SURGICAL PROCEDURE AND RESULTS OF THYROID CANCER PATIENTS WITH MEDIASTINAL LYMPH NODE METASTASIS

Abstract

There have been few comprehensive studies on the treatment and results of thyroid cancer patients with mediastinal lymph node metastasis because of its rarity. Total median sternotomy is generally adopted for mediastinal lymph node dissection, however, L-shaped, reversed L-shaped, or reversed T-shaped sternotomy can be used in these patients for minimally invasive surgery. We report our modification of the reversed T-shaped sternotomy. Our modification involves shifting the transverse division lines one costal space between the right and left sides for perfect apposition of the divided upper and lower sternum. Recently, we have tried upper mediastinal lymph node dissection in selected cases through the cervical approach. Even though mediastinal lymph node metastasis was removed by these procedures, the prognosis of patients with mediastinal lymph node metastasis is poorer than those without its metastasis because of distant metastasis.