Significance of Contralateral Central Lymph Node Dissection in Unilateral cN0 Differentiated Thyroid Carcinoma.
Significance of Contralateral Central Lymph Node Dissection in Unilateral cN0 Differentiated Thyroid Carcinoma.
There are so many contradictions over central lymph node dissection in unilateral
 cN0(Clinically N0) differentiated thyroid carcinoma.In order to provides a new theoretical
 basis for the operation of central lymph node in cN0(Clinically N0) differentiated thyroid
 cancer,researchers are going to complete this study to evaluate the significance of
 contralateral central lymph node dissection in unilateral cN0(Clinically N0) differentiated
 thyroid carcinoma.At the same time,it may play a certain impact on the revision of surgical
 guidelines for differentiated thyroid cancer.
Being the most common thyroid malignant tumor,differentiated thyroid carcinoma often
 metastasize to the neck lymph nodes in the early stage,especially to the central lymph
 node.For management of cervical lymph nodes ,the 2015 American Thyroid Association Management
 Guidelines suggest that thyroid+Prophylactic unilateral or bilateral central lymph node
 dissection should be undertaken in the patients with cN0(Clinically N0) progression (T3, T4)
 and cN1b(Clinically N1b).Chinese guidelines recommend that, in order to avoid operative
 complications as far as possible (i.e. effective protection of the parathyroid gland and
 recurrent laryngeal nerve), lymph node dissection in the central area on the same side of the
 lesion should be performed at least.However, in 2017, the second edition of National
 Comprehensive Cancer Network(NCCN) thyroid tumor guidelines believed that if lymph nodes in
 the central region were negative,preventive central region lymph node dissection was not
 recommended.In conclusion,there are so many contradictions over central lymph node dissection
 in unilateral cN0 differentiated thyroid carcinoma.However,we also can draw a conclusion that
 it may bring some benefits if bilateral central lymph node dissection were undertaken In some
 cases.According to researchers' preliminary clinical trials,it is not only that there is a
 great probability of metastasis in the ipsilateral central lymph nodes , contralateral
 metastasis is also possible,and even sometimes contralateral central lymph region metastas
 may occur without ipsilateral central lymph nodes metastasis.In order to provides a new
 theoretical basis for the operation of central lymph node in cN0 differentiated thyroid
 cancer,researchers are going to complete this study to evaluate the significance of
 contralateral central lymph node dissection in unilateral cN0 differentiated thyroid
 carcinoma.At the same time,it may play a certain impact on the revision of surgical
 guidelines for differentiated thyroid cancer.
Inclusion Criteria:

 -  Accurately diagnosing primary differentiated thyroid carcinoma according to
 pathological diagnostic criteria .

 -  Differentiated thyroid carcinoma with cN0(Clinically N0) was diagnosed by thyroid
 ultrasound text and/or neck CT,and was confirmed with differentiated thyroid
 carcinoma by postoperative pathological examination.

 -  The age is more than 18 years old and less than 65 years old. There is no gender
 restriction.

 -  Untreated patients who have not received surgery, interventional
 therapy,chemotherapy, biotherapy, and radiation therapy.

 -  Physical condition score of Eastern Cooperative Oncology Group（ECOG）: 0-2; no
 major organ dysfunction; oxygen partial pressure ≥ 10.64 kilopascal（kPa）; white
 blood cell count≥ 4 × 109/ L; hemoglobin≥ 9.5g/dL; neutrophil absolute count ≥
 1.5 × 109 / L; platelet count ≥ 100× 109 / L; total bilirubin ≤ 1.5 times of the
 upper limit of normal value;creatinine ≤ 1.25 times of the upper limit of normal
 value; and creatinine clearance ≥ 60ml / min.

 -  Be able to obtain complete follow-up information, understand the situation of
 this study and sign informed consent.

 Exclusion Criteria:

 -  • ①Bilateral DTC(differentiated thyroid cancer) patients ②Non-DTC(differentiated
 thyroid cancer)patients ③ Non-cn0(Clinically N0) patients ④ cN0(Clinically N0)
 patients but could not be operated on.

 -  Poorly controlled diabetics (fasting blood glucose levels > 200 mg/dL). In
 addition to four types of malignant tumors that can be treated with radical
 resection, such as cervical cancer in situ, basal or squamous cell skin cancer,
 (breast) ductal carcinoma in situ, and organ localized prostate cancer, suffering
 from any other malignant tumors within 5 years.• Breastfeeding and/or pregnant
 women.

 -  Patients with severe bleeding tendencies (prothrombin time less than 50%,cannot
 be corrected by treatment with vitamin K, etc.).

 -  Recent severe hemoptysis, severe cough, dyspnea or patients are not able to
 cooperate.

 -  People with severe emphysema, pulmonary congestion, and pulmonary heart disease.

 -  Researchers believe that the subject may not be able to complete this study or
 may not be able to comply with the requirements of this study (for management
 reasons or other reasons).