Therapeutic lateral neck dissection in well‐differentiated thyroid cancer: Analysis on factors predicting distribution of positive nodes and prognosis

• Published in: Head & neck Vol. 40; no. 2; pp. 242 - 250
• Main Authors: Lombardi, Davide, Paderno, Alberto, Giordano, Davide, Barbieri, Diego, Taboni, Stefano, Piazza, Cesare, Cappelli, Carlo, Bertagna, Francesco, Barbieri, Verter, Piana, Simonetta, Bellafiore, Salvatore, Spriano, Giuseppe, Mercante, Giuseppe, Nicolai, Piero
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cardiovascular system; Dissection; Female; Head and neck; Humans; lateral neck metastases; Lymphatic Metastasis; Male; Medical prognosis; Metastases; Metastasis; Middle Aged; Neck; Neck Dissection; neck levels; Neoplasm Recurrence, Local; Postoperative Complications - epidemiology; Prognosis; Retrospective Studies; survival; Survival Analysis; Thyroid cancer; Thyroid carcinoma; Thyroid Neoplasms - mortality; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; well‐differentiated thyroid cancer; Young Adult; lateral neck metastases; neck dissection; neck levels; well-differentiated thyroid cancer; survival
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.24936

Background Neck dissection is considered the treatment of choice in patients with lateral neck metastases from well‐differentiated thyroid cancer. Methods A multicenter, retrospective review of patients who underwent therapeutic lateral neck dissection for well‐differentiated thyroid carcinoma was carried out. Results The study included a total of 405 lateral neck dissections performed in 352 patients; 197 women (56%) and 155 men (44%). When considering ipsilateral neck metastases, levels IIa, IIb, III, IV, Va, Vb, and V (not otherwise specified) were involved in 42%, 6%, 73%, 67%, 11%, 31%, and 35% of cases, respectively. Five‐year and 10‐year overall survival (OS) were 93% and 81%, respectively. Age >55 years, pathologic T (pT)4 category, tumor diameter >4 cm, aggressive variants of well‐differentiated thyroid carcinoma, endovascular invasion, and number of positive nodes >5 turned out to be the most important prognostic factors. Conclusion Neck dissection is a valid treatment option in the presence of neck metastasis from well‐differentiated thyroid carcinoma. Levels IIa, III, IV, and Vb should always be removed.