Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node...

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Lateral lymph node metastasis (LLNM) is a risk factor for papillary thyroid microcarcinoma (PTMC) patients.
• The prevalence of LLNM in PTMC is low, and the utility of routine lateral level V dissection (LVD) remains unclear.
• Investigating the benefits and risks of LVD in PTMC patients with LLNM is crucial.

Purpose of the Study:

• To evaluate the impact of routine lateral level V dissection (LVD) on disease-free survival (DFS) in papillary thyroid microcarcinoma (PTMC) patients with lateral lymph node metastasis (LLNM).
• To identify risk factors for level V metastasis in PTMC patients.
• To assess the association of LVD with hospital stay and cost.

Main Methods:

• Retrospective analysis of 6,880 PTMC patients from January 2009 to July 2017.
• Inclusion of 252 N1b PTMC patients with LLNM.
• Multivariate logistic regression analysis to identify risk factors for level V metastasis.

Main Results:

• The overall and occult metastasis rates in level V lymph nodes were 21.4% and 6.4%, respectively.
• LVD did not significantly improve DFS in N1b PTMC patients (hazard ratio = 1.11, p = 0.85).
• LVD increased hospital stay (p = 0.03) and cost (p = 0.02). Three-level simultaneous lateral neck metastasis was an independent risk factor for level V metastasis (odds ratio = 8.6, p = 0.02).

Conclusions:

• Routine LVD is not recommended for N1b PTMC patients without clinical level V metastasis due to low metastasis rates and lack of survival benefit.
• LVD is associated with increased hospital stay and cost.
• Prophylactic LVD may be considered only for N1b PTMC patients with 3-level simultaneous lateral neck metastasis.