Neck dissections for metastasis of well-differentiated thyroid cancer

Abstract

Currently, choosing the correct surgical tactic for metastases of well-differentiated thyroid cancer is one of the major problems in endocrine surgery. In most cases, early detection of metastases and their timely surgical removal can prevent the dissemination of the disease. Aim of the research is to assess the behavior and the significance of lymphogenic metastasis of thyroid cancer, to determine the optimal approaches to the treatment of locoregional metastases. Material and Methods. Patients were operated and observed in the Department of Surgery of the Endocrine Glands of The State Institution «V.P. Komisarenko Institute of Endocrinology and Metabolism of the NAMS of Ukraine» for the period from 1990 to 2021. Results. Large dissections needed for metastases in the lateral lymphatic nodes (LN) of a neck are associated with the possibility of damaging the nerves (accessory nerve, marginal mandibular nerve, sympathetic nerve, phrenic nerve, vagus nerve, hypoglossal nerve, brachial nerve), risk of bleeding and lymphorrhea, esthetical problems (longer dissection). Complications of lateral neck dissections can reach 50%, lymphorrhea — up to 3.6%, chronic neck pain and numbness — 11% [13]. Some studies show that additional lateral dissection of the neck during surgery on the central cervical spine region doubles the risk of transient hypoparathyroidism. Conclusions. With thyroid carcinomas (TC) preventive central neck dissection should be performed for patients of intermediate and high-risk groups. With small non-invasive papillary TC preventive central neck dissection may not be performed. Suspicious lateral LN of the neck should be examined by the fine-needle aspiration biopsy of the thyroid under ultrasound control to confirm the lateral lesion of the neck, and if there are indications the complex therapeutic neck dissection should be performed at levels IIa, III, IV, and Vb. The absence of signs of metastatic lesions of the LN I or IIb compartments of the neck makes it possible not to perform their routine dissection and this reduces the risk of damage to the accessory nerve.