Routine level VI lymph node dissection for papillary thyroid cancer: surgical technique.

Area of Science:

• Oncology
• Surgical Oncology
• Endocrinology

Background:

• Papillary thyroid cancer (PTC) recurrence in cervical lymph nodes affects 10-15% of patients post-total thyroidectomy.
• Lymph node metastases are a significant factor in loco-regional recurrence and disease-related mortality in PTC.
• Modern surveillance using serum thyroglobulin and ultrasound detects lymph node metastases earlier, shifting treatment goals towards disease-free status.

Purpose of the Study:

• To evaluate the role and impact of routine central neck lymph node dissection in managing clinically significant papillary thyroid cancer.
• To assess the morbidity and efficacy of routine lymph node dissection compared to total thyroidectomy alone.

Main Methods:

• Comparative analysis of outcomes following total thyroidectomy with and without routine central neck lymph node dissection.
• Assessment of local recurrence rates, disease-related mortality, and serum thyroglobulin levels at 6 months post-treatment.

Main Results:

• Routine central neck lymph node dissection, when performed with total thyroidectomy, results in lower 6-month stimulated thyroglobulin levels.
• The procedure can be performed with no significant increase in morbidity.
• Regional lymph node metastases are associated with increased tumor recurrence and adverse survival outcomes.

Conclusions:

• Routine central neck lymph node dissection is a safe and effective addition to total thyroidectomy for clinically significant papillary thyroid cancer.
• This surgical approach can improve disease-free status and potentially survival by addressing lymph node metastases more comprehensively.