Related Experiment Video
Updated: Aug 2, 2025
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Level II lateral neck dissection for papillary thyroid carcinoma: A retrospective cohort study
Tian Lv1, Wen-Li Ma2, Zhuo Tan1
1Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China.
Papillary thyroid carcinoma (PTC) patients with lateral neck disease often have level II lymph node metastasis. Primary tumor location and multi-level lymph node involvement are key risk factors, guiding dissection decisions.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Lateral neck dissection (LND) including levels II-V is standard for N1b papillary thyroid carcinoma (PTC).
- Routine level II dissection is debated due to low metastasis rates and risks like shoulder syndrome.
Purpose of the Study:
- To evaluate the incidence and risk factors for level II lymph node metastasis in N1b PTC patients undergoing LND.
- To identify predictive factors for occult level II metastases to refine surgical strategies.
Main Methods:
- Retrospective analysis of N1b PTC patients undergoing LND (Jan 2019 - Apr 2021).
- Examination of clinicopathological features including tumor characteristics and lymph node status.
- Multivariate analysis to identify independent risk factors for level II metastasis.
Main Results:
- 51.83% overall and 34.84% occult level II metastases were found in cN1b PTC patients.
- Primary tumor location, primary tumor characteristics, and positive level V were independent risk factors for level II metastasis.
- For patients without suspected level II nodes, primary tumor location, and positive levels III/V predicted occult metastases.
Conclusions:
- Level II metastasis is common in PTC patients with lateral neck disease.
- Primary tumor location and multi-level nodal involvement are significant predictors of level II metastasis.
- Tumors <1cm in the lower two-thirds of the lobe have minimal risk of level II metastasis, potentially avoiding routine dissection.
