preoperative examination does not always allow determining the involvement of a group VI regional lymph collector.

Objective

Objective: to evaluate the frequency of group VI nodes involvement with clinical N0–Nx based on the results of a morphological examination after performing a preventive central neck lymph node dissection.

Materials and methods

Materials and methods: the study included 295 patients who underwent surgery from 2016 to 2022 for papillary thyroid cancer with cT1–T2, N0–Nx. There were 11.5 % of men included (n = 34) and 88.5 % of women (n = 261). Of these, 40.7 % (n = 120) were less than 55 years old. All patients underwent surgical treatment which included thyroidectomy or hemithyroidectomy with cervical lymph node dissection.

Results

Results: The study included 295 patients with cT1 — 247 (83.7 %) and cT2 — 48 (16.3 %). Pathomorphological examination changed the T index in some patients: pT1 was found in 80.3 % of cases (n = 237); рТ2 — in 9.2 % (n = 27); рТ3 — in 10.5 % (n = 31). Central neck lymph nodes involvement was detected in 77 (26.1 %) out of 295 patients. There was a correlation between the frequency of metastases detection and the size of the primary tumor: 22.8 % (n = 54) of metastases with pT1, 33.3 % (n = 9) with pT2, and 45.2 % (n = 14) with pT3. Transient hypocalcemia was found in 32 % of patients with pT1, 69 % with pT2, and 84 % with pT3. Two patients had unilateral transient paresis of the larynx.

Conclusions

Conclusions: Our analysis demonstrates that the preventive central neck lymph node dissection in patients with low grade thyroid cancer is an important component of surgical treatment, which allows to improve the treatment results with a possible subsequent reduction in the risk of distant progression. In this study 77 (26.1 %) of 295 patients had metastases in the lymph nodes of the central neck. The number of postoperative complications affecting the quality of life of patients was acceptable with 0.67 % of paresis of the larynx and 39 % of mild hypocalcemia.

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The authors declare that there are no conflicts of interest present.