ABSTRACT
The aim of this study is to establish the frequency, pattern and location of cervical lymph node metastases from thyroid cancer and to recommend the appropriate type and extent of neck dissection. Patients and The medica records of 86 patients operated upon for primary thyroid cancer at Kuwait Cancer Control Centre [KCCC] between March 1992 and June 1998 were retrospectively analysed; 48 patients had therapeutic cervical lymph node dissection [TCLND], either during the primary thyroid surgery [immediate] or at a later data [delayed]. The different forms of TCLND employed were functional, radical, central and selective. The pattern and level of lymph node metastasis were the main consideration deciding the type and extent of neck dissection. Forty-sis neck dissections were done synchronously with the primary thyroid surgery, while 2 had the neck dissection at a separate session. Twenty male and 28 female patients were offered TCLND. The age at initial presentation ranged from 11 to 88 years, with a mean age of 42 years. The primary lesions were papillary and medullary thyroid carcinomas in 43 and 5 patients, respectively. Ipsilateral functional neck dissection was carried out in 21 patients, while central neck clearance radical neck clearance was performed in 6 cases; 14 patients were offered and 5 had selective neck dissection; only patients had bilateral functional block. Forty-one patients were followed up for a period ranging from 3 to 9 years, with a mean of 3.2 years. The commonest postoperative complication was shoulder disability syndrome in 4 patients; one patient died on the third postoperative day due to cerebral haemorrhage. Recurrence of the disease following neck dissection was noted in 3 patients. A well-done functional neck dissection, concomitantly performed at the time of the initial thyroid cancer patients [mainly papillary carcinomas], having clinically suspicious and histological involved neck nodes by metastatic disease. On the other hand, for all patients with palpable medullary carcinoma, routine central and bilateral functional neck dissections should be considered. This aggressive approach reduces subsequent recurrences and the need for repeated surgeries and prevents the increasing morbidity of multiple operations for recurrent nodal disease