Neck Dissection Research Articles (Page 1)

Background: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine malignancy accounting for 1-5% of thyroid cancers. While often presenting with cervical lymphadenopathy, distant metastasis to bone and soft tissue mimicking a primary sarcoma is exceptionally rare. This report details a case of MTC where the primary diagnostic challenge was a massive, destructive shoulder mass. Case presentation: A 58-year-old woman presented with a disabling, 20 cm mass in her left shoulder, progressively enlarging over two years. The patient also noted a 30-year history of a stable, asymptomatic neck lump. Magnetic Resonance Imaging (MRI) revealed a large, hypervascular, destructive mass obliterating the scapula and invading surrounding musculature, with a radiological differential diagnosis of a primary soft tissue sarcoma. Laboratory investigation, however, revealed a massively elevated serum calcitonin (>2000 pg/mL) and carcinoembryonic antigen (CEA) (180 ng/mL). A CT-guided core biopsy of the shoulder mass, initially suspected to be a sarcoma, was negative for all sarcoma markers. Instead, it was strongly positive for neuroendocrine (Synaptophysin, Chromogranin A) and thyroid-specific (TTF-1, PAX-8) markers, as well as definitive MTC markers (Calcitonin, CEA). This confirmed the diagnosis of metastatic MTC. Staging was completed as pT3a pN1b M1. The patient underwent total thyroidectomy with bilateral central and left modified radical neck dissection, followed by planned palliative resection of the shoulder metastasis and systemic therapy with a selective RET inhibitor. Conclusion: This case highlights a critical diagnostic pitfall. Metastatic MTC can present as a massive soft tissue neoplasm mimicking a primary sarcoma. In such cases, a systematic diagnostic approach combining serum biomarkers (Calcitonin, CEA) with a comprehensive immunohistochemical panel is essential to establish the correct diagnosis and initiate appropriate, life-extending targeted therapy.

A BSTRACT An 11-month-old female presented with respiratory distress, neck swelling, and sepsis following the manual removal of a foreign body (a broken Shivling) from her throat. Imaging revealed pneumo-retropharynx and a large retropharyngeal abscess. After initial stabilization and resuscitation, transcervical endoscopy was employed to drain the abscess and repair a mucosal tear in the left pyriform sinus. The patient recovered well, with no postoperative complications and complete healing confirmed via endoscopy and esophagogram. This case highlights an innovative endoscopic approach, which enabled precise visualization and suturing of the hypopharyngeal perforation while avoiding extensive neck dissection, large cervical scars, and associated morbidity.

Background. Papillary thyroid carcinoma (PTC) is a malignant neoplasm originating from thyroid follicular cells and accounts for up to 80% of all thyroid cancer cases. It is the most common endocrine malignancy both in Ukraine and worldwide. Aim. The aim of this study was to investigate and evaluate the macroscopic invasive features of papillary thyroid carcinoma in overweight and obese patients, and to compare them with those in patients of normal weight. Participants and Methods: A total of 91 patients diagnosed with papillary thyroid carcinoma who underwent surgical treatment at Verum Expert Clinic (Kyiv, Ukraine) were included in the study. The cohort was divided based on body mass index (BMI): 26 patients with normal weight (BMI < 23.9 kg/m²); 45 patients with overweight (BMI 24.0–29.9 kg/m²); 20 patients with obesity (BMI ≥ 30.0 kg/m²). Clinical and pathohistological parameters were retrieved from archived medical records. All patients underwent standard preoperative evaluation, including thyroid hormone testing, clinical chemistry, and ionized calcium analysis. Results. A statistically significant difference in the frequency of macroscopic invasion into surrounding thyroid structures was observed across the BMI-based groups. Macroscopic invasion was identified in 6 patients with obesity (30%), 1 patient with overweight (2.2%), and in 4 patients with normal weight (15%) (p = 0.041). Further statistical analysis confirmed a significantly higher rate of macroscopic tumor spread in patients with obesity compared to other BMI categories (p = 0.019), suggesting a possible link between increased body weight and more aggressive local tumor behavior. Conclusions. Patients with papillary thyroid carcinoma and obesity demonstrate a higher incidence of macroscopic invasion into adjacent tissues, which may reflect a more aggressive biological behavior of the tumor. These findings highlight the importance of preoperative risk assessment in overweight and obese patients, the potential need for more radical surgical intervention (e.g., extended neck dissection), and careful long-term follow-up due to the increased risk of disease progression.

BackgroundSquamous cell carcinoma of the lip (LSCC) is a relatively rare malignancy. The criteria for performing a neck dissection remain unclear, as reliable predictors for lymph node metastasis (LNM) have not been fully established. This study aimed to identify risk factors for LNM to guide the indication for elective neck dissection.MethodsA total of 57 patients with LSCC were evaluated based on 81 clinical and pathological parameters, including three previously published pathological grading systems. Statistical analyses focused on identifying the most relevant and independent predictors of LNM using univariate and multivariate logistic regression, supplemented by the LASSO algorithm for feature selection.ResultsTumor size (OR 1.008, p = 0.85) and peritumoral tumor budding (OR 1.43, p = 0.059) emerged as the most relevant independent predictors of LNM. Notably, the number of peritumoral tumor buds was significantly higher in lymph node-positive (pN +) patients compared to lymph node-negative (pN −) patients (p < 0.01). Receiver operating characteristic (ROC) curve analysis demonstrated that peritumoral tumor budding outperformed other classification systems, with the highest area under the curve (AUC = 0.86).ConclusionPeritumoral tumor budding shows strong predictive potential for lymph node metastasis in LSCC, offering valuable insights for the preoperative evaluation and indication for elective neck dissection.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13005-025-00553-2.

Reoperative Thyroid Procedures: Do They Pose a Higher Risk of Complications Compared to First-time Surgery?

Rethinking drain protocols in pediatric thyroidectomy.

Prognostic impact and risk factors of level IV/V lymph nodes metastasis in laryngeal squamous cell carcinoma.

Hybrid neoplasm of the lacrimal gland, adenocarcinoma NOS with primary squamous cell carcinoma; A rare case report.

A rare presternal goiter: presentation and literature review.

Robotic modified radical neck dissection for thyroid carcinoma using a gas-insufflation one-step single-port transaxillary (GOSTA) approach

Clinicopathological study of invasion patterns and late cervical lymph node metastasis in pT1/T2 oral squamous cell carcinoma.

Objective:To investigate the clinical efficacy of robotic surgery via the bilateral axillo-breast approach（BABA） in lateral lymph node dissection for papillary thyroid carcinoma（PTC）. Methods:Clinicopathological records of 324 PTC patients receiving unilateral neck dissection in Tianjin Medical University Cancer Institute and Hospital from December 2020 to November 2024 were retrospectively analyzed. Of these patients, 108 underwent robotic surgery via BABA（robotic group）, while the remaining patients underwent conventional open surgery（open group）. The extent of lateral neck lymph node dissection included level Ⅱ, Ⅲ and Ⅳ. The differences in surgical indexes, postoperative complication rates and cosmetic outcomes of incisions were compared between two groups. Results:All study subjects completed the operation successfully, and there was no conversion in the robotic group. The average age of patients in the robotic group was lower than that in the open group, and the proportion of female patients was higher in the robotic group compared to the open group（P<0.05）. Patients in the robotic group had a greater number of dissected lymph nodes in level ⅡB and higher cosmetic scores（P<0.05）. There were no statistically significant differences between the two groups in the average dissection time of lateral cervical lymph nodes, the number of dissected lymph nodes and metastatic lymph nodes in level ⅡA, Ⅲ, and Ⅳ, average postoperative drainage volume, average postoperative hospital stay, and postoperative complication rates（P>0.05）. Conclusion:The application of robotic surgical system via BABA in lateral neck lymph node dissection for PTC is safe and feasible, with superior advantages in level ⅡB dissection and better postoperative cosmetic outcomes.

Background/AimThe optimal extent of neck dissection (ND) in oral squamous cell carcinoma (OSCC) is controversial, particularly regarding levels IV and V in cases with metastases in levels I-III. This study evaluated the probability of metastases in levels IV-V when levels I-III are pN+ in cN0 necks and analyzes prognostic factors influencing their occurrence.Patients and MethodsA retrospective study was performed at the Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Germany, including 61 patients with primary OSCC treated surgically including ND. Patients underwent either supraomohyoid ND (SOND) of levels I-III with secondary extension to IV-V or modified radical ND (MRND) of levels I-V. Statistical analysis assessed the correlation between metastases in levels IV-V and extracapsular spread (ECS), number of positive lymph nodes, T-classification, bone infiltration, grading, lymphovascular invasion, vascular invasion, and perineural invasion.ResultsAmong the 61 patients with metastases in levels I-III, 6 patients (9.8%) had metastases in levels IV-V. A significant correlation (p=0.042) indicated that pN+ in levels I-III is associated with >5% risk of level IV-V metastases. The presence of more than one metastasis in levels I-III significantly (p=0.027) predicted level IV-V involvement. A pN status of >pN2b significantly (p=0.002) increased the prevalence of metastases in levels IV-V. ECS showed a trend toward increased IV-V involvement, though not statistically significant (p=0.078).ConclusionThe risk of level IV-V metastases in patients with pN+ in levels I-III exceeds 5% in cN0 necks. The number of affected nodes and pN classification were the strongest predictors. These findings support selective extension of ND beyond level III in specific patients and emphasize individualized treatment strategies.

Background: The management of the clinically N0 neck in buccal squamous cell carcinoma (BSCC) remains controversial due to the potential for occult nodal metastasis (ONM). This study aimed to map the anatomical pattern and incidence of ONM in BSCC patients presenting with a clinically negative neck, and to correlate these findings with specific pathological high-risk features. Methods: A cross-sectional study was performed on 48 patients with clinically N0 BSCC who underwent Selective Neck Dissection (SND) at a tertiary care center over a nine-month period. Pathological findings were analyzed for overall nodal status (pN), the specific levels of lymph node involvement, the relationship between clinical T-stage and nodal burden, and the presence of perineural invasion (PNI) and lymph vascular invasion (LVI). Results: The study demonstrated an extremely high incidence of occult nodal metastasis at 97.9% (47/48 patients), highlighting the clinical unreliability of cN0 staging for this specific site. Analysis of the nodal patterns revealed that metastasis was predominantly confined to the superior cervical regions. Level IIA (48.4%) was the most frequently involved nodal basin, followed closely by Level IB (41.9%) and Level IA (25.8%). Crucially, no isolated skip metastases to Level IIB or Level III were observed. Furthermore, the presence of high-risk pathological features was a definitive predictor of ONM: of cases with Perineural Invasion (PNI) (n=18) and of cases with Lymph vascular Invasion (LVI) (n=14) were pathologically node-positive. Clinical T-stage also correlated with nodal burden, with T4N0MX tumors showing a higher mean number of positive nodes (2.1) compared to T2N0MX (1.6). Conclusion: The exceptionally high incidence and predictable pattern of occult nodal metastasis confirm that prophylactic neck management is mandatory for clinically N0 BSCC. The anatomical risk mapping strongly supports performing a Selective Neck Dissection targeting Levels I and IIA. The presence of PNI and LVI serves as an absolute indicator for aggressive regional management.

Abstract Background Histopathological markers may facilitate disease prognosis and patient-specific treatment. The aim of this study is to evaluate tumor budding and other histopathological markers in laryngeal squamous cell carcinoma. This is a retrospective descriptive analysis of the histopathology of 116 patients with primary squamous cell cancer of the larynx. We reviewed the tumor budding score, degree of differentiation, lymphovascular and perineural invasion, stromal and host lymphocyte response, and depth and pattern of invasion. The outcomes were lymph node metastasis and disease-specific survival. Results The average age of the patients was 64.95 ± 9.92 years, 94.0% were male, and 71.55% had advanced disease (T3 and T4). Most patients (84.5%) had a negative clinical nodal stage, 58.6% underwent neck dissection, 24.1% had a positive histopathological nodal stage, and 22 patients (18.1%) had regional recurrence, bringing the total of regional metastasis to 36.2% ( n = 42). Immunohistochemistry increased the observed budding activity. High budding activity &gt;5/high-powered field was associated with advanced T stages, lymph node metastasis, and depth of invasion &gt;5 mm. Conclusion Tumor budding and depth and pattern of invasion may be prognostic factors in laryngeal squamous cell cancer. Further research is needed to determine whether they may be evaluated in biopsy material.

Robotic thyroidectomy via the bilateral axillo-breast approach (BABA) provides excellent cosmetic outcomes, but its adoption is limited by a steep learning curve and concerns about functional safety. This study aimed to define the learning curve trajectory and evaluate functional safety outcomes-with the primary endpoint of intraoperative RLN adverse events and secondary endpoints of inadvertent parathyroidectomy and PTH recovery. A prospective cohort study was conducted at a high-volume endocrine surgery center from March 2018 to March 2024. A total of 537 consecutive patients with differentiated thyroid carcinoma underwent robotic BABA thyroidectomy with central neck dissection. Intraoperative refinements included real-time recurrent laryngeal nerve (RLN) monitoring, intraoperative parathyroid-hormone (PTH) testing, and nanocarbon lymph node mapping. Learning phases were defined by cumulative sum analysis. Primary outcomes were intraoperative RLN adverse events and inadvertent parathyroidectomy; secondary outcomes included operative time, lymph node yield, PTH recovery, complication rates, and tracheal injury. Among 537 patients (401 women, 74.7%; median age 43years), operative time decreased from 189.9 to 129.3min (P < 0.001), with plateaus at 152 and 352 cases. RLN adverse events declined from 16.7% (95% CI 7.9-30.2%) to 1.6% (95% CI 0.3-4.8%), and inadvertent parathyroidectomy decreased from 23.8% (95% CI 12.0-39.5%) to 1.6% (95% CI 0.3-4.8%). Six-month PTH levels improved from 3.15 to 4.14pmol/L, and lymph node yield increased from 9.9 to 13.3 (P = 0.019). Three patients (0.6%) developed tracheal fistula. Robotic BABA thyroidectomy demonstrates a structured learning curve in which functional safety improves with surgical experience and intraoperative standardization. These data-driven milestones may inform structured training and credentialing frameworks for robotic thyroid surgery.

Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity, often necessitating extensive surgical resection. Such interventions may result in complex intraoral defects requiring immediate reconstruction to restore function and aesthetics. Objective: This case report highlights the surgical management of a patient with OSCC involving the tongue, floor of the mouth and mandibular ridge, reconstructed using a radial forearm free flap (RFFF). Case report: A 51-year-old male with a history of heavy smoking presented with a necrotic lesion affecting the left mandibular alveolar ridge, floor of the mouth, and tongue. Methods: Histopathological examination confirmed a diagnosis of moderately differentiated keratinizing OSCC (G2). After oncologic resection and selective neck dissection, the defect was reconstructed using an RFFF harvested from the left forearm. The facial artery and anterior jugular vein served as recipient vessels for microvascular anastomosis. A split-thickness skin graft (STSG) was used to close the donor site. Results: The postoperative course was generally favorable. Minor complications, including a localized hematoma and neck wound dehiscence, were conservatively managed. Functional outcomes such as oral intake and wrist mobility were successfully restored with rehabilitation. The RFFF provided durable, well-vascularized coverage over exposed mandibular bone, critical for minimizing the risk of osteoradionecrosis in the context of planned adjuvant radiotherapy. Conclusions: The radial forearm free flap remains a reliable reconstructive option for complex oral defects post-OSCC resection. Multidisciplinary collaboration and meticulous surgical technique are essential to achieve optimal oncologic, functional, and aesthetic outcomes.

Remote access approaches to the neck have gained attention due to cosmetic concerns with conventional cervical incisions. Their safety, reproducibility, and oncologic outcomes remain to be fully validated. We retrospectively analyzed our initial experience with retroauricular robotic neck surgery using the Da Vinci system. Thirty-two patients were included. Data collected comprised demographics, procedure type, surgical features, and oncological follow-up. Thirty-five surgeries were performed: 13 posterolateral neck dissections (levels II-V) with central (VI), 5 modified radical dissections (I-V), 5 posterolateral dissections (II-V), and 1 super-selective neck dissection (I). Twelve neck dissections were combined with thyroidectomy. Additional procedures included 4 partial thyroidectomies, 3 submandibular gland resections, 3 schwannoma resections, and 1 branchial cyst excision, totaling 60 procedures. Twenty patients had malignant disease (62.5%). Median hospital stay was 2days (range 1 9), similar to conventional approaches. Complications included 5 temporary nerve palsies, 1 lymphatic fistula, 1 transient hypoparathyroidism, and 1 minor flap necrosis, all managed conservatively; 1 hematoma required reoperation. Conversion to a conventional approach occured in 4 cases (6.7%). No additional intraoperative or postoperative complications were observed. The mean lymph node yield was 54 in posterolateral/radical dissections and 13 in central dissections. Median follow-up of malignant cases was 41.3months (range 18-56), with a 3-year regional control rate of 94.7%. Our experience with 60 retroauricular robotic procedures demonstrates this approach to be safe, feasible, and oncologically effective, with complication rates, hospital stay, and oncological outcomes comparable to conventional surgery.

ABSTRACTPrimary thyroid lymphoma (PTL) is a rare malignancy, comprising 1%–5% of thyroid cancers and 2%–5% of extranodal lymphomas, with diffuse large B‐cell lymphoma (DLBCL) being the most common subtype. PTL often coexists with Hashimoto thyroiditis, leading to diagnostic delays. We report a case of a man in his early 70s who presented with a progressively enlarging, painless anterior neck mass over 2.5 years. Initial fine needle aspiration cytology (FNAC), repeated twice over 18 months, suggested lymphocytic thyroiditis. Due to persistent growth and inconclusive FNAC results, the patient underwent a right hemithyroidectomy with central neck dissection. Histopathological examination and immunohistochemistry confirmed DLBCL, activated B cell (ABC) subtype. He was started on R‐CHOP chemotherapy. FNAC, although a first‐line diagnostic tool for thyroid nodules, has a low sensitivity to PTL, especially in the context of underlying thyroiditis. Advanced diagnostic techniques such as immunohistochemistry, flow cytometry, and core needle biopsy (CNB) significantly improve accuracy but are often inaccessible in low‐resource settings. CNB offers a preserved tissue architecture and a higher diagnostic yield, reducing unnecessary surgeries. This case underscores the diagnostic limitations of FNAC in PTL and highlights the need for improved diagnostic approaches, including CNB and auxiliary tests, to ensure early and accurate diagnosis, especially in settings with limited resources.

Buccinator myomucosal flaps (BMFs) have been proposed as a reconstructive solution for defects of the tongue and oral floor; however, their harvest requires preservation of the facial artery and vein. This study aimed to evaluate the oncologic safety of this approach compared with free fasciocutaneous flaps (FFF). A retrospective multicenter case-control study including cT1-T3 cN0 tongue/oral floor squamous cell carcinoma was performed. Cases received BMFs while controls received FFFs. The primary endpoint was progression-free survival (PFS) tested for non-inferiority. Secondary endpoints were overall survival (OS), disease-specific survival (DSS), and cumulative incidence of local, regional, and distant recurrence using competing-risk methods. A total of 615 patients (BMF n = 390; FFF n = 225) with comparable baselines were included. Five-year PFS was 69.8% (BMF) versus 66.2% (FFF); adjusted HR (FFF vs. BMF) 0.87 (95% CI: 0.43-1.78), meeting non-inferiority. Five-year OS was 77.9% versus 73.5%. Cumulative incidence of recurrence was similar: local 7.5% versus 8.3%, regional 6.3% versus 6.1%, and distant 2.1% versus 1.7%. Preservation of the facial artery and vein during selective neck dissection did not compromise oncologic outcomes. Facial-vessel-based BMFs are a valid option for small-to-medium tongue/oral floor defects in appropriately selected cN0 patients when meticulous level I clearance is performed and a pull-through resection is not required.