title: The extent of lateral lymph node dissection in differentiated thyroid cancer in the N+ neck.
abstract: The management of the lateral neck in metastatic differentiated thyroid cancer (DTC) varies widely. Most groups advocate dissection of nodal levels II-IV but many perform a more extensive dissection. We aimed to asses whether there was any evidence for a modified radical neck dissection over a selective neck dissection by looking at the extent to which DTC metastases to levels I and V. We performed a review of the current literature including adult and paediatric patients who underwent a lateral neck dissection for metastatic DTC. The primary endpoint was histological confirmation of metastases in nodal levels I and V. 650 abstracts were identified and reviewed. 23 papers were included in the study. The incidence of level V metastases during routine level V dissection in patients with DTC is 20 % and the incidence of level I metastases during routine level I dissection in patients with DTC is 8 %. Histologically proven metastases were found in 22.5 % of level V neck dissection of which 2.5 % were pre-operatively suspected of metastases. 20 % had histologically proven metastases to level I of which 12 % were pre-operatively suspected of metastases. Our study has shown a 20 % incidence of level V metastases in the N+ neck suggesting that level V should be part of a planned neck dissection. Evidence is lacking for routine dissection of level I. A future prospective study is required to asses the question of risk factors for lateral nodal metastases, recurrence and survival.
authors.affiliation: Royal Berkshire Hospital, Reading, UK, soniakumar111@googlemail.com.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: C
authors.initials: C
authors.lastname: Burgess
authors.forename: R
authors.initials: R
authors.lastname: Moorthy
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000601:surgery*; D000328:Adult; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D002648:Child; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D037981:Neck Dissection / Q000379:methods*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome