The Impact of Neck Dissection on Health-Related Quality of Life

Abstract

Objective: To compare health-related quality of life in patients having no neck dissection and those having a selective dissection, with particular reference to shoulder dysfunction.

Risk factors for level V lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases

“…Extensive LND has the potential to decrease regional recurrence and increase disease‐free survival, but may lead to clinically important postoperative morbidities 13, 14, 15. Therefore, determining a rational extent of therapeutic LND is vital.…”

“…On the basis of the above reasons and the prognostic significance, it is universally agreed that therapeutic LND should include at least a comprehensive but selective LND of levels II–IV. However, whether therapeutic LND should routinely include level V lymphadenectomy remains controversial 13, 14, 15, 16, 17, 18, 19, 20, 21, 22.…”

“…The risk of postoperative morbidity (especially injury to the spinal accessory nerve and cervical plexus) that can lead to increased morbidity and affect the quality of life increases with the extent of LND. Therefore, the necessity of routine level V dissection has been questioned 13, 14, 15. Furthermore, because level V LNM are comparatively rare, some researchers have suggested that routine level V dissection is not necessary for patients with PTC and lateral cervical lymphadenopathy 16, 17, 18.…”

“…However, determining the appropriate extent of LND remains controversial. Radical operations, such as those with increased extent of LND, may lead to clinically important postoperative morbidities (shoulder dysfunction, neck numbness, and neuropathic pain) because of injury to the spinal accessory nerve or the cervical plexus despite gross preservation of these nerves 13, 14, 15. Therefore, an oncologically effective therapeutic LND is critical to postoperative outcome.…”

The Study of Utility of Single Drop Neck Incision for Neck Dissection

“…Similar improvement in shoulder function was observed in a study done by Lavericks who compared the neck dissec tion unilateral vs bilateral with patients treated without the neck dissection. 11 Twelve patients reported that they had difficulty in lifting weights, five of whom had pain in shoulder or neck. This may be due to nonfunctioning spinal acce ssory nerve, lack of physiotherapy and some amount of shoulder joint capsulitis.…”