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Long-Term Outcomes of Lateral Neck Dissection in Patients with Recurrent or Persistent Well-Differentiated Thyroid
Steven B Chinn1,2, Mark E Zafereo1, Steven G Waguespack3
11 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston, Texas.
Thyroid : Official Journal of the American Thyroid Association
|August 16, 2017
Summary
Comprehensive lateral neck dissection (LND) for recurrent well-differentiated thyroid carcinoma (WDTC) offers excellent long-term regional control and survival. This effective treatment for WDTC recurrence has a low complication rate.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Well-differentiated thyroid carcinoma (WDTC) frequently metastasizes to regional lymph nodes.
- Lateral neck recurrence rates can reach 24% after initial treatment for WDTC.
- Adjuvant radioactive iodine (RAI) treatment is common but does not eliminate recurrence risk.
Purpose of the Study:
- To assess the efficacy and safety of comprehensive lateral neck dissection (LND) for recurrent or persistent WDTC.
- To evaluate the long-term outcomes of LND in managing lateral neck WDTC recurrence.
- To analyze survival rates and regional control after LND in a tertiary referral center.
Main Methods:
- Retrospective analysis of 429 LND procedures for recurrent WDTC in 307 patients.
- Standardized LND of levels II-V for cytopathology-confirmed lateral neck recurrence.
- Survival analysis using Cox regression, with a median follow-up of 7.2 years.
Main Results:
- 96% in-field lateral neck control at 10 years; 88% overall regional control.
- 10-year overall survival (OS) was 78%, and disease-specific survival (DSS) was 91%.
- Younger patients (<50 years) had better OS and DSS, but worse neck control (<24 years).
- Ultimate lateral neck regional control reached 98% after salvage LND for recurrences.
Conclusions:
- Expert comprehensive LND of levels II-V is safe and highly effective for recurrent WDTC.
- This surgical approach achieves excellent long-term in-field and overall regional control.
- LND is a critical component in managing persistent or recurrent WDTC in the lateral neck.
