Therapeutic Neck Dissection for Differentiated Thyroid Cancer, to Whom and to What Extent?
Bilateral total thyroidectomy is the standard surgical procedure for metastatic thyroid cancers. In this section, the definition and the extent of neck dissection will be discussed for thyroid cancer patients with lateral neck metastases. Since the first description of the radical neck dissection by George Crile almost a century ago, the surgical management of thyroid cancer patients with metastatic regional lymph nodes continues to be a challenge. The level of regional lymphatic spread in thyroid cancer is independent of tumor size and its location in the thyroid. In treatment, cervical lymphatic dissection has a place only in clinically proven metastatic disease. In clinically proven cases of nodal disease with preoperative USG and fine needle aspiration cytology (FNAC) or thyroglobulin (Tg) measurements, lymph node dissection during surgery may reduce the risk of relapses and possible mortality. In proven cervical metastatic disease, compartmental lymph node dissection is effective and adequate for treatment and which is also the recommendations of the guidelines.
- 1.Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133. https://doi.org/10.1089/thy.2015.0020.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Medina JE, Hefetz AK. Lateral neck dissection: indications. In: Randolph GW, editor. Surgery of the thyroids and parathyroid glands. Philadelphia: Elsevier; 2013. p. 382–8.Google Scholar
- 12.Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, et al. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbeck's Arch Surg. 2013;398:347–75. https://doi.org/10.1007/s00423-013-1057-6. Epub 2013 Mar 3.CrossRefGoogle Scholar
- 13.Stack BC Jr, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, et al. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid. 2012;22:501–8. https://doi.org/10.1089/thy.2011.0312. Epub 2012 Mar.CrossRefPubMedGoogle Scholar
- 14.Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010;20:1341–9.CrossRefGoogle Scholar
- 16.Castagna MG, Maino F, Cipri C, Belardini V, Theodoropoulou A, Cevenini G, et al. Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients. Eur J Endocrinol. 2011;165:441–6.CrossRefGoogle Scholar