Abstract
The extent of lateral neck dissection (LND) in surgical resection of papillary thyroid carcinoma (PTC) with clinically lateral LNM (LLNM) remains controversial. We aimed to explore the frequency of and risk factors for level V LNM in patients with solitary PTC and clinically LLNM. To analyze the frequency and risk factors for level V LNM, we retrospectively reviewed 220 solitary PTC patients who underwent total thyroidectomy, bilateral central neck dissection, and therapeutic LND. LLNM were present in 82.3% patients, and levels II–V LNM were present in 45.9%, 62.7%, 55.5%, and 12.3% patients, respectively. Ipsilateral level V LNM was significantly associated with tumor size >10 mm, extrathyroidal extension, ipsilateral central LNM ratio ≥50%, and contralateral central LNM (CLNM), bilateral CLNM, and simultaneous levels II–IV LNM. Contralateral CLNM was an independent risk factor for level V LNM. In patients with solitary PTC and clinically LLNM, level V LNM was relatively uncommon. Therefore, routine level V lymphadenectomy may be unnecessary in these patients unless level V LNM is suspected on preoperative examination or associated risk factors, especially contralateral CLNM, are present.
Highlights
Cervical lymph node metastases (LNM) in papillary thyroid carcinoma (PTC), the most common histological type of thyroid cancer with an increasing worldwide incidence [1], are frequent and occur in approximately 30–80% patients [2, 3]
To determine a correlation that could define the rational extent of therapeutic lateral neck dissection (LND) in PTC, we aimed to explore the frequency of and the risk factors for level V LNM in solitary PTC patients with clinically lateral LNM (LLNM)
On the basis of the comparatively low frequency of level V LLNM in this study and the risk of postoperative complications, we propose that therapeutic LND should not routinely include level V lymphadenectomy except when level V LLNM is suspected on the basis of preoperative examination, such as US and computed tomography (CT), or there are associated risk factors
Summary
Cervical lymph node metastases (LNM) in papillary thyroid carcinoma (PTC), the most common histological type of thyroid cancer with an increasing worldwide incidence [1], are frequent and occur in approximately 30–80% patients [2, 3]. There is universal agreement that therapeutic lateral neck dissection (LND) should be undertaken in patients with PTC and clinically lateral LNM (LLNM) on the basis of palpation or imaging examination [11, 12]. Determining the appropriate extent of LND remains controversial. Radical operations, such as those with increased extent of LND, may lead to clinically important postoperative morbidities (shoulder dysfunction, neck numbness, and neuropathic pain) because of injury to the spinal accessory nerve or the cervical plexus despite gross preservation of these nerves [13,14,15]. An oncologically effective therapeutic LND is critical to postoperative outcome
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
