Abstract
BackgroundIndication and extent of lateral prophylactic neck dissection (PLND) in papillary thyroid carcinoma (PTC) is very controversial.MethodsWe retrospectively analysed 131 patients who underwent thyroidectomy and prophylactic lateral neck dissection from level II to V for PTC.Results140 PLND were performed. The occult lymph node metastases (OLNM) overall rate was 18.6%. The incidence of node involvement was 10% at level III and 6.4% at level IIa. Level IV and level Vb were both concerned by 5.7% OLNM. Only 2.9% of level IIb contained OLNM. None of the level Va ND revealed OLNM.ConclusionsOLNM from PTC occurs commonly in level IIa, III, IV and Vb. Incidence in other levels is low. For surgeons that usually perform PLND, we believe that a selective neck dissection of levels IIa, III, IV and Vb in N0 neck PTC is sufficient for the clearance of occult metastases.
Highlights
Indication and extent of lateral prophylactic neck dissection (PLND) in papillary thyroid carcinoma (PTC) is very controversial
Extent and spread of lateral node metastasis in PTC we retrospectively reviewed data from patients in our institution treated with systematic prophylactic neck dissection
Lateral neck dissection was associated with a level VI full dissection in 37 cases (26%). 98 of the 140 PLND (70%) included a level Ib dissection
Summary
Indication and extent of lateral prophylactic neck dissection (PLND) in papillary thyroid carcinoma (PTC) is very controversial. The management of papillary thyroid carcinoma (PTC) with no clinical nodes remains controversial. Occult lymph node metastases (OLNM) occur in 21 to 90% of patients [1,2,3], but their role as a prognostic factor for recurrence or death has not been clearly established. The place for central and lateral neck dissection for tumours of more than 1cm in diameter, without clinical lymph node involvement remains controversial. The use of radioactive iodine has allowed successful non-operative management of low-volume cervical disease [4,5]. Many surgeons do not systematically perform prophylactic lateral neck
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