Mohammed Ghunaim Francois Pattou,
University of Lille II School of Medicine, France
Title: Risks and benefi ts of prophylactic lymph node dissection during thyroidectomy for suspicious nodule
Biography
Biography: Mohammed Ghunaim Francois Pattou,
Abstract
Introduction: Th e FNA has become essential for the surgical management of thyroid nodule. When cytology indicates a possible malignancy, some teams combine a prophylactic thyroidectomy and lymphadenectomy. Up to date, the risk and benefi t ratio of prophylactic lymphadenectomy has not been evaluated particulary in case of uncertain diagnosis (Bethesda score=3/4). Materials & Methods: Retrospective study was conducted in 227 patients (179 women, 48 men) consecutive operated since July 2010 for a suspected thyroid nodule, isolated or dominant, and who had a preoperative ultrasound and fi ne needle aspiration in an expert single center. Th e intervention consisted of a total thyroidectomy with or without a cervical lymph node dissection (removal of at least 6 nodes). Th e dissection was considered prophylactic in the absence of suspicious lymph nodes identifi ed in the preoperative ultrasound. Results: FNA results were correlated by Bethesda pathological diagnosis of malignancy (B3: 23%, B4: 31%, B5: 73%, B6: 90%). Preoperative ultrasound found no adenopathy in 201 patients (88.6%), including 139 (69% ) underwent a prophylactic lymphadenectomy (≥6 nodes). In this case, the median number of lymph nodes removed was 14 (IQR=9 to 19). Lymph node involvement was found in 0/14 patients B3 (0%), 0/72 B4 patients (0%), 8/72 patients B5 (11%) and 10/42 patients B6 (24%). Th e overall rate of postoperative complications (hypocalcemia, laryngoscopy abnormal, cervical hematoma, surgical site infection) was 49% in cases of prophylactic dissection and 28% in the absence of dissection (p=0.001, Chi 2). Performing dissection signifi cantly increased length of hospital stay (1.5±1.0 vs. 2.2±2.0 days, p<0.001). In multivariate analysis, the implementation of prophylactic lymphadenectomy increased the risk of complications by 47% (OR 2.033, 95% CI: 1.003 to 4.118, p=0.049), regardless of tumor size (p=0.81). Conclusion: 1. During a thyroidectomy for suspicious nodule, prophylactic lymphadenectomy increases postoperative morbidity of 47% and lengthens hospitalization. 2. Role of prophylactic lymph node dissection seems to be questionable when Bethesda’s score is less than 5 regardless of tumor size.