Institutional experience with lateral neck dissections for thyroid cancer

• Published in: Surgery Vol. 158; no. 4; pp. 972 - 980
• Main Authors: Glenn, Jason A., MD, Yen, Tina W.F., MD, MS, Fareau, Gilbert G., MD, Carr, Azadeh A., MD, Evans, Douglas B., MD, Wang, Tracy S., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015
• Subjects: Adenoma, Oxyphilic; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma - pathology; Carcinoma - surgery; Carcinoma, Neuroendocrine - pathology; Carcinoma, Neuroendocrine - surgery; Carcinoma, Papillary; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neck Dissection; Postoperative Complications - epidemiology; Retrospective Studies; Surgery; Thyroid Carcinoma, Anaplastic - pathology; Thyroid Carcinoma, Anaplastic - surgery; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Treatment Outcome; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2015.03.066

Introduction Compartment-oriented neck dissection is recommended for patients with evidence of thyroid cancer metastases to lateral compartment lymph nodes. This study reviews the outcomes of patients who underwent lateral neck dissections (LND) at a high-volume institution. Methods This is a retrospective review of patients who underwent LND for metastatic thyroid cancer from January 2009 to June 2014. Preoperative evaluation, operative findings, and postoperative outcomes were analyzed. Results Ninety-six patients underwent 127 LNDs. Fine-needle aspiration (FNA) confirmed metastases in 82 lateral necks (65%). The remaining 45 LNDs (35%) were performed based on clinical suspicion of metastases; 29 (64%) had metastases on final pathology. Twenty patients had 26 complications, which included chyle leak (7 [6%]), spinal accessory nerve dysfunction (7 [6%]), neck seroma requiring drainage (2 [2%]), and surgical site infection (10 [8%]). Conclusion LND is associated with a risk of early postoperative morbidity, but long-term complications are uncommon in the hands of experienced surgeons. In patients with thyroid cancer, a comprehensive preoperative evaluation of the lateral neck with physical examination, ultrasonography, and possible FNA should be performed. For those with suspicion of metastases, LND can be an important therapeutic option, but discussion with the patient regarding potential risks and benefits is essential.