Advertisement

Thyroid Cancer pp 543-544 | Cite as

Surgical Management of Lymph Node Metastases

  • Gerard M Doherty
Chapter

Abstract

Lymph node metastases are common with some types of thyroid cancer, and less common with others. Papillary thyroid cancer quite commonly includes spread to the lymph nodes at presentation, which can be managed by operative resection, radioiodine therapy, or a combination of both. The management strategy for potential nodal disease depends first upon the identification of the disease when present. The preoperative documentation of nodal disease allows the patient and the surgeon to plan appropriate intervention. If the staging ultrasound does not show node metastases, then there should be an active evaluation of the central (level 6) lymph nodes during operation for evidence of metastasis.

Keywords

Malignant thyroid tumors Papillary thyroid cancer Papillary adenocarcinoma Follicular adenocarcinoma Hürthle cell carcinoma Anaplastic thyroid cancer Lymph node metastases Surgical management Operative resection Radioiodine therapy 

References

  1. 1.
    Cooper DS, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.CrossRefPubMedGoogle Scholar
  2. 2.
    Smallridge RC, et al. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2012;22(11):1104–39.CrossRefPubMedGoogle Scholar
  3. 3.
    Kouvaraki MA, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134(6):946–54; discussion 954–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Barczynski M, et al. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg. 2013;100(3):410–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Popadich A, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery. 2011;150(6):1048–57.CrossRefPubMedGoogle Scholar
  6. 6.
    Hartl DM, et al. Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J Surg. 2013;37(8):1951–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Sywak M, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140(6):1000–5; discussion 1005–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Bonnet S, et al. Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab. 2009;94(4):1162–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Hartl DM, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg. 2012;255(4):777–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Laird AM, et al. Evaluation of postoperative radioactive iodine scans in patients who underwent prophylactic central lymph node dissection. World J Surg. 2012;36(6):1268–73.CrossRefPubMedGoogle Scholar
  11. 11.
    Wang TS, et al. Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol. 2012;19(13):4217–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Costa S, et al. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital. 2009;29(2):61–9.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Ryu IS, et al. Lymph node ratio of the central compartment is a significant predictor for locoregional recurrence after prophylactic central neck dissection in patients with thyroid papillary carcinoma. Ann Surg Oncol. 2014;21(1):277–83.CrossRefPubMedGoogle Scholar
  14. 14.
    Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope. 2009;119(6):1135–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Hughes DT, et al. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148(6):1100–6; discussion 1006–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Lang BH, et al. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol. 2012;19(1):60–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Raffaelli M, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery. 2012;152(6):957–64.CrossRefPubMedGoogle Scholar
  18. 18.
    Zetoune T, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol. 2010;17(12):3287–93.CrossRefPubMedGoogle Scholar
  19. 19.
    Sancho JJ, et al. Prophylactic central neck disection in papillary thyroid cancer: a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg. 2014;399(2):155–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Randolph GW, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22(11):1144–52.CrossRefPubMedGoogle Scholar
  21. 21.
    Moreno MA, et al. In papillary thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. Thyroid. 2012;22(4):347–55.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Gyorki DE, et al. Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence. Ann Surg Oncol. 2013;20(7):2285–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of SurgeryBoston Medical Center, Boston UniversityBostonUSA

Personalised recommendations