[Results of surgical treatment of papillary thyroid cancer with lymph node metastasis - review of our data in a 5-year period].

Papillary thyroid cancer carries an excellent prognosis. Although long-term survival rates are high, regional lymph node metastases are common. Surgical management of thyroid cancer and cervical lymph nodes are ready to define the survival. This article focuses on observational data of metastatic papillary thyroid cancer patients operated in the Head and Neck Multidisciplinary Cancer Center of the National Institute of Oncology between 2013 and 2018. In the National Institute of Oncology, consecutive series of 130 metastatic papillary thyroid cancer patients were treated by the two authors between 2013 and 2018. Thyroidectomy and central neck dissection (level VI) were performed in every case with/without lateral neck dissection (level II–V) according to the ATA (American Thyroid Association) 2015 guidelines. All excised specimens were examined by experienced pathologists. We evaluated the influence of age, gender, tumor multifocality, bilaterality, capsular, vascular, lymphatic invasion on lymph node metastasis. We also analyzed the postoperative complications. 43 patients out of 130 underwent total thyroidectomy with only central lymph node dissection, 87 had dissection on both lateral (level II–V) and central (level VI) lymph nodes. Transient hypocalcemia occurred in 30 patients (23%), permanent hypocalcemia occurred in 4 patients (3%). Transient recurrent laryngeal nerve palsy was diagnosed in 12 (9.2%), permanent in 3 (2.3%) cases. Pathologists revealed vascular and capsular invasion in 75 cases (57.7%). Lymphatic invasion occurred in 63 cases (48.5%), Hashimoto thyroiditis was found in 51 cases (39.2%). Microcarcinoma (tumor size smaller than 1 cm) occurred in 43 cases (33%). 48% of the dissected lymph nodes were metastatic. This was associated only with the size of the primary tumor, but did not correlate with the age. Associations between lymph node metastasis and multifocality, capsular, lymphatic, vascular invasion, Hashimoto thyroiditis or gender were not statistically significant. Survival rate was correlated with capsular, vascular and lymphatic invasion, and also with the tumor size. Total thyroidectomy and adequate lymph node dissection are the key points in the therapy. With completion radioiodine treatment, this is the optimal oncological procedure. Thyroid cancer is the most common endocrine tumor. Adequate surgical intervention is the most important factor of the multidisciplinary therapy. The authors review their 5-year experiences with metastatic papillary thyroid cancer patients. Orv Hetil. 2024; 165(3): 83–88.