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Surgery of the Thyroid and Parathyroid Glands pp 223–234Cite as

Modified Radical Neck Dissection

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Abstract

The role of neck dissection in the management of thyroidcancer is controversial, due to the indolent natural history of mostwell-differentiated thyroid cancers (WDTC), as well as the high prevalence of clinically apparent or occult lymph node metastases. This is particularly true in papillary thyroid carcinoma, where high rates of nodal positivity are found even in microcarcinomas; Wada et al. have reported a 64% rate of nodal metastasis in the central neck and 45% in the lateral neck. Lymph node metastasis is more likely in cancers harboring the BRAF V600E mutation. Despite the high rate of nodal involvement, there are no prospective data on the impact of lateral neck dissection on survival or locoregional recurrence. Although Noguchi et al. reported an improvement in cause-specific survival among patients with WDTC undergoing modified radical neck dissection (MRND), there was no difference in overall survival, and this study was performed in a cohort not receiving adjuvant radioactive iodine therapy.

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References

  1. Wada N, Duh QY, Sugino K et al (2003) Lymph node metastases from 259 papillary thyroid microcarcinomas. Ann Surg 237:399–407

    PubMed  Google Scholar 

  2. Rodolico V, Cabibi D, Pissolanti G et al (2007) BRAFV600E mutation and p27kip1 expression in papillary carcinomas of the thyroid < or = 1 cm and their paired lymph node metastases. Cancer 110:1218–1226

    Article  PubMed  Google Scholar 

  3. Basolo F, Torregrossa L, Giannini R et al (2010) Correlation between the BRAF V600E mutation and tumor invasiveness in papillary thyroid carcinomas smaller than 20 millimeters: analysis of 1060 cases. J Clin Endocrinol Metab 95:4197–4205

    Article  PubMed  CAS  Google Scholar 

  4. Noguchi S, Murakami N, Yamashita H et al (1998) Papillary thyroid carcinoma: modified radical neck dissection improves prognosis. Arch Surg 133:276–280

    Article  PubMed  CAS  Google Scholar 

  5. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  6. Greene FL et al (eds) (2002) AJCC cancer staging manual, 6th edn. Springer, New York, pp 77–87

    Google Scholar 

  7. Crile G (1906) Excision of cancer of the head and neck. JAMA 47:1786–1789

    Google Scholar 

  8. Bocca E, Pignataro O, Sasaki CT (1980) Functional neck dissection: a description of operative technique. Arch Otolaryngol 106:524–527

    Article  PubMed  CAS  Google Scholar 

  9. Robbins KT, Shaha AR, Medina JE et al (2008) Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 134:536–538

    Article  PubMed  Google Scholar 

  10. Stulak JM, Grant CS, Farley DR et al (2006) Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 141:489–494

    Article  PubMed  Google Scholar 

  11. Kouvaraki MA, Shapiro SE, Fornage BD et al (2003) Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery 134:946–955

    Article  PubMed  Google Scholar 

  12. Bhattacharyya N (2003) Surgical treatment of cervical nodal metastases in patients with papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 129:1101–1104

    Article  PubMed  Google Scholar 

  13. Shaha AR (2004) Prognostic factors in papillary thyroid carcinoma and implications of large nodal metastasis. Surgery 135:237–239

    Article  PubMed  Google Scholar 

  14. Kloos RT, Eng C, Evans DB et al (2009) Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 19:565–612

    Article  PubMed  Google Scholar 

  15. Raina S, Rocko JM, Swaminathan AP et al (1983) Current attitudes in the management of thyroid cancer. Am Surg 49:110–112

    PubMed  CAS  Google Scholar 

  16. Nicolosi A, Malloci A, Esu S et al (1993) The role of node-picking lymphadenectomy in the treatment of differentiated carcinoma of the thyroid. Minerva Chir 48:459–463

    PubMed  CAS  Google Scholar 

  17. Munacchio MJ, Kim AW, Vijungco JD, Prinz RA et al (2003) Greater local recurrence occurs with “berry picking” than neck dissection in thyroid cancer. Am Surg 69:191–197

    Google Scholar 

  18. Gemsenjäger E, Perren A, Seifert B et al (2003) Lymph node surgery in papillary carcinoma. J Am Coll Surg 197:182–190

    Article  PubMed  Google Scholar 

  19. Kupferman ME, Patterson DM, Mandel SJ et al (2004) Safety of modified radical neck dissection for differentiated thyroid carcinoma. Laryngoscope 114:403–406

    Article  PubMed  Google Scholar 

  20. Kupferman ME, Weinstock YE, Santillan AA et al (2008) Predictors of level V metastasis in well-differentiated thyroid cancer. Head Neck 30:1469–1474

    Article  PubMed  Google Scholar 

  21. Roh JL, Kim JM, Park C II (2008) Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol 15:1177–1182

    Article  PubMed  Google Scholar 

  22. Lee J, Sung TY, Nam KH et al (2008) Is level IIb lymph node dissection always necessary in N1b papillary thyroid carcinoma patients? World J Surg 32:716–721

    Article  PubMed  Google Scholar 

  23. Farrag T, Lin F, Brownlee N et al (2009) Is routine dissection of level II-B and V-A necessary in patients with papillary thyroid cancer undergoing lateral neck dissection for FNA-confirmed metastases in other levels. World J Surg 33:1680–1683

    Article  PubMed  Google Scholar 

  24. Leboulleux S, Girard E, Rose M et al (2007) Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab 92:3590–3594

    Article  PubMed  CAS  Google Scholar 

  25. Kuna SK, Bracic I, Tesic V et al (2006) Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer. J Ultrasound Med 25:1531–1537

    PubMed  Google Scholar 

  26. Sivanandan R, Soo KC (2001) Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid. Br J Surg 88:1241–1244

    Article  PubMed  CAS  Google Scholar 

  27. Machens A, Hinze R, Thomusch O et al (2002) Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26:22–28

    Article  PubMed  Google Scholar 

  28. Caron NR, Tan YY, Ogilvie JB et al (2006) Selective modified radical neck dissection for papillary thyroid cancer – is level I, II and V dissection always necessary? World J Surg 30:833–840

    Article  PubMed  CAS  Google Scholar 

  29. Pingpank JF, Sasson AR, Hanlon AL et al (2002) Tumor above the spinal accessory nerve in papillary thyroid cancer that involves lateral neck nodes. Arch Otolaryngol Head Neck Surg 128:1275–1278

    PubMed  Google Scholar 

  30. Uchino S, Noguchi S, Yamashita H et al (2004) Modified radical neck dissection for differentiated thyroid cancer: operative technique. World J Surg 28:1199–1203

    Article  PubMed  Google Scholar 

  31. Koo BS, Seo ST, Lee GH et al (2010) Prophylactic lymphadenectomy of neck level II in clinically node-positive papillary thyroid carcinoma. Ann Surg Oncol 17:1637–1641

    Article  PubMed  Google Scholar 

  32. Schoder H, Carlson DL, Kraus DH et al (2006) 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med 47:755–762

    PubMed  Google Scholar 

  33. Slattery WH 3rd, Stringer SP, Cassisi NJ (1995) Prophylactic antibiotic use in clean, uncontaminated neck dissection. Laryngoscope 105:244–246

    Article  PubMed  Google Scholar 

  34. Ito Y, Higashiyama T, Takamura Y et al (2007) Risk factors for recurrence to the lymph node in papillary thyroid carcinoma patients without preoperatively detectable lateral node metastasis: validity of prophylactic modified radical neck dissection. World J Surg 31:2085–2091

    Article  PubMed  Google Scholar 

  35. Seven H, Sayin I, Turgut S (2004) Antibiotic prophylaxis in clean neck dissections. J Laryngol Otol 118:213–216

    Article  PubMed  Google Scholar 

  36. Cappiello J, Piazza C, Nicolai P (2007) The spinal accessory nerve in head and neck surgery. Curr Opin Otolaryngol Head Neck Surg 15:107–111

    Article  PubMed  Google Scholar 

  37. Nahum AM, Mullally W, Marmor L (1961) A syndrome resulting from radical neck dissection. Arch Otolaryngol 74:424–428

    Article  PubMed  CAS  Google Scholar 

  38. Roh JL, Kim DH, Park CIL (2007) Prospective identification of chyle leakage in patients undergoing lateral neck dissection for metastatic thyroid cancer. Ann Surg Oncol 15:424–429

    Article  PubMed  Google Scholar 

  39. Nussenbaum B, Liu JH, Sinard RJ (2000) Systematic management of chyle fistula: the Southwestern experience and review of the literature. Otolaryngol Head Neck Surg 122:31–38

    Article  PubMed  CAS  Google Scholar 

  40. Erisen L, Coskun H, Basut O (2002) Objective and early diagnosis of chylous fistula in the postoperative period. Otolaryngol Head Neck Surg 126:172–175

    Article  PubMed  Google Scholar 

  41. Rodgers GK, Johnson JT, Petruzzelli GJ et al (1992) Lipid and volume analysis of neck drainage in patients undergoing neck dissection. Am J Otolaryngol 13:306–309

    Article  PubMed  CAS  Google Scholar 

  42. Shaha AR (2007) Complications of neck dissection for thyroid cancer. Ann Surg Oncol 1:397–399

    Google Scholar 

  43. Collard JM, Laterre PF, Boemer F et al (2000) Conservative treatment of postsurgical lymphatic leaks with somatostatin-14. Chest 117:902–905

    Article  PubMed  CAS  Google Scholar 

  44. Itkin M, Kucharczuk JC, Kwak A et al (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139:584–590

    Article  PubMed  Google Scholar 

  45. de Gier HHW, Balm AJ, Bruning PF et al (1996) Systematic approach to the treatment of chylous leakage after neck dissection. Head Neck 18:347–351

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Beth Israel Medical Center, 10 Union Square East, Ste 4E11, New York, NY, 10003, USA

    Jennifer L. Marti M.D.

  2. Department of Surgery, Yale University School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA

    Robert Udelsman M.D., M.B.A.

Authors
  1. Jennifer L. Marti M.D.
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  2. Robert Udelsman M.D., M.B.A.
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Corresponding author

Correspondence to Robert Udelsman M.D., M.B.A. .

Editor information

Editors and Affiliations

  1. Chairman, Department of Surgery, University Hospital Basel, Spitalstr. 21, Basel, 4031, Switzerland

    Daniel Oertli

  2. Yale-New Haven Hospital, Department of Surgery, Yale University School of Medicine, Cedar Street 330FMB 102, New Haven, CT, 06520-8062, USA

    Robert Udelsman

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© 2012 Springer-Verlag Berlin Heidelberg

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Marti, J.L., Udelsman, R. (2012). Modified Radical Neck Dissection. In: Oertli, D., Udelsman, R. (eds) Surgery of the Thyroid and Parathyroid Glands. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-23459-0_17

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  • DOI: https://doi.org/10.1007/978-3-642-23459-0_17

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-23458-3

  • Online ISBN: 978-3-642-23459-0

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