World Journal of Surgery

, Volume 31, Issue 11, pp 2085–2091 | Cite as

Risk Factors for Recurrence to the Lymph Node in Papillary Thyroid Carcinoma Patients without Preoperatively Detectable Lateral Node Metastasis: Validity of Prophylactic Modified Radical Neck Dissection

  • Yasuhiro Ito
  • Takuya Higashiyama
  • Yuuki Takamura
  • Akihiro Miya
  • Kaoru Kobayashi
  • Fumio Matsuzuka
  • Kanji Kuma
  • Akira Miyauchi



Although papillary carcinoma usually shows mild characteristics, it metastasizes and shows recurrence to the lymph node in high incidences. Of the two representative lymph node compartments to which papillary carcinoma metastasizes, the central compartment can be routinely dissected via the surgical incision made for thyroidectomy. However, the routine application of prophylactic lateral node dissection (modified radical neck dissection [MND]) remains controversial. In this study, we investigated risk factors for lymph node recurrence of papillary carcinoma to determine the appropriate application of prophylactic MND.


We investigated risk factors for lymph node recurrence in 1,231 patients without preoperatively detectable lateral node metastasis who underwent thyroidectomy, central node dissection, and prophylactic MND for papillary carcinoma between 1987 and 1995.


The incidence of lateral node metastasis and the number of metastatic lateral nodes significantly increased with carcinoma size. The lymph node disease-free survival (LN-DFS) was also significantly worse in carcinoma with a maximal diameter greater than 3 cm. Massive extrathyroid extension, male gender, and age 55 years or older also reflected a poorer LN-DFS. The 10-year LN-DFS rates of patients with carcinoma having two and three or four of these features were low at 88.5% and 64.7%, respectively, although the rates of those with carcinoma having no or only one characteristic were better than 95%.


Prophylactic MND is recommended for cases of papillary carcinoma demonstrating two or more of the following four characteristics; male gender, age 55 years or older, maximal tumor diameter larger than 3 cm, and massive extrathyroid extension.


Papillary Carcinoma Lateral Node Radical Neck Dissection Maximal Tumor Diameter Lateral Node Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Noguchi S, Noguchi A, Murakami N (1970) Papillary carcinoma of the thyroid. I. Developing pattern of metastasis. Cancer 26:1053–1060PubMedCrossRefGoogle Scholar
  2. 2.
    Ito Y, Miyauchi A, Jikuzono T, et al. (2007) Risk factors contributing to a poor prognosis of papillary thyroid carcinoma; validity of UICC/AJCC TNM classification and stage grouping. World J Surg 31:838–848PubMedCrossRefGoogle Scholar
  3. 3.
    Kouvaraki MA, Shapiro SE, Bruno MS, et al. (2003) Role of preoperative ultraosonography in the surgical management of patients with thyroid cancer. Surgery 134:946–955 PubMedCrossRefGoogle Scholar
  4. 4.
    Stulak JM, Grant CS, Farley DR, et al. (2006) Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid carcinoma. Arch Surg 141:489–496PubMedCrossRefGoogle Scholar
  5. 5.
    Dralle H, Gimm O (1996) Lymphadenektomie beim schilddrusencarcinom. Chirurg 67:788–806 (in German)PubMedCrossRefGoogle Scholar
  6. 6.
    Martenson H, Terins J (1985) Recurrent laryngeal nerve palsy in thyroid gland surgery related to operations and nerves at risk. Arch Surg 120:475–482Google Scholar
  7. 7.
    Scheumann GF, Seeliger H, Musholt TF, et al. (1996) Completion thyroidectomy in 131 patients with differentiated thyroid carcinoma. Eur J Surg 162:677–684PubMedGoogle Scholar
  8. 8.
    McConahey WM, Hay ID, Woolner LB, et al. (1986) Papillary thyroid cancer treated at Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy and outcome. Mayo Clin Proc 61:978–996PubMedGoogle Scholar
  9. 9.
    DeGroot LJ, Kaplan EL, McCormick M, et al. (1990) Natural history, treatment, and course of papillary thyroid carcinomas. J Clin Endocrinol Metab 71:414–424PubMedCrossRefGoogle Scholar
  10. 10.
    Mazzaferri EL, Young RL (1981) Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 70:511–518PubMedCrossRefGoogle Scholar
  11. 11.
    Cunningham MP, Duda RB, Recant W, et al. (1990) Survival discriminants for differentiated thyroid cancer. Am J Surg 160:344–347PubMedCrossRefGoogle Scholar
  12. 12.
    Bacourt F, Asselain B, Savoie JC, et al. (1986) Multivariate study of prognostic factors in differentiated thyroid carcinoma and re-evaluation of the important of age. Br J Surg 73:274–277PubMedCrossRefGoogle Scholar
  13. 13.
    Grabe SKG, Hay ID (1996) Thyroid cancer nodal metastasis. Surg Oncol Clin North Am 5:43–63Google Scholar
  14. 14.
    Sellers M, Beenken S, Blankenship A, et al. (1992) Prognostic significance of cervical lymph node metastases in differentiated thyroid cancer. Am J Surg 164:578–581PubMedCrossRefGoogle Scholar
  15. 15.
    Franssila KO (1975) Prognosis in thyroid carcinoma. Cancer 36:1138–1146PubMedCrossRefGoogle Scholar
  16. 16.
    Lungdren CI, Hall P, Dickman PW, et al. (2006) Clinically significant prognostic factors for differentiated thyroid carcinoma. A population-based, nested case-control study. Cancer 106:524–531CrossRefGoogle Scholar
  17. 17.
    Simon D, Goretzki PE, Witte J, et al. (1996) Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 20:860–866PubMedCrossRefGoogle Scholar
  18. 18.
    Noguchi S, Murakami N, Yamashita H, et al. (1998) Papillary thyroid carcinoma. Modified radical neck dissection improves prognosis. Arch Surg 133:276–280PubMedCrossRefGoogle Scholar
  19. 19.
    Sakamoto A, Kasai N, Sugano H (1983) Poorly differentiated carcinoma of the thyroid. A clinicopathologic entity for a high-risk group of papillary and follicular carcinomas. Cancer 52:1849–1855PubMedCrossRefGoogle Scholar
  20. 20.
    DeLellis RA, Lloyd RV, Heitz PU, et al. (2004) WHO Classification of Tumours, Pathology and Genetics of Tumours of Endocrine Organs. IARC Press, Lyon, France, pp 73–76Google Scholar
  21. 21.
    Sobin LH, Wittekind Ch (2002) eds. UICC; TNM classification of malignant tumors, 6th Edition. New York, Wiley-LissGoogle Scholar
  22. 22.
    Antonelli A, Miccoli P, Ferdeghini M, et al. (1995) Role of neck ultrsonography in follow-up of patients operated on for different thyroid cancer. Thyroid 5:25–29PubMedCrossRefGoogle Scholar
  23. 23.
    Uruno T, Miyauchi A, Shimizu K, et al. (2005) Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg 29:493–495Google Scholar
  24. 24.
    Miyauchi A, Matsusaka K, Kihara M, et al. (1998) The role of ansa-to-recurrent-laryngeal nerve anastomosis in operations for thyroid cancer. Eur J Surg 164:927–933PubMedCrossRefGoogle Scholar
  25. 25.
    Miyauchi A, Yokozawa T, Kobayashi K, et al. (2001) Opposite ansa cervicalis to recurrent laryngeal nerve anastomosis to restore phonation in patients with advanced thyroid cancer. Eur J Surg 167:540–541PubMedCrossRefGoogle Scholar
  26. 26.
    Mazzaferri EL, Young RL, Oertel JE, et al. (1977) Papillary thyroid carcinoma: the impact of therapy in 576 patients. Medicine 56:171–195PubMedCrossRefGoogle Scholar
  27. 27.
    Ito Y, Tomoda C, Uruno T, et al. (2004) Papillary microcarcinoma of the thyroid: how should it be treated? World J Surg 28:1115–1121PubMedCrossRefGoogle Scholar
  28. 28.
    Ito Y, Miyauchi A. Lateral and mediastinal lymph node dissection in differentiated thyroid carcinoma: indications, benefits and risks. World J Surg 31:905–915Google Scholar
  29. 29.
    Ito Y, Tomoda C, Uruno T, et al. (2004) Preoperative ultrasonographic examination for lymph node metastasis is useful when designing lymph node dissection for papillary microcarcinoma. World J Surg 28:498–501PubMedCrossRefGoogle Scholar
  30. 30.
    Simon D, Goretzki PE, Witte J, et al. (1996) Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 20:860–866PubMedCrossRefGoogle Scholar
  31. 31.
    Kaupferman ME, Patterson DM, Mandel SJ, et al. (2004) Safety of modified radical neck dissection for differentiated thyroid carcinoma. Laryngoscope 114:403–406CrossRefGoogle Scholar
  32. 32.
    Ito Y, Tomoda C, Uruno T, et al. (2006) Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 30:780–786PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Yasuhiro Ito
    • 1
  • Takuya Higashiyama
    • 1
  • Yuuki Takamura
    • 1
  • Akihiro Miya
    • 1
  • Kaoru Kobayashi
    • 1
  • Fumio Matsuzuka
    • 1
  • Kanji Kuma
    • 1
  • Akira Miyauchi
    • 1
  1. 1.Department of SurgeryKuma HospitalKobe CityJapan

Personalised recommendations