Risk factors and indication for dissection of right paraesophageal lymph node metastasis in papillary thyroid carcinoma

BackgroundRight paraesophageal lymph nodes (RPELNs) are located behind right recurrent laryngeal nerve which often ignored in central compartment lymph nodes (LNs) dissection of papillary thyroid carcinoma (PTC) patients. The aim of this study was to identify the risk factors for RPELN metastasis and indications for RPELN dissection.MethodsMedical record of 246 consecutive PTC patients (194 female, 52 male), who underwent total thyroidectomy (244 patients) or right lobectomy (2 patients) with central compartment LN dissection (13 ipsilateral and 233 bilateral), were reviewed. The RPELNs were kept separately during the operation. The clinical pathology data was collected and analyzed.ResultsRPELN metastasis was confirmed in 33 patients (13.4%) and were discovered in 18.5% (31/168) of right lesion, 34.4% (31/90) of right central group LN (rCLN) metastasis, 33.3% (18/54) of lateral compartment LN (LLN) metastasis, 25.7% (9/35) of local recurrent patients respectively. The ultrasound suspected metastatic LNs, tumor diameter, tumor number, tumor location, and numbers of metastatic Delphian LNs, central group LNs (CLNs), rCLNs, and LLNs between patients with and without RPELN metastasis showed significant differences in univariate analysis (P < 0.05). In multivariate analysis, number of metastatic rCLNs (1–2: OR 13.6, 95% CI, 2.7–67.5; ≧3: OR39.4, 95% CI, 7.7–200.9), right side tumor (OR 6.4, 95% CI, 1.1–35.6), and three or more metastatic LLNs (OR 3.5, 95% CI, 1.2–10.2) were independent risk factors for RPELN metastasis.ConclusionsPTC patients with right lobe lesions, especially with potential rCLN metastasis, are at considerable risk of RPELN metastasis. RPELN dissection should be considered in these patients.