When thyroid cancer undergoes the process of metastasizing, the lymph nodes in the neck may be affected. However, these lymph node tumors can be very small and undetectable by ultrasound tests done prior to thyroid removal surgery – or even during the surgery itself.
Published in a recent issue of the journal Surgery, UCLA researchers demonstrate that removal of neck lymph nodes during the early stages of thyroid surgery for papillary cancer may reduce recurrence rates and lower levels of thyroglobulin. This compound is a thyroid tumor marker that is often an indicator for the presence of thyroid cancer when its levels are raised.
During the study, scientists from UCLA examined data from 606 patients who had received treatment in one of three surgical groups in the U.S., England, and Australia. Patients were then separated into two groups of interest: Group A patients underwent only total thyroid removal and Group B patients had undergone both thyroid removal and dissection of neck lymph nodes. Patients were then observed for a follow up period of three-and-a-half years after surgery.
Researchers discovered the disease recurrence rate amongst the study population to be 6.9 percent. It was discovered that the need for central neck re-operation was greatly reduced for patients who had undergone the routine initial central neck lymph-node dissection (1.5 percent), compared with those who had undergone only thyroid removal (6.1 percent).
Stimulated thyroglobulin levels were also found to be lower among Group B patients, potentially demonstrating a more thorough excision of the disease in patients who had received both thyroid and neck lymph-node removal procedures, the researchers said.
According to Dr. Mark Sywak of the University of Sydney in Australia, “This significant reduction in the need for further surgery in the critical central area of the neck is important since it reduces risk to the many vital structures housed here, such as the nerves supplying the voice.”
According to the researchers, the next step could be to conduct a prospective, randomized clinical trial to further determine the effect of routinely removing central neck lymph nodes during initial surgery for papillary thyroid cancer.