Is Level Ⅴ Dissection Necessary for Low-risk Patients with Papillary Thyroid Cancer Metastasis in Lateral Neck Levels II, III, and IV

Abstract

Whether it is beneficial to dissect level Ⅴ in papillary thyroid cancer (PTC) patients with positive lateralneck lymph nodes at levels II-IV is still controversial, especially for low risk cases. In this study, we reviewedthe medical records of 47 patients who underwent 47 ipsilateral selective lateral neck dissections (levels Ⅱ-Ⅳ)for previously untreated papillary thyroid carcinomas between October 2006 and October 2008 to assist inestablishing the optimal strategy for lateral neck dissection in low risk PTC patients with clinically negativelevel V nodes. All 47 patients were confirmed to have positive lymph nodes pathologically. Seventeen (36.12%),36 (76.6%), and 34 (72.34%) patients had positive lymph nodes in levels II, III, and IV, respectively. The meannumber of pathologically positive lymph nodes was 1.7 in level II, 2.9 in level III, 2.8 in level IV. No death anddistant metastasis were recorded during follow up period. Just 2 patients exhibited recurrence to lymph nodes,and only one showed nodal recurrence in ipsilateral level V, who had positive lymph nodes in all of levels II, III,and IV at initial neck surgery. In conclusion, for PTC low risk patients with clinically negative lymph nodes inlevel V, non-performance of level V dissection would still achieve good survival results as traditional modifiedradical neck dissection, with a “wait and see” strategy to be recommended.