Anterior neck dissection for carcinoma of the thyroid gland

Anterior neck dissection, a regional neck dissection in which the internal jugular chain of nodes is dissected completely but the posterior triangle is left undisturbed, has been developed by us. Metastases of carcinoma of the thyroid to cervical lymph nodes were studied clinically and pathologically in 54 patients who had undergone therapeutic total neck dissections in order to determine selection guidelines for anterior neck dissections. If the 7 patients in whom nodes in the posterior triangle of the neck were palpable preoperatively were eliminated, there were 47 evaluable patients for this portion of the study. Nine (19%) of the 47 patients had nonpalpable but histologically positive nodes in the posterior triangle. If these patients were divided into 4 groups, I, II, III, and IV in which the number of palpable nodes in each was 1, 2, 3, and 4 or more, respectively, the incidence of microscopically positive nodes in each group was 1/20 (5%), 2/11 (18%), 2/8 (25%), and 4/8 (50%), respectively. Twenty-one evaluable anterior neck dissections were performed and followed from 4 to 9 years postoperatively. In 18 patients, there was a single palpable node and in 3 patients, there were 2 palpable nodes. No nodal recurrence has occurred in the necks with a single palpable node, but there has been one recurrence in the group with 2 palpable nodes. We conclude that anterior neck dissection is beneficial to patients with a single palpable node in carcinoma of the thyroid in reducing cosmetic disfigurement and preserving function.