Surgical Management of Retropharyngeal Nodes Metastases from Papillary Thyroid Carcinoma

• Published in: World journal of surgery Vol. 38; no. 11; pp. 2831 - 2837
• Main Authors: Togashi, Takafumi, Sugitani, Iwao, Toda, Kazuhisa, Kawabata, Kazuyoshi, Takahashi, Sugata
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.11.2014; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Bilateral Neck Dissection; Carcinoma - pathology; Carcinoma - surgery; Carcinoma, Papillary; Cardiac Surgery; Disease-Free Survival; Female; General Surgery; Humans; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neck Dissection; Neck Dissection - adverse effects; Neck Dissection - methods; Neoplasm Recurrence, Local; Original Scientific Report; Papillary Thyroid Carcinoma; Pharynx; Retropharyngeal Space; Retrospective Studies; Surgery; Thoracic Surgery; Thyroid Cancer, Papillary; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Transoral Approach; Vascular Surgery; Young Adult; Papillary Thyroid Carcinoma; Bilateral Neck Dissection; Retropharyngeal Space; Neck Dissection; Transoral Approach
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-014-2707-8

Background Papillary thyroid carcinoma (PTC) often metastasizes to the central and lateral neck lymph nodes, but rarely affects retropharyngeal nodes (RPN). Methods We retrospectively reviewed 12 patients (three men, nine women) with PTC who underwent dissection of RPN metastases between 1994 and 2012. Mean age at dissection was 65 years (range 23–77). Results Dissection was performed with the initial surgery for PTC in eight patients, while the remaining four patients underwent dissection as secondary surgery. RPN metastases arose from an ipsilateral primary in nine patients, bilateral in two, and contralateral in one, with primaries located at the superior pole of the thyroid lobe in nine patients. All patients showed simultaneous or previous lymph node metastases in the upper jugular chain. A transcervical approach was applied for RPN dissection in 11 patients, while a transcervical-transparotid approach was applied in the remaining patient. No patients needed mandibulotomy or showed severe complications. Median duration of follow-up after RPN dissection was 48 months (range 3–206). No recurrences in the retropharyngeal space were identified. Two patients died of the disease, one died from other carcinoma, and five survived with distant metastases from PTC. The remaining four patients remain free of the disease as at the time of writing. Conclusions If lymph node metastases are identified in the upper jugular chain, the possibility of RPN metastases should be checked. Most RPN metastases from PTC can be dissected safely without mandibulotomy. In particular, low-risk patients can expect favorable outcomes.