Is Comprehensive Neck Dissection a Sole Choice for the Treatment of Recurrent Papillary Thyroid Carcinoma in the Lateral Neck? / 대한이비인후과학회지

ABSTRACT

BACKGROUND AND OBJECTIVES: Therapeutic comprehensive neck dissection has been recommended for the patients with recurrent papillary thyroid carcinoma (PTC) confined to the neck after initial total thyroidectomy. However, the benefit of comprehensive neck dissection to remove asymptomatic metastatic lymph node towards improving clinical recurrences or survival is largely unproven. We analyzed the pattern of recurrence in the lateral compartment of neck and evaluated the possible application of limited lymph node dissection against comprehensive neck dissection. SUBJECTS AND METHOD: A retrospective review was carried out for 43 patients who underwent surgical treatment for recurrent PTC in the lateral neck from 2000 to 2005, and their clinicopathological results were stratified according to the extent of surgery into two groups, the limited surgery group and the comprehensive surgery group. RESULTS: Recurrence rate in lateral neck after initial total thyroidectomy was 14.5% (43/296), and the most common level of recurrence was level IV (50.9%). Although limited surgery group showed a tendency toward more frequent recurrence after treatment of the first recurrence than did the comprehensive surgery group, this tendency had no statistical significance. Moreover, no patients in either group have died of PTC during over a mean follow-up period of 80 months. In the aspect of factors associated with surgical morbidity, such as operating time, duration of admission, and complication, the limited surgery group had superior results when compared to the comprehensive group. CONCLUSION: The benefit of comprehensive neck dissection concerning recurrence and survival was not verified in the present study hence a more preservative approach could be applied to selective patients with recurrent PTC in the lateral compartment of neck.