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10 - The evaluation of the localization and the extent of lymphathic dissection in central neck dissection
Evren Besler, Nurcihan Aygün, Müveddet Banu Yılmaz Özgüven, Sıtkı Gürkan Yetkin, Mehmet Mihmanlı, Adnan İşgör, Mehmet Uludağ
Objectives: The central neck dissection (CND) for thyroid cancer is applied prophylactically or therapeutically. Although its reported that minimum 8 lymph nodes should be resected in bilateral central dissection and minimum 4 in unilateral for proper staging, the extent of the applied central neck dissections are not clear yet. We aimed to evaluate the localizations and the number of the lymph nodes resected in central neck dissection in this study.
Material and Method: The number of the lymph nodes and their anatomical localisations of the patients whom underwent standard unilaterally or bilaterally central neck dissection in addition to total thyroidectomy for differentiated thyroid carcinoma by the same surgeon were evaluated. Chi-square and Fishers exact test were used for statistics.
Results: The mean age of 43 patients who underwent central neck dissection prophylactically or therapeutically for differentiated thyroid cancer was 45.7±15.1. Bilateral and unilateral central neck dissections were applied to 32 patients and 11 patients, respectively. The unilaterally resected number of lymph nodes was 9±6 (2-23), and bilaterally 14±6 (5-30), which was higher in the bilaterally dissected group (p<0.05). The number of prelaryngeal, pretracheal, right paratracheal and left paratracheal lymph nodes were 3±3, 2±3, 5±2, 5±4, respectively. The number of right paratracheal (p=0.001) and left paratracheal (p>0.01) lymph nodes were significantly higher than pretracheal. Additionally the number of right paratracheal lymph nodes was significantly higher (p=0.001) than prelaryngeal.
Conclusions: Although the average number of the resected lymph nodes was adequate and higher than the advised, it was seen that the number of resected lymph nodes was in a wide range, between 2-30. Although the 2/3 of the lymph nodes of the central neck area were located in the pretracheal region in cadaveric studies, the important part of the lymph nodes were in paratracheal region in the central neck dissection specimen. Central neck dissection should be applied according to anatomical borders of the regions and the lymph nodes of paratracheal region should not be excluded. Notably, the tissue behind the recurrent laryngeal nerve is important for the complete dissection of the right paratracheal area.
Keywords: Localization, lymph node, central neck dissection
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