文章：

甲状腺癌伴侧颈淋巴结转移的手术时机：延迟性与同期侧颈淋巴结清扫术对比

Surgical Timing in Thyroid Cancer with Lateral Neck Metastases: Delayed Versus Contemporary Lateral Neck Dissection

原文发布日期：14 August 2025

DOI: 10.3390/cancers17162649

类型: Article

开放获取: 是

英文摘要：

Backgrounds.Lateral neck dissection (LND) is standard for thyroid cancer patients with neck metastases, mostly performed at the same time as total thyroidectomy (cLND). We introduced a new delayed LND (dLND), 4 weeks after thyroidectomy to reduce surgical morbidity. This study aims to compare the oncologic/complication outcomes between the two strategies, based on a large retrospective cohort of patients.Methods.Between 1996 and 2024, 215 patients were treated with total thyroidectomy, central neck dissection (CND) and LND, and grouped by surgical strategy (cLND vs. dLND); survival/complication outcomes were analyzed and compared between the two groups.Results.The overall and disease-free survival were comparable between groups. Age, extracapsular extension, and nodal burden predicted recurrence. dLND was associated with a significantly lower risk of vocal fold palsy. Extranodal extension (ECE) strongly predicted nerve injury.Conclusions.dLND offers similar oncologic outcomes to cLND, with reduced risk of vocal fold palsy. A staged approach enhances nerve preservation and might be considered in treatment planning.

摘要翻译： 

背景。对于伴有颈部转移的甲状腺癌患者，侧颈淋巴结清扫术（LND）是标准治疗方式，通常与全甲状腺切除术同期进行（同期LND）。为降低手术并发症发生率，我们引入了一种新的延迟性LND方案（dLND），即在甲状腺切除术后4周进行。本研究基于大型回顾性患者队列，旨在比较两种策略的肿瘤学结果与并发症发生情况。 方法。1996年至2024年间，共有215例患者接受全甲状腺切除术、中央区颈淋巴结清扫术（CND）及LND治疗，按手术策略分为两组（同期LND组 vs. 延迟LND组）；对两组的生存情况及并发症结果进行分析比较。 结果。两组的总生存率和无病生存率相当。年龄、包膜外侵犯及淋巴结负荷是预测复发的因素。延迟LND与显著降低的声带麻痹风险相关。淋巴结外侵犯（ECE）是神经损伤的强预测因子。 结论。延迟LND在肿瘤学结果上与同期LND相当，且能降低声带麻痹风险。分阶段手术方案有助于提高神经保护率，值得在治疗规划中予以考虑。

原文链接：

Surgical Timing in Thyroid Cancer with Lateral Neck Metastases: Delayed Versus Contemporary Lateral Neck Dissection