World Journal of Endocrine Surgery

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VOLUME 13 , ISSUE 1 ( January-April, 2021 ) > List of Articles

Original Article

Level V Lateral Neck Dissection in FNA-proven Papillary Thyroid Carcinoma

Mohamad S Farahat, Mohamed K Kamel, Doaa A Saad, Hosam M Hamza

Keywords : Chylous leak, Lateral neck dissection, Level V metastases, Lymph nodes, Papillary thyroid carcinoma, Spinal accessory nerve

Citation Information : Farahat MS, Kamel MK, Saad DA, Hamza HM. Level V Lateral Neck Dissection in FNA-proven Papillary Thyroid Carcinoma. World J Endoc Surg 2021; 13 (1):4-8.

DOI: 10.5005/jp-journals-10002-1315

License: CC BY-NC 4.0

Published Online: 20-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


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.

  1. Kim W. A closer look at papillary thyroid carcinoma. Endocrinol Metab (Seoul) 2015;30(1):1–6. DOI: 10.3803/EnM.2015.30.1.1.
  2. Zhu X, Yao J, Tian W. Microarray technology to investigate genes associated with papillary thyroid carcinoma. Mol Med Rep 2015;11(5):3729–3733. DOI: 10.3892/mmr.2015.3180.
  3. Raposo L, Morais S, Oliveira MJ, et al. Trends in thyroid cancer incidence and mortality in Portugal. Eur J Cancer Prev 2017;26(2):135–143. DOI: 10.1097/CEJ.0000000000000229.
  4. Dralle H, Machens A. Surgical management of the lateral neck compartment for metastatic thyroid cancer. Curr Opin Oncol 2013;25(1):20–26. DOI: 10.1097/CCO.0b013e328359ff1f.
  5. Stack BC Jr, Ferris RL, Goldenberg D, et al. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 2012;22(5):501–508. DOI: 10.1089/thy.2011.0312.
  6. Wang L, Ganly I. Nodal metastases in thyroid cancer: prognostic implications and management. Future Oncol 2016;12(7):981–994. DOI: 10.2217/fon.16.10.
  7. Hay ID. Papillary thyroid carcinoma. Endocrinol Metab Clin North Am 1990;19(3):545–576. DOI: 10.1016/S0889-8529(18)30310-4.
  8. Madenci AL, Caragacianu D, Boeckmann J, et al. Lateral neck dissection for well-differentiated thyroid carcinoma: a systematic review. Laryngoscope 2014;124(7):1724–1734. DOI: 10.1002/lary.24583.
  9. Wang Y, Guan Q, Xiang J. Nomogram for predicting level V lymph node metastases in papillary thyroid carcinoma with clinically lateral lymph node metastases: a large retrospective cohort study of 1037 patients from FDUSCC. J Cancer 2019;10(3):772. DOI: 10.7150/jca.28527.
  10. Javid M, Graham E, Malinowski J, et al. Dissection of levels II through V is required for optimal outcomes in patients with lateral neck lymph node metastasis from papillary thyroid carcinoma. J Am Coll Surg 2016;222(6):1066–1073. DOI: 10.1016/j.jamcollsurg.2016.02.006.
  11. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2015;26(1):1. DOI: 10.1089/thy.2015.0020.
  12. Shim MJ, Roh JL, Gong G, et al. Preoperative detection and predictors of level V lymph node metastasis in patients with papillary thyroid carcinoma. Br J Surg 2013;100(4):497–503. DOI: 10.1002/bjs. 9024.
  13. Kim SK, Park I, Hur N, et al. Patterns, predictive factors and prognostic impact of multilevel metastasis in N1b papillary thyroid carcinoma. Br J Surg 2017;104(7):857–867. DOI: 10.1002/bjs.10514.
  14. Kim SK, Park I, Hur N, et al. Should level V be routinely dissected in N1b papillary thyroid carcinoma? Thyroid 2017;27(2):253–260. DOI: 10.1089/thy.2016.0364.
  15. Xu JJ, Yu E, McMullen C, et al. Patterns of regional recurrence in papillary thyroid cancer patients with lateral neck metastases undergoing neck dissection. J Otolaryngol Head Neck Surg 2017;46(1):43. DOI: 10.1186/s40463-017-0221-3.
  16. Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer 2006;106(3):524–531. DOI: 10.1002/cncr.21653.
  17. Eskander A, Merdad M, Freeman JL, et al. Pattern of spread to the lateral neck in metastatic well-differentiated thyroid cancer: a systematic review and meta-analysis. Thyroid 2013;23(5):583–592. DOI: 10.1089/thy.2012.0493.
  18. Yanir Y, Doweck I. Regional metastases in well-differentiated thyroid carcinoma: pattern of spread. Laryngoscope 2008;118(3):433–436. DOI: 10.1097/MLG.0b013e31815ae3e4.
  19. Kupferman ME, Weinstock YE, Santillan AA, et al. Predictors of level V metastasis in well-differentiated thyroid cancer. Head Neck 2008;30(11):1469–1474. DOI: 10.1002/hed.20904.
  20. Lim YC, Choi EC, Yoon YH, et al. Occult lymph node metastases in neck level V in papillary thyroid carcinoma. Surgery 2010;147(2):241–245. DOI: 10.1016/j.surg.2009.09.002.
  21. Zhang XJ, Liu D, Xu DB, et al. Should level V be included in lateral neck dissection in treating papillary thyroid carcinoma? World J Surg Oncol 2013;11(1):304. DOI: 10.1186/1477-7819-11-304.
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