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Should Level V Be Routinely Dissected in N1b Papillary Thyroid Carcinoma?
Seo Ki Kim1, Inhye Park1, Nayoon Hur1
11 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea .
Thyroid : Official Journal of the American Thyroid Association
|October 21, 2016
Summary
Routine level V dissection in papillary thyroid carcinoma (PTC) surgery may be unnecessary. Studies show low metastasis rates but increased shoulder syndrome risk, suggesting selective dissection for specific cases.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Modified radical neck dissection (MRND) for N1b papillary thyroid carcinoma (PTC) typically includes levels II-V.
- Routine level V dissection is debated due to low metastasis rates and increased morbidity.
Purpose of the Study:
- To compare outcomes of MRND (levels II-V) versus selective neck dissection (SND; levels II-IV) in N1b PTC patients.
- To assess the necessity and impact of level V dissection in N1b PTC.
Main Methods:
- Retrospective review of 646 N1b PTC patients undergoing unilateral MRND (1997-2015).
- Propensity score matching to compare MRND (II-V) with SND (II-IV).
Main Results:
- Overall and occult level V metastases occurred in 13.9% and 8.6% of patients.
- Level V recurrence was observed in 7.7% of patients who underwent MRND.
- Shoulder syndrome was significantly more frequent after MRND (9.1%) than SND (2.7%).
- Three-level simultaneous metastasis (II-IV) predicted level V metastasis (aOR=3.079).
Conclusions:
- Level V dissection in N1b PTC may be reserved for patients with three-level metastasis or evident level V metastasis.
- Selective neck dissection (levels II-IV) may reduce morbidity like shoulder syndrome.
