Management of Retropharyngeal Lymph Node Metastases in Thyroid Cancer

Retropharyngeal lymph node (RPLN) metastases in thyroid cancer are rare, with optimal management underreported.

Retrospective study of consecutive thyroid cancer patients with RPLN metastases treated at MD Anderson Cancer Center between 2000 and 2024.

One hundred and sixty-seven patients (75% differentiated, 21% medullary, 4% poorly differentiated thyroid cancer) were divided into three groups: active surveillance (AS) (13%), surgery (56%), and nonsurgical treatment (31%). In the AS group (median follow-up 2.3 years), RPLN metastases grew a median 3% (range: 0-56) or 0.02 cm (range: 0-0.7) per year. Surgical therapy included transcervical (73%), transoral robotic (14%), transoral (12%), and transmandibular (1%) approaches. Median RPLN metastasis size was 1.7 cm (interquartile range: 1.3-2.2) at surgery. Three months post-operatively, 11% had dysphagia and 1% had velopharyngeal insufficiency. Nonsurgical treatments included radioactive iodine (10%), radiation therapy (11%), and systemic targeted therapy (79%).

RPLN metastases grow slowly, and those ≥ 1 cm typically undergo surgical resection without significant long-term morbidity.