Indications for Bilateral Modified Radical Neck Dissection in Patients With Papillary Carcinoma of the Thyroid

Abstract

Hypotheses: After subtotal thyroidectomy with modified radical neck dissection of the affected side, nodal recurrence at the contralateral cervical side indicates a poor prognosis for patients with papillary thyroid cancer. Bilateral modified radical neck dissection is beneficial for patients at high risk for contralateral nodal recurrence.

Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.

“…Therefore, the decision to dissect both ipsi-and contralateral compartments should take into account the high probability of cure in a limited proportion of patients and surgery-related inconveniences (longer operation, cosmetic and painful sequels) for all. When thyroid tumour is bilateral, dissection of both lateral compartments appears to be indicated at first attempt as previously suggested (26).…”

Patterns of Lateral Neck Metastasis in Papillary Thyroid Carcinoma

“…11 Bilateral NDs have also been advocated by some surgeons. 12,13 There is no clear consensus regarding the appropriate levels of the neck that must be removed.…”

Metástasis cervical de carcinoma papilar tiroideo oculto

“…48 En cuanto a la necesidad de un vaciamiento cervical radical modificado bilateral, algunos estudios aconsejan su realización en aquellos casos que presentan un alto riesgo de metástasis ganglionares contralaterales como son: aquellos con un tumor primario de gran tamaño o cercano al istmo tiroideo, con extensión extracapsular, invasión de tejidos vecinos o presencia de linfadenopatías de gran tamaño. 49 39 ), the greatest incidence found in autopsy studies seems to suggest that most of these follow a benign course. 40 In a recent study Ito & cols. 41 25,35,42,43 Even in a small percentage of patients the presence of distant metastasis was observed.…”

“…48 With regard to the need for bilateral modified radical neck dissection, some studies advise carrying this out in those cases that present a high risk of contralateral lymph node metastasis such as: those with a primary tumor of a large size or near the thyroid isthmus, with extracapsular extension, invasion of neighboring tissue or the presence of lymphadenopathies of a large size. 49 With regard to papillary thyroid carcinoma, given the development of imaging techniques for diagnosis and the use of fine needle aspiration, there has been an increase in incidental diagnoses in recent years. As a result, there has been controversy surrounding the need for therapy in these cases and how extensive this should be.…”