Surgical treatment strategy for thyroid gland carcinoma nodal metastases

Abstract

The authors present their experience with surgical treatment for nodal metastases of thyroid carcinoma based on neck dissections. The specificity of the surgical approach to the lymph nodes was determined by the biologic behavior of each thyroid tumor. Using the available literature on metastases from thyroid tumors, an opinion is supported that surgery for differentiated carcinomas (papillary and follicular neoplasms) can be more conservative and can be safely limited to modified neck dissections. In contrast, a more extended type of selective neck dissection, and only rarely a comprehensive neck dissection, is needed for medullary carcinoma. Because of its rapid spread to distant sites local aggressivity, extirpation of individual lymph nodes or neck dissection is not justified in patients with anaplastic thyroid carcinoma.

Thyroid surgery in children and adolescents

“…They substantiate this approach by patient's mutilation, not considered as desirable in pediatric patients [21]. The opinion of diminishing of neck dissection radicalness in order to restrict the mutilation is considered as obsolete nowadays [9,11,17].…”

“…Some authors recommend some less radical surgeries in cases of differentiated thyroid cancer [9,17]. Some papers [6,11,16,17,[20][21][22] recommend selective radical neck dissections in thyroid malign tumors. On the other hand some authors accept only excision of the concerned nodules and indicate a neck dissection only on an individual basis.…”

“…Thyroid (neck) ultrasound, completed with aspiration cytology is useful for the cytology diagnosis of the thyroid disease [9][10][11][12][13][14][15]. The examination by an otorhinolaryngologist is indicated in tumor diseases, in a hoarseness and before a scheduled thyroid surgery.…”

“…The extent of the thyroid surgery is a not completely solved problem in thyroid surgery [9,11,[16][17][18][19][20]. The tactics of the surgical treatment depends on the biological nature of the disease.…”

Surgical Management of the Neck in Thyroid Cancer

“…Surgery is often not indicated, even with overt metastases, because the primary cancer is seldom amenable to surgical excision [8]. If the primary tumor is easily removed, neck dissection is indicated for gross disease.…”