J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 5099KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 81(11): 1387-1397, 1980

Original article

A PROPER GROUPING OF CERVICAL LYMPHNODES FOR NECK DISSECTION OF THYROID CANCER

1) The Department of Head and Neck Surgery
2) The Department of Pathology, Cancer Institute Hospital
3) The 1st Department of Surgery, The Jikei University School of Medicine

Nobukatsu Kasai1), Atsuhiko Sakamoto2), Masaoki Uchida1), Noboru Shinozaki3), Tetsu Watanuki3)

Using 61 cases with extensive sub-thyroidectomy and typical modified neck dissection, the rate of metastasis after surgical treatment of thyroid cancer was statistically examined to clarify a more proper grouping of the cervical lymphnodes for neck dissection.
The para-glandular nodes are locating on the netted out-side menbrane of the thyroid and the frequency of the metastasis is 27% of all cases. The pre- and para-tracheal nodes are enclosed by the common carotid arteries, the brachiocephalic vein and the thyroid and 75% of all have metastases. The jugular nodes are divided into three groups; namely upper-jugular, mid-jugular and low-jugular. The lymphnode metastasis father than the superior thyroid artery is rare, 30%. So the upper-jugula nodes should be excluded from the area inside of superior thyroid artery (the bifurication of carotid artery). The mid-jugular nodes are located between the superior thyroid artery and omohyoidal muscle and these are involved in 78% of the cases. The low-jugular nodes mean the area outside of the omohyoidal muscles and their metastases show 63 %. The posterior cervical nodes lie along the spinal accesary nerve, and the metastasis to this area is I5% in frequency. The pre-laryngeal, submaxila and submental nodes have rare metastases; 8%, 3% and 0%, respectively. Generally the paraesophagial nodes are thought to be a part of para-tracheal nodes. The metastasis to this area usually shows large and should be dealt independently. The antero-superior mediastinal nodes are present near the juxta-brachiocephalic artery and vein. As the cases with the metastases to these nodes are operable, the area has a reason of independency. The superficial nodes are located on the triangle of carotid artery and surperficial sternocleidomastoid muscle. The positive nodes of this area indicated the presence of deep cervical metastases.

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