Abstract
Lymph node metastases occur early and often in papillary thyroid cancer, the most common differentiated cancer of the thyroid gland. Therefore, it is critical that surgeons involved in the management of patients with differentiated thyroid cancer (DTC) understand the biological progression of metastases to regional lymph nodes, and its implications, so as to perform anatomically appropriate and oncologically effective neck dissection, when indicated. Microscopic dissemination of papillary carcinoma occurs quite often: As many as 60% of patients harbor occult metastases in the clinically negative neck at the time of initial diagnosis of the primary tumor [1]. Clinically apparent or radiologically demonstrated metastases are present in no more than 10–15% of patients at initial presentation. Nevertheless, despite the large number of patients having micrometastases at initial presentation, only 4–5% of these patients progress to clinically apparent metastases, if they are observed after surgery of the primary tumor without elective regional node dissection. Their long-term survivorship and disease-specific mortality is not affected by this approach of observation of the clinically negative neck, with therapeutic neck dissection when these nodes become clinically apparent. It is also well known that the vast majority of patients—even those with nodal metastases at presentation—will be cured of disease with appropriate initial surgery, with minimal morbidity from their procedure. The surgeon who embarks on neck dissection for DTC must therefore be knowledgeable about the patterns of neck metastases from thyroid cancer and competent to resect all clinically significant disease—while identifying, protecting, and preserving all vital structures within the lateral neck.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Shaha AR, Shah JP, Loree TR. Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg. 1996;172:692–4.
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.
Stack Jr BC, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, et al. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid. 2012;22:501–8.
Simo R, Nixon I, Tysome JR, Balfour A, Jeannon JP. Modified extended Kocher incision for total thyroidectomy with lateral compartment neck dissection – a critical appraisal of surgical access and cosmesis in 31 patients. Clin Otolaryngol. 2012;37:395–8.
Hughes CJ, Shaha AR, Shah JP, Loree TR. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck. 1996;18:127–32.
McNamara WF, Wang LY, Palmer FL, Nixon IJ, Shah JP, Patel SG, Ganly I. Pattern of neck recurrence after lateral neck dissection for cervical metastases in papillary thyroid cancer. Surgery. 2016;159:1565–71.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer-Verlag GmbH Germany
About this chapter
Cite this chapter
Nixon, I.J., Shah, J.P. (2017). Modified Neck Dissection for Differentiated Thyroid Cancer. In: Howe, J. (eds) Endocrine and Neuroendocrine Surgery. Springer Surgery Atlas Series. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54067-1_9
Download citation
DOI: https://doi.org/10.1007/978-3-662-54067-1_9
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-54065-7
Online ISBN: 978-3-662-54067-1
eBook Packages: MedicineMedicine (R0)