INTRODUCTION: Lymph node dissections due to thyroid cancers from neck are difficult and many anatomic structures are in danger to be injured. We present our some lateral lymph node neck dissection experiences in thyroid cancers.
METHODS: Demographic, clinical, and pathologic data of the patients who underwent lateral lymph node dissection between January 1, 2017, and December 31, 2019. Routine dissections of IIA, III, IV, and VB were performed. In addition, we added IIB and VA in cases when metastasis confirmed in papillary thyroid cancers (PTC). We completely dissected compartment II to V in the cases of medullary thyroid cancers. Post-operative concerned hemorrhage, nerve injury, chyle leakage, and whether received RIA treatment, the presence of loco-regional relapse and mortality was documented.
RESULTS: We performed neck dissection in 14 women and 14 men, with an average age of 45.7 (2078). Histopathological examination revealed that 25 patients had papillary, two medullary thyroid, and one patient had mixed medullary and PTCs. Bilateral neck dissection was performed in five patients. Tumor stages were T1 in 13, T2 in two, T3 in 12, and T4 in one patient. An average of 26.8 (872) lymph nodes was dissected from the lateral compartments and metastatic ones were 4.6 (020). We had three thoracic duct leakages and three local edemas. All three leakages were dissolved end resolved spontaneously with long lasting drains without negative pressure aspiration and employing slight compression locally. Only 22 patients could receive RIA. The recurrence in the thyroid location and/or lateral lymph node compartment was seen in five patients. Mortality was seen in two patients due to other reasons.
DISCUSSION AND CONCLUSION: Management of patients with papillary thyroid carcinoma should involve a balance in the risk from treatment and disease so decisions to perform neck dissection should be made individually. An oncological complete surgical resection is to remove all gross metastatic disease and preserving vital neurovascular structures. A thyroid surgeon should know the indications, the anatomic structures at lateral neck region and also techniques to decrease the rates of locoregional recurrences, to improve survival, and to prevent the occurrence of some serious complications.