II trattamento delle metastasi linfonodali nel carcinoma ben differenziato e midollare della tiroide: Analisi retrospettiva di 52 casi

TObjective: To define the surgical principles of neck directions as applied to the head and neck squamous cell carcinomas, extending their rationale to treatment of lymph nodes metastases from thyroid carcinomas. Materials and methods: Between January 1994 and June 2002, 52 patients affected by well-differentiated thyroid cancers (1 follicular, 9 medullary, and 42 papillary cancers) underwent uni- or bilateral neck dissections at our Department, for a total of neck dissections. at our subdivided into 2 groups:37 simultaneously treated on the thyroid and the neck (Group A)and 15 operated elsewhere on the thyroid and for a neck recurrence and/or peisistcnce at our Department (Group B). Results: 48 patients underwent a regular follow-up (range: 3-86 months, mean: 38). Among patients alive with disease, 5 in (Group A and 4 in (Group B) had a local- regional recurrence. In particular, 2 patients for each group (2 medullary and 2 papillary cancers) had a regional 'recurrence on the N site, at the level of one or more lymph nodes "in field" as regards the neck dissection previously performed. Moreover, in al! these patients a local recurren-ce on the i site has been observed. Discussion: lymph nodes metastases have a minor prognostic impact in well-differenliated thyroid cancers in respect of the rest o f head ami neck cancers. Nonetheless, when performing a curative or elective neck direction, the gold standard surgical principles must be the same.As- a matter of fact, a 20% o incidence of lymph nodes metastascs at the V level often not specifically addrese neck dissections for thyroid cancels, it is noteworthy. Aim of sit eh an aggressive surgical approach of the neck is to obtain a low incidence of "in field" regional recurrences, which become no more amenable of a subsajueni siagical satvage Conclusion: Surgical techniques as lymphatleneclomy on "pick-berry procedure" must be abandoned because they do not respect the basic anatomic, physiopathologic. and onco logic principles of neck disunion, along cervical fasciac and spaces.