Aim and objective: Papillary thyroid carcinoma (PTC) constitutes 80% of thyroid cancer cases. It has a high risk for lymph node metastases in both central and lateral compartments of the neck. This study is an attempt to better define the need for level V dissection in PTC, possible predictors of involvement, and rate of complications.
Materials and methods: In the General Surgery Department, Minia University Hospital, Egypt, 35 patients diagnosed with PTC were subjected to lateral neck dissection (LND) in the period from October 2015 till January 2019. In LND, we spared the internal jugular vein, spinal accessory nerve, and sternocleidomastoid muscle. All neck specimens were intraoperatively labeled by level for the pathologist.
Results: Ten patients (28.6%) were males and 25 (71.4%) were females. Total level V metastases were detected in 20 specimens (38.5%) all having level Vb metastases except three specimens having metastases in level Va (no skip metastases). Level III metastases were more frequent than level V and level II. 67.3% of specimens were positive for extrathyroidal extension (ETE) and 57.7% positive for lymphovascular invasion. Injury of the spinal accessory nerve was detected in one case; 1.9% and chylous leak in one case; 1.9%.
Conclusion: In experienced hands, including level V leads to better local control without a high rate of complications. We concluded that formal modified radical neck dissection (MRND) is necessary to reduce the morbidity of reoperation surgery in PTC.
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