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Updated: May 25, 2026
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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Level V in therapeutic neck dissections for papillary thyroid carcinoma
Avi Khafif1, Jesus E Medina, K Thomas Robbins
1Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel. avironit@Bezeqint.net
Head & Neck
|January 31, 2012
Summary
Neck dissection for papillary thyroid carcinoma (PTC) requires careful consideration of lymph node levels. This study suggests level V dissection, particularly sublevel VB, may be indicated in specific cases of regional metastasis.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Neck dissection is standard for papillary thyroid carcinoma (PTC) with regional metastases.
- The optimal extent of neck dissection, particularly concerning level V, remains debated.
Purpose of the Study:
- To develop evidence-based recommendations for including level V or its sublevels in neck dissections for PTC patients.
- To clarify the risk of metastasis to level V lymph nodes in PTC.
Main Methods:
- A comprehensive literature review was conducted.
- Studies evaluating the occurrence of metastases in level V of the neck in PTC patients with regional metastases were analyzed.
Main Results:
- Metastases to level V occur in 5% to 10% of cases, with significant variability.
- When present, metastases in level V are almost exclusively found in sublevel VB, with rare involvement of sublevel VA.
- Recent studies increasingly specify risk by sublevels of level V.
Conclusions:
- Therapeutic dissection of level V is warranted with clinical evidence of disease in this zone.
- Elective dissection of sublevel VB is recommended if level IV is involved, or with multiple positive nodes in levels II and III.
- Sublevel VA may often be spared even when sublevel VB dissection is indicated.
