Purpose : Papillary thyroid carcinoma(PTC) has a very high rate of lateral neck node metastases, and completeness of surgical resection is an important determinant of outcomes. The extent of therapeutic lateral neck dissection remains controversial. This study aims to access the impact of lateral neck node dissection of levels II to V in a large patient series.
A retrospective review of the clinical charts and hospital records of 778 consecutive patients who had metastatic PTC and who underwent unilateral cervical lymph node dissection at a single institution between 1999 January and 2009 December .
A total of 289 modified radical neck dissection(MRND) (levels II~V) and 489 internal jugular node dissection(IJND)(level II~IV) were performed in 781 patients. Among these initial dissections, 391(50.1%), 585(74.0%), 517(66.2%), and 98(12.5%) had positive lymph nodes in levels II, III, IV, and V, respectively. In multivariate analysis, female sex, tumor size, and multi-level simultaneous metastasis was an independent predictor for level V metastasis. A total of 84(10.8%) metastases occurred after initial operations and there were 5 patients of level V recurrence(one in SLND and four in MRND). Postoperative complications were similar in MRND and IJND group.
Conclusions : IJND achieves favorable postoperative results in PTC with lateral neck node metastasis patients and level V metastasis/recurrence incidence is low. Therefore, the extent of lateral neck node dissection whether IJND or MRND can be considered who showed multi-level simultaneous metastasis and large tumor size patients.