Management of the Central Compartment in Well-Differentiated Thyroid Carcinoma

Part of the Head and Neck Cancer Clinics book series (HNCC)


The central compartment of the neck is bounded superiorly by the hyoid bone, laterally by the carotid arteries, anteriorly by the superficial layer of the deep cervical fascia, posteriorly by the deep layer of the deep cervical fascia, and inferiorly by the innominate artery on the right and the corresponding axial plane on the left. [1] As illustrated in Fig. 3.1, the first echelon of lymphatic drainage of the thyroid is to the pretracheal, paratracheal and recurrent laryngeal nodes in the central compartment (level VI). This puts them at the highest risk of lymphatic metastasis in thyroid cancer. Subsequent lymphatic spread takes place to the superior mediastinal lymph nodes (level VII) and/or the lateral compartment of the neck (levels II–V), as has been outlined in Chap. 2 on lymph node metastasis in well-differentiated thyroid carcinoma (WDTC). Microscopic involvement of regional node occurs in 30–90 % of cases of papillary thyroid carcinomas (PTCs), with an incidence of clinically evident lymph node metastases at presentation ranging from 30 to 40 % [2–5]. The most commonly involved central lymph nodes in thyroid carcinoma are the prelaryngeal (Delphian), pretracheal, and the right and left paratracheal nodes [1].


Neck Dissection Recurrent Laryngeal Nerve Total Thyroidectomy Central Compartment Central Neck 


  1. 1.
    American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Carty SE, Cooper DS, Doherty GM, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153–8.CrossRefGoogle Scholar
  2. 2.
    White ML, Gauger PG, Doherty GM. Central lymph node dissection in differentiated thyroid cancer. World J Surg. 2007;31:895–904.PubMedCrossRefGoogle Scholar
  3. 3.
    Mazzaferri EL, Young RL. Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med. 1981;70:511–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Sanders LE, Rossi RL. Occult well differentiated thyroid carcinoma presenting as cervical node disease. World J Surg. 1995;19:642–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Cady B, Sedgwick CE, Meissner WA, et al. Changing clinical, pathologic, therapeutic, and survival patterns in differentiated thyroid carcinoma. Ann Surg. 1976;184:541–53.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.CrossRefGoogle Scholar
  7. 7.
    Cooper DS, Doherty GM, Haugen BR, et al.; American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109–42.PubMedCrossRefGoogle Scholar
  8. 8.
    Carling T, Carty SE, Ciarleglio MM, et al.; American Thyroid Association Surgical Affairs Committee. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22:237–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Tisell LE, Hansson G, Jansson S, et al. Reoperation in the treatment of asymptomatic metastasizing medullary thyroid carcinoma. Surgery. 1986;99:60–6.PubMedGoogle Scholar
  10. 10.
    Dralle H, Damm I, Scheumann GF, et al. Frequency and significance of cervicomediastinal lymph node metastases in medullary thyroid carcinoma: results of a compartment-oriented microdissection method. Henry Ford Hosp Med J. 1992;40:264–7.PubMedGoogle Scholar
  11. 11.
    Tisell LE, Nilsson B, Mölne J, et al. Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg. 1996;20:854–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Scheumann GF, Grimm O, Wegener G, et al. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg. 1994;18:559–67; discussion 567–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140:1000–5; discussion 1005–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Gemsenjäger E, Perren A, Seifert B, et al. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg. 2003;197:182–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 1998;383:167–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007;245:604–10.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery. 2005;138:1095–100.PubMedCrossRefGoogle Scholar
  18. 18.
    Frasoldati A, Pesenti M, Gallo M, et al. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer. 2003;97:90–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Simon D, Goretzki PE, Witte J, et al. Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg. 1996;20:860–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Segal K, Friedental R, Lubin E, et al. Papillary carcinoma of the thyroid. Otolaryngol Head Neck Surg. 1995;113:356–63.PubMedCrossRefGoogle Scholar
  21. 21.
    Alvarado R, Sywak MS, Delbridge L, et al. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: Is there added morbidity? Surgery. 2009;145:514–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Cheah WK, Arici C, Ituarte PH, et al. Complications of neck dissection for thyroid cancer. World J Surg. 2002;26:1013–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Kupferman ME, Patterson DM, Mandel SJ, et al. Safety of modified radical neck dissection for differentiated thyroid carcinoma. Laryngoscope. 2004;114:403–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Kim ES, Kim TY, Koh JM, et al. Completion thyroidectomy in patients with thyroid cancer who initially underwent unilateral operation. Clin Endocrinol (Oxf). 2004;61:145–8.CrossRefGoogle Scholar
  25. 25.
    Moley JF, Wells SA. Compartment-mediated dissection for papillary thyroid cancer. Langenbecks Arch Surg. 1999;384:9–15.PubMedCrossRefGoogle Scholar
  26. 26.
    Cavicchi O, Piccin O, Caliceti U, et al. Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol Head Neck Surg. 2007;137:654–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Horne SK, Gal TJ, Brennan JA. Prevalence and patterns of intraoperative nerve monitoring for thyroidectomy. Otolaryngol Head Neck Surg. 2007;136:952–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Sturgeon C, Sturgeon T, Angelos P. Neuromonitoring in thyroid surgery: attitudes, usage patterns, and predictors of use among endocrine surgeons. World J Surg. 2009;33:417–25.PubMedCrossRefGoogle Scholar
  29. 29.
    Dralle H, Sekulla C, Lorenz K, et al. ; German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32:1358–66.PubMedCrossRefGoogle Scholar

Copyright information

© K. Alok Pathak, Richard W. Nason, Janice L. Pasieka, Rehan Kazi, Raghav C. Dwivedi 2015

Authors and Affiliations

  • K. Alok Pathak
    • 1
  • Rehan Kazi
    • 2
  • Richard W. Nason
    • 3
  1. 1.Head and Neck Surgical OncologyCancerCare Manitoba, University of ManitobaWinnipegCanada
  2. 2.Manipal University KarnatakaManipalIndia
  3. 3.Head and Neck Surgical OncologyCancerCare ManitobaWinnipegCanada

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