Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: A systematic review and meta-analysis

Won, Ho-Ryun; Chang, Jae Won; Kang, Yea Eun; Kang, Jae Yoon; Koo, Bon Seok

doi:10.1016/j.oraloncology.2018.10.035

Cited by 28 publications

(26 citation statements)

References 57 publications

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“…An ongoing debate concerns the optimal extent of therapeutic LND in the management of N1b PTMC patients ( 2 , 19 – 21 ). Considering the excellent prognosis and potential complications associated with surgery, the extensive LND is not well recognized nor yet accepted in the clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have reported the association between the recurrence risk and the extent of LND, but the exact extent of the LND from a prophylactic LND to a comprehensive neck dissection of all lateral neck lymph nodes have not been well understood ( 11 , 23 , 31 , 32 ). A systematic review and meta-analysis ( 19 ) have revealed that the extent of LND may not change the rate of recurrence and recommended SND for N1b PTC patients without any other risk factors. Kobayashi et al ( 10 ) also believed that the conservative SND may represent a suitable treatment for patients at low-risk.…”

Section: Discussionmentioning

confidence: 99%

“…An ongoing debate concerns the optimal extent of therapeutic LND in the management of N1b PTMC patients (2,(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

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Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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Background: The optimal extent of therapeutic lateral neck dissection (LND) in the management of N1b papillary thyroid microcarcinoma (PTMC) is still under debate in clinical practice. In this light, our study aims to explore the incidence, patterns, and predictive factors of the lateral multiple-level metastasis in N1b PTMC patients. Methods: The clinical records of 142 patients diagnosed with N1b PTMC who underwent therapeutic LND from July 2015 to November 2018 at our institution were retrospectively reviewed. Univariate and multivariate analyses were conducted to examine the predictive factors associated with lateral multiple-level metastasis. The recurrence-free survival was analyzed and confirmed by Kaplan–Meier plots and log-rank test. Results: The overall frequency of lateral multiple-level metastasis was 50.7% in N1b PTMC patients, and two-level to four-level simultaneous metastasis were present in 26.8, 17.6, and 6.3% patients, respectively. Extrathyroidal extension (ETE) (OR = 5.79, 95% CI, 1.36–24.59; P = 0.017) and the central metastatic lymph node ratio (CLNR) with values equal or higher than 0.61 (OR = 6.18, 95% CI, 2.53–15.09; P < 0.001) served as independent predictors of multiple-level metastasis in N1b PTMC patients. Moreover, locoregional recurrence was significantly higher in the selective neck dissection (SND) group compared to the modified radical neck dissection (MRND) one (HR = 3.65, 95% CI, 1.11–12.00; P = 0.03). Conclusion: Our results show that the lateral multiple-level metastasis was relatively common, and we suggest MRND to be considered for N1b PTMC patients with ETE or CLNR equal or higher than 0.61.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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“…These findings are similar to those of other studies. [9][10][11] The incidence of metastasis to the posterior cervical region in patients with papillary thyroid carcinoma is low, and few studies have documented the frequency of metastasis at level IIb. Initial nodal spread from papillary thyroid carcinoma occurs in the central compartment of the ipsilateral neck (level VI).…”

Section: Discussionmentioning

confidence: 99%

Relevance of level IIb neck dissection in patients with papillary thyroid carcinoma

et al. 2021

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Background Cervical nodal metastasis is a key prognostic factor in patients with papillary thyroid carcinoma. The role of lymph nodes in papillary thyroid carcinoma management and prognosis remains controversial. Methods Level IIb lymph nodes obtained from 44 patients with papillary thyroid carcinoma were histopathologically examined retrospectively. Specimens were classified as ipsilateral or contralateral. The number of dissected nodes and prevalence of level IIb metastasis were compared according to pre-operative clinical nodal stage. Results In the node-negative neck, the prevalence of contralateral and ipsilateral IIb nodes was 0 out of 20 and 0 out of 3, respectively. In the node-positive neck, the prevalence of contralateral and ipsilateral IIb nodes was 1 out of 13 (7.70 per cent) and 3 out of 41 (7.32 per cent), respectively. Clinically determined and pathologically confirmed level IIb node negativity were significantly associated. Thirty-four patients (77.3 per cent) developed accessory nerve complications from level IIb dissection. Conclusion Level IIb neck dissection for papillary thyroid carcinoma may be required if pre-operative examination reveals multilevel, level IIa or suspicious level IIb metastasis.

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“…28,32 Extensive dissection in these patients will increase the risk of complications, for instance, accessory nerve injury, chyle leakage, skin numbness around the ear, neck and shoulder. [33][34][35][36] When performing lymph node dissection, it is necessary to make clear the scope of dissection, grasp the clear anatomical hierarchy, and protect the vascular branches and nerves. Therefore, in order to ensure the surgical benefit of patients, single regional or several sub-regional lymph node dissections is feasible for PTC patients with SLNM.…”

Section: Discussionmentioning

confidence: 99%

<p>Preoperative Sonographic and Clinicopathological Predictors for Solitary Lateral Neck Node Metastasis in Papillary Thyroid Carcinoma: A Retrospective Study</p>

Yang

Chen

et al. 2020

CMAR

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Background: Cervical lymph node metastasis (LNM) is an independent risk factor for poor prognosis of papillary thyroid carcinoma (PTC), but the scope of PTC lateral neck dissection (LND) is controversial. Solitary lateral lymph node metastasis (SLNM) is a special type of PTC with lateral LNM. Currently, study on the preoperative clinical characteristics of SLNM has been seldomly reported. This study evaluated the preoperative characteristics for predicting the SLNM of PTC. Methods: We included 391 patients diagnosed with PTC between May 2011 and July 2017. Among those patients, 44 had SLNM and 347 had multiple lateral neck node metastasis (MLNM). The clinicopathologic characteristics and other central lymph node metastasis risk factors were retrospectively analyzed. Results: Univariate analysis revealed that age and tumor size (≤1 cm) were significantly correlated with SLNM. In ROC curve analysis, the optimal cutoff age of preoperative predictors for the prediction of SLNM was 46.5 years (AUC=0.623, 0.536-0.710). Besides, the frequency and mean number of CLNM was significantly less in the SLNM than MLNM group. The oval and round tumor shape and well-defined margin of the tumor were more common in the SLNM group (p =0.001; p=0.024, respectively). In addition, multivariate analysis revealed that age ≥47, capsular invasion, no extrathyroidal extension, with central lymph node metastases and irregular shape were independent SLNM predictors of PTCs (odds ratio 2.386, 0.173, 0.284, 0.239, 0.188; 95%

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Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: A systematic review and meta-analysis

Cited by 28 publications

References 57 publications

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Relevance of level IIb neck dissection in patients with papillary thyroid carcinoma

<p>Preoperative Sonographic and Clinicopathological Predictors for Solitary Lateral Neck Node Metastasis in Papillary Thyroid Carcinoma: A Retrospective Study</p>

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