title: Elective paratracheal neck dissection for lateral metastases from papillary carcinoma of the thyroid: is it indicated?
abstract: BACKGROUND
  Therapeutic paratracheal neck dissection for patients with papillary carcinoma of the thyroid is standard treatment. Its use as an elective procedure is controversial.
  
  
  METHODS
  Thirty-seven patients with papillary carcinoma of the thyroid and evidence of positive adenopathy at levels II-V underwent selective neck dissection and elective/therapeutic paratracheal neck dissection. Results of preoperative ultrasonography of the neck were compared with the dissection specimens.
  
  
  RESULTS
  Morbidity of the surgical procedure was minimal (1 permanent hypocalcemia). All specimens showed metastases from papillary thyroid carcinoma: 100% (37/37) in the jugular chain of lymphatics and 83.7% (31/37) in the paratracheal region. The rate of occult (negative physical examination and ultrasonography) metastases in the paratracheal region in the presence of metastases in the ipsilateral jugular chain was 83.3% (20/24).
  
  
  CONCLUSIONS
  The high rate of occult metastases in the paratracheal region and the low rate of surgical morbidity speak in favor of elective paratracheal neck dissection in patients with metastatic papillary carcinoma of the thyroid.
authors.affiliation: The Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. avironit@bezeqint.net
authors.forename: Avi
authors.initials: A
authors.lastname: Khafif
authors.forename: Rami
authors.initials: R
authors.lastname: Ben-Yosef
authors.forename: Avrum
authors.initials: A
authors.lastname: Abergel
authors.forename: Ada
authors.initials: A
authors.lastname: Kesler
authors.forename: Roee
authors.initials: R
authors.lastname: Landsberg
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D003657:Decision Making; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D014132:Trachea