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Management of Retropharyngeal Lymph Node Metastases in Thyroid Cancer

Isabelle Fournier1, Ashwini Venkata Bandi1, Sarah Hamidi2

  • 1Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Head & Neck
|September 2, 2025
PubMed
Abstract

Insights

Thyroid cancer with retropharyngeal lymph node (RPLN) metastases is rare. These metastases grow slowly, with larger ones often managed surgically with minimal long-term issues.

Area of Science:

  • Oncology
  • Head and Neck Surgery
  • Endocrinology

Background:

  • Retropharyngeal lymph node (RPLN) metastases are uncommon in thyroid cancer.
  • Optimal management strategies for these metastases remain underreported.

Purpose of the Study:

  • To analyze the management and outcomes of thyroid cancer patients with RPLN metastases.
  • To evaluate the growth patterns and treatment efficacy for RPLN metastases.

Main Methods:

  • Retrospective analysis of 167 thyroid cancer patients with RPLN metastases treated between 2000 and 2024.
  • Patients were categorized into active surveillance, surgical, and nonsurgical treatment groups.
  • Surgical approaches included transcervical, transoral robotic, and transoral methods.

Main Results:

  • RPLN metastases demonstrated slow growth, with a median annual increase of 3% in size.
  • Surgery was the primary treatment for metastases ≥1 cm, with low rates of post-operative dysphagia (11%) and velopharyngeal insufficiency (1%).
  • Nonsurgical options included radioactive iodine, radiation therapy, and systemic targeted therapy.

Conclusions:

  • Retropharyngeal lymph node metastases in thyroid cancer exhibit slow growth.
  • Surgical resection is effective for larger metastases (≥1 cm) with generally low long-term morbidity.
Keywords:
medullarypapillaryretropharyngeal lymph node metastasessurgerythyroid cancer

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