Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma?
BACKGROUND
Although the pattern of cervical lymph node metastases from papillary thyroid carcinoma (PTC) has been described, little is known about the pattern of lateral cervical nodal recurrence. The aim of this study was to establish the optimal strategy for neck dissection in patients who underwent reoperation for lateral cervical recurrence of PTC.


METHODS
We reviewed the records of 22 patients who underwent neck dissection for lateral nodal recurrence of thyroid cancer between 2002 and 2004. Eight patients had thyroid remnants or recurrent tumors in the bed and 6 had undergone lateral neck dissection prior to referral. Patients underwent comprehensive dissection of the posterolateral and ipsilateral (n = 10) or bilateral (n = 12) central neck. The pattern of nodal recurrence and postoperative morbidity were analyzed.


RESULTS
All patients had lateral compartment involvement, 91% at mid-lower, 45% at upper, and 18% at posterior sites. Central nodes were involved in 86% of patients: 82% at ipsilateral paratracheal, 32% at pretracheal, 27% at superior mediastinal, and 2 patients at contralateral sites. Skip lateral recurrence with no positive central nodes was rarely observed (14%). Postoperative vocal cord palsy (n = 1) and hypoparathyroidism (n = 5) developed only in patients undergoing bilateral central compartment dissection.


CONCLUSIONS
The inclusion of comprehensive ipsilateral central and lateral neck dissection in the reoperation for patients with lateral neck recurrence of PTC is an optimal surgical strategy.
Roh
Jong-Lyel
JL
Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea. rohjl@amc.seoul.kr
Park
Jae-Yong
JY
Rha
Ki Sang
KS
Park
Chan Il
CI
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012086:Reoperation; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods; D014826:Vocal Cord Paralysis / Q000209:etiology