MEDIASTINAL LYMPH-NODES METASTASES FROM D IFFERENTIATED THYROID-CARCINOMA - TREATMENT BY TOTAL MEDIASTINAL DISSECTION IN 9 CASES

Nine patients with mediastinal lymph node metastasis in differentiated thyroid carcinoma (7 papillary carcinomas, 1 Hurtle's cells carcinoma , 1 insular carcinoma) have been treated by systematic mediastina diss ection, 2 case arose 6 and 10 years after the initial surgery, 2 cases after 18 and 20 months, but 5 revealed their metastases at the moment of the diagnosis or 3 months later. Investigations caused by a rise i n thyroglobuline level (4 cases) necessarily involve a mediastinal CT scan, which always proved conclusive. All the patients underwent a med ian total sternotomy associated with a cervicotomy either for total th yroidectomy with conservative bilateral neck dissection, or for revisi on of the initial dissection. We describe the technique of mediastinal dissection allowing the resection of all the mediastinal lymph nodes. Mortality was zero and morbidity remained reasonable. 3 patients had recurrences : 2 died from multiple diffused metastases 18 months later , the third has pulmonary and mediastinal metastases well controled by radio-iodine and external radiotherapy with a 5 years follow-up. 6 ar e under total remission without sequel with a follow up ranging from 6 months to 8 years. Rather uncommon, total mediastinal dissection give s a long lasting remission with good living conditions to patients unr esponsive to other therapies.