Video mediastinoscopy-assisted superior mediastinal dissection is relatively safe for the treatment of suspected mediastinal lymph node metastases of thyroid cancer, according to a new study published in BMC Surgery. The approach can help diagnose and treat the cancer and control its locoregional recurrences, the study found.

Mediastinal lymph node metastases occur in up to 48.1% of thyroid cancer cases, according to the literature. Surgical extirpation is the preferred method of treatment, when possible. Here, a team of researchers from China explored the potential of video mediastinoscopy-assisted superior mediastinal dissection to diagnose and treat thyroid carcinoma with mediastinal lymphadenopathy. The effectiveness of this approach had not been investigated previously.

The team led by Bin Zhang, MD, PhD, retrospectively reviewed the data of 19 patients with thyroid cancer with suspected mediastinal lymph node metastases who were treated with video mediastinoscopy-assisted mediastinal dissection between 2017 and 2020.


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Of these 19 patients, 14 had medullary thyroid carcinoma (MTC) and 5 had papillary thyroid carcinoma. In 9 of the 14 patients with MTC, superior mediastinal nodes were positive; this was also the case in 4 of the 5 patients with papillary thyroid carcinoma.

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Following the operations, no fatal bleeding occurred. Three patients had temporary recurrent laryngeal nerve palsy, 1 of them bilaterally. Moreover, 4 patients had temporary hypocalcemia, which required supplementation to treat. One patient had a chyle fistula. Another had a postoperative wound infection.

The molecular markers of the disease decreased in all patients after the operation. All but 1 remained disease-free over a median follow-up of 33 months.

“Video mediastinoscopy-assisted superior mediastinal dissection can be performed relatively safely in patients with suspicious [mediastinal lymph node metastases],” the researchers concluded. They added that further studies should be performed to determine the impact of mediastinal lymph node metastases on the long-term prognosis of thyroid cancer.

Reference

Song Y, Dai L, Xu G, et al. Video mediastinoscopy-assisted superior mediastinal dissection in the treatment of thyroid carcinoma with mediastinal lymphadenopathy: preliminary results. BMC Surg. 2021;21(1):329. doi:10.1186/s12893-021-01326-9