Optimal Surgical Extent of Therapeutic Lateral Neck Dissection in Well-Differentiated Thyroid Carcinoma Patients with Clinical Lateral Lymph Node Metastasis

ABSTRACT

Regional neck metastases in well-differentiated thyroid carcinoma (WDTC) are relatively frequent. The prognostic effects of lymph node (LN) metastases remain controversial. However, it is well known that lateral LN metastasis is related to the recurrence of the disease. In general, when lateral neck LN metastasis is confirmed in WDTC patients, therapeutic lateral neck dissection is recommended. However, the optimal surgical extent of therapeutic lateral neck dissection in WDTC patients with clinical lateral LN metastasis is not clearly presented. Traditional comprehensive neck dissection including level II, III, IV and V even in patients with minimal lateral neck metastases may not be reasonable when considering both oncologic safety and functional aspects. There is controversy whether it is always necessary to perform level II and V LN dissection for all WDTC patients with clinical lateral LN metastasis. This is due to the fact that the likelihood of postoperative complications by the damage of the spinal accessory nerve increases with level II and level V dissection. Therefore, many studies have been reported on the possibility of omitting levels II (especially IIb) and V during therapeutic comprehensive lateral neck dissection.However, there have been no definite conclusions about it, and it is still debate. In this article, we reviewed to find out optimal lateral neck dissection range for WDTC patients with clinical lateral neck metastasis.