François Pattou, Mohammed Ghunaim, Robert Caiazzo, Emmanuelle Leteurtre, Sébastien Aubert, Christine Docao, Adrien Sterkers, Yasser Ikkache, Fanelly Torres and Bruno Carnaille
University of Lille II School of Medicine, France
Posters-Accepted Abstracts: Surgery Curr Res
Introduction: The 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 benefit ratio of prophylactic lymphadenectomy has not been evaluated in 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 fine needle aspiration in an expert single center. The intervention consisted of a total thyroidectomy with or without a cervical lymph node dissection (removal of at least 6 nodes). The dissection was considered prophylactic in the absence of suspicious lymph nodes identified 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 (â?¥ 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%). The 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 significantly 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: During a thyroidectomy for suspicious nodule, prophylactic lymphadenectomy increases post-operative morbidity of 47% and lengthens hospitalization. Role of prophylactic lymph node dissection seems to be questionable when Bethesdaâ??s score is less than 5 regardless of tumor size.
François Pattou is the Chairman of General Surgery, Bariatric and Endocrine Surgery at the University Hospital of Lille, France. He is a Professor since 2004. He has published more than 50 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Email: dr.mg82@gmail.com
