Superior mediastinal dissection for papillary thyroid carcinoma: approaches and outcomes.

BACKGROUND

Superior mediastinal surgery for thyroid carcinoma is not a standardized procedure like the neck dissection. The objective of this study was to evaluate the effectiveness of superior mediastinal dissection for mediastinal metastasis of papillary thyroid carcinoma (PTC).

METHODS

We conducted a retrospective review of 119 patients who underwent superior mediastinal dissection for the treatment of PTC. The postoperative characteristics and follow-up data were analyzed. Cox regression was performed to identify the factors related to the mediastinal control.

RESULTS

No severe complications occurred in this series. The five-year local (mediastinum) disease-free survival rates of comprehensive (n = 29) and partial (n = 90) superior mediastinal dissection were 86.3 and 84.0%, respectively (log-rank = 0.562; p = 0.452). Different patterns of superior mediastinal dissection did not turn out to be related to mediastinal recurrence in the cox regression. Bilateral paratracheal metastasis was identified as an individual risk factor of mediastinal recurrence with a relative risk value of 4.635 (95% CI: 1.399-15.355; p = 0.012).

CONCLUSIONS

Both partial and comprehensive superior mediastinal dissections are effective and safe for the treatment of mediastinal metastasis of PTC if appropriately designed.