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Surgical Management of Right Innominate Interarteriovenous Lymph Node Metastasis in Thyroid Carcinoma: Clinical
Zhaoyang Wang1, Fa Zhang1, Qing Zhou2
1Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background:
The right innominate interarteriovenous lymph nodes (RIAVLN) represent a distinct nodal group situated between the right innominate artery and vein. This area lies outside the conventional level VI-VII boundaries in thyroid carcinoma surgery and is seldom addressed in standard guidelines. Metastasis in this region is difficult to detect and surgically challenging due to its proximity to major vascular structures. This study aimed to analyze the clinical characteristics and surgical management of RIAVLN metastasis in patients with thyroid carcinoma.
Methods:
We retrospectively reviewed 103 patients with thyroid carcinoma who underwent RIAVLN dissection between July 2017 and January 2024. All patients had preoperative contrast-enhanced CT scans suggesting nodal metastasis in this region. Demographic data, tumor subtype, surgical approach, and pathological findings were analyzed. The surgical technique emphasized cervical exposure of the carotid sheath, mobilization of the common carotid artery, and careful dissection of the interarteriovenous space, with partial sternotomy reserved for cases with severe adhesion or bleeding risk.
Results:
The mean patient age was 39.9 ± 12.3 years (range, 18-68), with 42 males and 61 females. The cohort included 24 primary papillary, 63 recurrent papillary, 2 primary medullary, and 13 recurrent medullary thyroid carcinoma cases. Overall, 93 patients (90.3%) were successfully treated via a transcervical approach, while 10 (9.7%) required partial sternotomy. The mean number of RIAVLN dissected was 3.1 ± 2.9, and metastasis was confirmed in 77 patients (74.8%). The mean number of metastatic nodes among positive cases was 1.5 ± 2.4, with extranodal extension observed in 12 patients (11.7%). No major vascular injury or operative mortality occurred.
Conclusions:
RIAVLN metastasis is relatively common in recurrent thyroid carcinoma and represents an anatomically unique nodal group not covered by traditional classifications. In most cases, complete clearance can be safely achieved through a transcervical approach. Partial sternotomy should be reserved for patients with dense adhesions or high bleeding risk. Recognition of this region as a potential site of recurrence and mastery of its surgical anatomy are crucial for achieving optimal oncologic outcomes in thyroid cancer surgery.
