Papillary carcinoma of the thyroid. II. Value of prophylactic lymph node excision.

Abstract

Among 57 patients with papillary adenocarcinoma of the thyroid who underwent systematic excision of lymph nodes from January 1967 to July 1968, 90% were shown to have evidence of metastasis. the majority of metastatic deposits were small, i.e., 57% measured less than 3 mm in diameter. of the patients operated on before 1962, 39% revealed metastases before or during surgery; thus, a majority of small metastatic tumors might have been overlooked. Among those patients operated on before 1962 and judged not to have metastasis and who did not undergo lymph node excision, 83% are assumed to have undiagnosed metastasis. Survival without recurrence in those patients considered free from metastasis was as high as 77% after 15 years. Survival without recurrence in patients with diagnosed metastasis who received individual-not systematic and not en bloc-lymph node excision was 43% after 10 years. in those patients in whom metastatic deposits were microscopic, no malignant biologic effect has been demonstrable. in those patients in whom gross nodal involvement was present, small metastatic tumors did not regress after removal of both primary tumor and affected nodes, but enlarged and caused recurrence. Systematic excision of regional lymph nodes appears of less importance in cases with no gross nodal involvement at time of surgery. Radical excision is required, however, in cases with gross involvement.