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Article: Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma

TitleImpact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma
Authors
KeywordsThyroglobulin
Ablation therapy
Cancer staging
Hypoparathyroidism
Major clinical study
Issue Date2012
PublisherSpringer New York LLC. The Journal's web site is located at http://www.annalssurgicaloncology.org
Citation
Annals of Surgical Oncology, 2012, v. 19 n. 1, p. 60-67 How to Cite?
AbstractBACKGROUND: Prophylactic central neck dissection (CND) remains controversial in papillary thyroid carcinoma (PTC). Because postsurgical stimulated thyroglobulin (sTg) level is a good surrogate for recurrence, the study aimed to evaluate the impact of prophylactic CND on preablative and postablative sTg levels after total thyroidectomy. METHODS: Of the 185 patients retrospectively analyzed, 82 (44.3%) underwent a total thyroidectomy and prophylactic CND (CND-positive group) while 103 (55.7%) underwent total thyroidectomy only (CND-negative group). All patients had no preoperative or intraoperative evidence of lymph node metastases. Clinicopathological characteristics, postoperative outcomes, and preablative and postablative sTg levels were compared between the two groups. Preablative sTg level was taken at the time of radioiodine ablation, while postablative sTg level was taken 6 months after ablation. A multivariable analysis was conducted to identify factors for preablative athyroglobulinemia (sTg<0.5 mug/L). RESULTS: Relative to the CND-negative group, the CND-positive group had larger tumors (15 mm vs. 10 mm, P < 0.005), more extrathyroidal extension (26.8% vs. 14.6%, P<0.003), more tumor, node, metastasis system stage III disease (32.9% vs. 9.7%, P < 0.001), and more temporary hypoparathyroidism (18.3% vs. 8.7%, P=0.017). Fourteen patients (17.1%) in the CND-positive group were upstaged from stages I/II to III as a result of prophylactic CND. The CND-positive group experienced lower median preablative sTg (<0.5 mug/L vs. 6.7 mug/L, P < 0.001) and a higher rate of preablative athyroglobulinemia (51.2% vs. 22.3%, P = 0.024), but these differences were not observed 6 months after ablation. Prophylactic CND was the only independent factor for preablative athyroglobulinemia. CONCLUSIONS: Although performing prophylactic CND in total thyroidectomy may offer a more complete initial tumor resection than total thyroidectomy alone by minimizing any residual microscopic disease, such a difference becomes less noticeable 6 months after ablation.
Persistent Identifierhttp://hdl.handle.net/10722/144923
ISSN
2015 Impact Factor: 3.655
2015 SCImago Journal Rankings: 1.902
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLang, BHHen_US
dc.contributor.authorWong, KPen_US
dc.contributor.authorWan, KYen_US
dc.contributor.authorLo, CYen_US
dc.date.accessioned2012-02-21T05:43:04Z-
dc.date.available2012-02-21T05:43:04Z-
dc.date.issued2012en_US
dc.identifier.citationAnnals of Surgical Oncology, 2012, v. 19 n. 1, p. 60-67en_US
dc.identifier.issn1068-9265en_US
dc.identifier.urihttp://hdl.handle.net/10722/144923-
dc.description.abstractBACKGROUND: Prophylactic central neck dissection (CND) remains controversial in papillary thyroid carcinoma (PTC). Because postsurgical stimulated thyroglobulin (sTg) level is a good surrogate for recurrence, the study aimed to evaluate the impact of prophylactic CND on preablative and postablative sTg levels after total thyroidectomy. METHODS: Of the 185 patients retrospectively analyzed, 82 (44.3%) underwent a total thyroidectomy and prophylactic CND (CND-positive group) while 103 (55.7%) underwent total thyroidectomy only (CND-negative group). All patients had no preoperative or intraoperative evidence of lymph node metastases. Clinicopathological characteristics, postoperative outcomes, and preablative and postablative sTg levels were compared between the two groups. Preablative sTg level was taken at the time of radioiodine ablation, while postablative sTg level was taken 6 months after ablation. A multivariable analysis was conducted to identify factors for preablative athyroglobulinemia (sTg<0.5 mug/L). RESULTS: Relative to the CND-negative group, the CND-positive group had larger tumors (15 mm vs. 10 mm, P < 0.005), more extrathyroidal extension (26.8% vs. 14.6%, P<0.003), more tumor, node, metastasis system stage III disease (32.9% vs. 9.7%, P < 0.001), and more temporary hypoparathyroidism (18.3% vs. 8.7%, P=0.017). Fourteen patients (17.1%) in the CND-positive group were upstaged from stages I/II to III as a result of prophylactic CND. The CND-positive group experienced lower median preablative sTg (<0.5 mug/L vs. 6.7 mug/L, P < 0.001) and a higher rate of preablative athyroglobulinemia (51.2% vs. 22.3%, P = 0.024), but these differences were not observed 6 months after ablation. Prophylactic CND was the only independent factor for preablative athyroglobulinemia. CONCLUSIONS: Although performing prophylactic CND in total thyroidectomy may offer a more complete initial tumor resection than total thyroidectomy alone by minimizing any residual microscopic disease, such a difference becomes less noticeable 6 months after ablation.en_US
dc.languageengen_US
dc.publisherSpringer New York LLC. The Journal's web site is located at http://www.annalssurgicaloncology.orgen_US
dc.relation.ispartofAnnals of Surgical Oncologyen_US
dc.rightsCreative Commons: Attribution 3.0 Hong Kong Licenseen_US
dc.rightsThe original publication is available at www.springerlink.comen_US
dc.subjectThyroglobulinen_US
dc.subjectAblation therapyen_US
dc.subjectCancer stagingen_US
dc.subjectHypoparathyroidismen_US
dc.subjectMajor clinical study-
dc.titleImpact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinomaen_US
dc.typeArticleen_US
dc.identifier.emailLang, BHH: blang@hkucc.hku.hk-
dc.identifier.emailLo, CY: cylo@hkucc.hku.hk-
dc.description.naturepublished_or_final_versionen_US
dc.identifier.doi10.1245/s10434-011-1833-xen_US
dc.identifier.pmid21681379-
dc.identifier.pmcidPMC3251780-
dc.identifier.scopuseid_2-s2.0-84856657053en_US
dc.identifier.hkuros187593-
dc.identifier.volume19en_US
dc.identifier.issue1en_US
dc.identifier.spage60en_US
dc.identifier.epage67en_US
dc.identifier.eissn1534-4681en_US
dc.identifier.isiWOS:000298852700012-
dc.publisher.placeUnited States-
dc.description.otherSpringer Open Choice, 21 Feb 2012en_US
dc.identifier.citeulike9434216-

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