Lateral Neck Dissection for Well-Differentiated Thyroid Carcinoma : Is Prophylactic Level V Neck Dissection Necessary? A Retrospective Cohort Study
OBJECTIVE: The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disease, the prognostic benefit of level V prophylactic ND remains debatable.
METHODS: All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database.
RESULTS: A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P = .648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk.
CONCLUSION: There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study's findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:102 |
|---|---|
| Enthalten in: |
Ear, nose, & throat journal - 102(2023), 7 vom: 13. Juli, Seite NP349-NP357 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Neiderman, Narin N Carmel [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Journal Article |
|---|
| Anmerkungen: |
Date Completed 26.06.2023 Date Revised 26.06.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1177/01455613211003805 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM324683103 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM324683103 | ||
| 003 | DE-627 | ||
| 005 | 20231225190834.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1177/01455613211003805 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1082.xml |
| 035 | |a (DE-627)NLM324683103 | ||
| 035 | |a (NLM)33915059 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Neiderman, Narin N Carmel |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Lateral Neck Dissection for Well-Differentiated Thyroid Carcinoma |b Is Prophylactic Level V Neck Dissection Necessary? A Retrospective Cohort Study |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 26.06.2023 | ||
| 500 | |a Date Revised 26.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disease, the prognostic benefit of level V prophylactic ND remains debatable | ||
| 520 | |a METHODS: All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database | ||
| 520 | |a RESULTS: A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P = .648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk | ||
| 520 | |a CONCLUSION: There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study's findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a lateral neck dissection | |
| 650 | 4 | |a level V | |
| 650 | 4 | |a locoregional disease | |
| 650 | 4 | |a neck dissection | |
| 650 | 4 | |a neck metastasis | |
| 650 | 4 | |a prophylactic neck dissection | |
| 650 | 4 | |a therapeutic neck dissection | |
| 700 | 1 | |a Baris, Harel |e verfasserin |4 aut | |
| 700 | 1 | |a Duek, Irit |e verfasserin |4 aut | |
| 700 | 1 | |a Warshavsky, Anton |e verfasserin |4 aut | |
| 700 | 1 | |a Ringel, Barak |e verfasserin |4 aut | |
| 700 | 1 | |a Izkhakov, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Horowitz, Gilad |e verfasserin |4 aut | |
| 700 | 1 | |a Fliss, Dan M |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Ear, nose, & throat journal |d 1984 |g 102(2023), 7 vom: 13. Juli, Seite NP349-NP357 |w (DE-627)NLM000261459 |x 1942-7522 |7 nnns |
| 773 | 1 | 8 | |g volume:102 |g year:2023 |g number:7 |g day:13 |g month:07 |g pages:NP349-NP357 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1177/01455613211003805 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 102 |j 2023 |e 7 |b 13 |c 07 |h NP349-NP357 | ||