Operative indication and method for mediastinal lymph node metastasis of papillary thyroid carcinoma

—an approach by L-shaped partial sternotomy

Abstract

Papillary thyroid carcinoma is in general considered to have a good prognosis. But mediastinal lymph node metastasis causes esophageal stenosis and airway obstruction unless it is carefully observed for a long period. Therefore, mediastinal lymph node dissection is sometimes in the operative indication, even if there is distant metastasis to the lung or bones. Although it is important to evaluate the patient's age, general condition and extent of tumor invasion in the planning for mediastinal dissection, L- shaped partial sternotomy is convenient when the airway and upper digestive tract are also preserved. Because this operative method is thought to be safe and not so difficult and has few demerits, such as restriction of lateral arm extension on the affected side three months after the operation, we advocate this method to head and neck physicians to treat mediastinal lymph node metastasis with papillary thyroid cancer.