title: Modified radical neck dissection for differentiated thyroid cancer: operative technique.
abstract: Our standard surgical approach to patients with papillary thyroid cancer is subtotal thyroidectomy with modified radical neck dissection (MRND) on the affected side. MRND preserves the jugular vein, the sternocleidomastoid muscle, and the accessory nerve, effectively conserving function and cosmesis. Knowledge of the anatomy of the neck, precise staging, prognostic evaluation, and experience are needed for a surgeon to perform MRND. Radical neck dissection should not be performed unless the tumor invades the jugular vein and sternocleidomastoid muscle. Berry picking is not indicated for patients with thyroid cancer. The skin incision used is an extended collar incision. If lymph node metastasis is present at the upper bifurcation of the carotid artery, a modified MacFee incision is used. Taping of the carotid artery or sternocleidomastoid muscle is avoided unless the tumor invades these tissues. MRND is a safe procedure when performed by skilled, experienced surgeons.
authors.affiliation: Department of Surgery, Noguchi Thyroid Clinic and Hospital Foundation, 6-33 Noguchi Naka-machi Beppu, 874-0932 Oita, Japan. uchino@noguchi-med.or.jp.
authors.forename: Shinya
authors.initials: S
authors.lastname: Uchino
authors.forename: Shiro
authors.initials: S
authors.lastname: Noguchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Shin
authors.initials: S
authors.lastname: Watanabe
mesh_terms: D006801:Humans; D008207:Lymphatic Metastasis; D009333:Neck / Q000098:blood supply; D037981:Neck Dissection / Q000379:methods*; D009334:Neck Muscles / Q000601:surgery; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy