Modified radical neck dissection for differentiated thyroid cancer: operative technique

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Papillary thyroid cancer treatment often involves surgical intervention.
• Standard surgical approach includes subtotal thyroidectomy with modified radical neck dissection (MRND).
• MRND aims to preserve critical anatomical structures for functional and cosmetic outcomes.

Purpose of the Study:

• To describe the standard surgical approach for papillary thyroid cancer using MRND.
• To highlight the indications and contraindications for MRND versus radical neck dissection.
• To emphasize the importance of surgical expertise in performing MRND.

Main Methods:

• Subtotal thyroidectomy combined with MRND on the affected side.
• Utilization of an extended collar incision for skin access.
• Modified MacFee incision employed for metastasis at the carotid artery bifurcation.
• Avoidance of carotid artery or sternocleidomastoid muscle manipulation unless tumor invasion is present.

Main Results:

• MRND successfully preserves the jugular vein, sternocleidomastoid muscle, and accessory nerve.
• The procedure conserves both function and cosmesis post-surgery.
• Berry picking is deemed inappropriate for thyroid cancer patients.
• MRND is demonstrated as a safe procedure when executed by experienced surgeons.

Conclusions:

• MRND is a safe and effective surgical technique for papillary thyroid cancer.
• Preservation of key neck structures is achievable with MRND.
• Surgeons must possess thorough anatomical knowledge, precise staging, and prognostic evaluation skills for optimal MRND outcomes.