Paratracheal node dissection for well-differentiated cancer of the thyroid: indications, technique and results

Metastases to regional lymphatics are common in patients with well-differentiated thyroid cancer (WDTC) but the treatment of paratracheal adenopathy remains an issue of controversy among head and neck surgeons. The purpose of the current study was to review the indications for paratracheal neck dissection (PTND) in patients with WDTC. Most of the studies published in the English literature and examining PTND for WDTC were reviewed. No prospective randomized studies exist and thus this review examined the best available data. The occurrence of regional metastases in the paratracheal region is common in patients with WDTC and PTND is a safe and effective treatment for such metastases. Therapeutic PTND is the standard of care in patients with proven metastases to the paratracheal region. Elective PTND seems to be indicated in several groups of patients such as patients with clinically proven metastases in the lateral neck, even if the paratracheal region seems free of metastases on preoperative imaging studies. Male patients older than 45 years of age with thyroid cancer may also be candidates for this procedure. PTND may be indicated in several groups of patients with WDTC either as an elective or therapeutic procedure. Modern imaging and cytopathologic procedures may reveal suspected or proven metastatic disease in the paratracheal lymph nodes, particularly after previous surgery. However, the impact of such disease on the patients survival is questionable. More data regarding the benefit from this procedure in terms of regional control and long-term survival are needed.