gms | German Medical Science

Introduction: Papillary Thyroid Cancer (PTC) is the most common thyroid cancer. They often spread to the lymph nodes of the neck. Indications and the extent of surgical treatment of the neck in PTC are still part of many studies. That is mainly due to the increased risk we put the recurrent laryngeal nerve and parathyroid glands during central compartment neck dissections and increased related risks of lateral neck dissections towards a slow progression of the disease in a high percentage of patients with PTC.

The aim of this study is to analyze related factors that may suggest the extent of neck dissection in patients with PTC.

Methods: This is a retrospective study of 38 consecutive patients diagnosed with PTC, who underwent Total Thyreoidectomy with paratracheal and lateral neck dissection between 2000–2014. Clinico-pathological features were analyzed.

Results: In total 44 lateral neck dissections were performed. Multifocality, size of the primary tumor (above 1 cm), extra-thyroid invasion and age and gender were correlated to central compartment and lateral neck metastases.

Circa 63% of included patients were multifocal. Only 5% presented with a primary microcarcinoma (<1 cm). Capsule and/or surrounding tissue invasion was encountered in 72%. More than 93% of patients belonged to the high risk age group. In 22%, level Vb positive lymph node metastases were encountered.

Conclusions: In PTC patients surgical treatment of central compartment should be related to multifocality, size of the primary tumor, invasiveness and age and gender. Bilateral paratracheal dissection should be considered based on localization of the primary tumor and multifocality. Lateral neck dissection of levels II-V should be performed only when there is a clinical positive lateral neck.

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