title: Pattern of neck recurrence after lateral neck dissection for cervical metastases in papillary thyroid cancer.
abstract: The objective of this study was to determine the rate and pattern of nodal recurrence in patients who underwent a therapeutic, lateral neck dissection (LND) for papillary thyroid cancer (PTC) with clinically evident cervical metastases and to determine if there was any correlation between the extent of initial dissection and the rate and pattern of neck recurrence.
  
  
  
  A total of 3,664 patients with PTC treated between 1986 and 2010 at Memorial Sloan Kettering Cancer Center were identified from our institutional database. Tumor factors, patient demographics, extent of initial LND, and adjuvant therapy were recorded. Patterns of recurrent lateral neck metastases by level involvement were recorded and outcomes calculated using the Kaplan-Meier method.
  
  
  
  A total of 484 patients had an LND for cervical metastases; 364 (75%) had a comprehensive LND (CLND) and 120 (25%) had a selective neck dissection (SND). The median duration of follow-up was 63.5 months. As expected, patients with CLND had a greater number of nodes removed as well as a greater number of positive nodes (P < .001). There was no difference in overall lateral neck recurrence-free status (CLND 94.4% vs SND 89.4%, P = .158), but in the dissected neck, the ipsilateral lateral neck recurrence-free status was superior in the CLND patients (97.7% vs 89.4%, P < .001).
  
  
  
  Patients with clinically evident neck metastases from PTC managed by CLND have lesser rates of recurrence in the dissected neck compared with patients managed by SND. SND should only be done in highly selected cases with small volume disease.
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: William F
authors.initials: WF
authors.lastname: McNamara
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Laura Y
authors.initials: LY
authors.lastname: Wang
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Palmer
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ganlyi@mskcc.org.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D015996:Survival Rate; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D013965:Thyroidectomy