Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients

Abstract

Background: Prognostic value of prophylactic level VII nodal dissection in papillary thyroid carcinoma has been highlighted. Materials and Methods: A total of 27 patients with papillary thyroid carcinoma with N0 neck underwent total thyroidectomy with level VI and VII nodal dissection through same collar neck incision. Multicentricity, bilaterality, extrathyroidal extension, level VI and VII lymph nodes were studied as separate and independent prognostic factors for DFS at 24 months. Results: 21 females and 6 males with a mean age of 34. Conclusions: Level VII prophylactic nodal dissection is an important and integral prognostic factor in papillary thyroid carcinoma. A larger multicenter study is crucial to reach a satisfactory conclusion about the necessity and safety of this approach.

Competing-Risks Model for Predicting the Postoperative Prognosis of Patients with Papillary Thyroid Adenocarcinoma Based on The Surveillance, Epidemiology, and End Results (SEER) Database

“…There have been many investigations of the prognostic factors for PTC [ 6 – 8 ], but almost all of them have used traditional survival-analysis methods when analyzing multiple potential factors, such as the Kaplan-Meier marginal regression analysis of patient survival probability, the log-rank test for comparing survival curves, or the Cox proportional-hazards model. The premise of regression in traditional survival analysis is to assume that the censoring time is independent of the expiration time, which assumes that there is no competing risk present and that the outcome is a single endpoint [ 9 ].…”

Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

“…Since level VI, which sits high up in the neck, as well as level VII, which is hidden behind the manubrium sterni and medial thirds of both clavicles, cannot be assessed accurately by ultrasound and CT with poor sensitivity ranging between 50 and 70 % Mulla (2012), in addition, normal-sized, Level VII lymph nodes can still harbor macrometastatic disease (Wang et al, 2013), and since level VII nodes are an important and integral prognostic factor in papillary thyroid carcinoma (Choi et al, 2011;Wang et al, 2013;Fayek 2015); the dissection of those nodal groups is an important step in the management plan of PTC.…”

“…Many studies highlighted the prognostic importance of additional dissection of level VII nodes as an integral and complementary component to Level VI neck nodes in pCND through the same cervical neck incision required for PTC (Choi et al, 2011;Wang et al, 2013;Fayek 2015), However only one study addressed the safety of the procedure regarding hypoparathyroidism and vocal cord dysfunction (Wang et al, 2013) requesting further studies to highlight and evaluate the previous results.…”