Level vi neck dissection and central neck dissection are terms often used interchangeably to describe surgical excision of all lymph nodes from the hyoid bone to the sternal notch between the carotid arteries, but the addition of the superior mediastinal lymph nodes in compartment vii should be included in the central neck dissection. Thyroid cancer central neck dissection riassunto i tumori differenziati della tiroide possono essere associati a metastasi linfonodali regionali nel 2050% dei casi. Commonly performed snds are illustrated in figure 2, and include lateral, posterolateral, supra omohyoid, anterolateral and central. The indication for central neck dissection is still debated especially in patients with cn0 disease. For recurrent local or residual disease the best results. Randomization to group a central neck dissection or group b no central neck dissection. These guidelines were formulated in response to inconsistencies in the terminology pertaining to central neck dissection in the current scientific literature. The upper limits of central neck dissection endocrine. Pdf central neck dissection in differentiated thyroid cancer. The term neck dissection has evolved to encompass several different operations that may be selected based on the nature of the disease. Therapeutic central neck dissection for differentiated thyroid cancer is recommended in the setting of clinically positive disease.
See table iiie1 pdf and cervical lymphadenectomy general considerations protocol of selected n1 neck dissection. The primary motivation for this has been to alleviate the negative impact that some patients may perceive from a central neck scar. Neck dissection was originally based on halsteads principles of en bloc removal of lymph nodes in the neck for the management of patients with head and neck tumors. Management of chyle leak after head and neck surgery. Central neck compartment dissection in papillary thyroid. Prophylactic central compartment lymph node dissection in papillary. Marco lucioni practical guide to neck dissection with 5 figures, mostly in colour 123 forewords by italo serafini, jatin p. In the central neck, this is achieved through a unilateral or bilateral level vi dissection. Tnm staging of head and neck cancer and neck dissection. Medullary thyroid cancer suny downstate medical center. Total thyroidectomy with central neck dissection c. The routine addition of central neck dissection to total thyroidectomy has been debated over the years. Central neck lymph node dissection plays an important role in the appropriate treatment of papillary thyroid cancer at initial presentation and in cases of recurrent disease.
Indications and extent of central neck dissection for. The radical neck dissection is effective but produces characteristic cosmetic changes. During thyroid surgery for nodules with inconclusive cytology, routine central compartment neck dissection is not advocated because of potential morbidity to the recurrent laryngeal nerve rln and parathyroid glands. The description of a central neck dissection should include both the indication therapeutic vs. What is the role of central neck dissection in the. Central neck dissection via the transoral approach. The british thyroid association and the royal college of physicians, in the third edition of their guidelines in the management of thyroid cancer 2014, recommended that overt disease in the central compartment discovered prior toat surgery. Central neck dissection in differentiated thyroid cancer. Central neck compartment dissection in papillary thyroid carcinoma. Gene associated with hereditary medullary carcinoma of the thyroid is. Because so much tissue is removed, one side of the neck may appear flatter than the other. The role of lymphadenectomy in patients with clinically negative disease is a matter of controversy and therefore extent of surgery varies. The most accurate code for this is 38999 unlisted procedure, hemic or lymphatic system.
American academy of otolaryngologyhead and neck surgery. Central neck lymph node dissection for papillary thyroid cancer. Socrates 470 399 bc please go to to view related video. To determine the histopathological correlation between central and lateral neck metastasis in differentiated thyroid carcinoma, and its potential therapeutic impact. The procedure allows pathologic staging of lymph nodes of the central compartment and treatment of the micrometastases. Althoughlessfrequent, metastasestolymphnodes inthelateral neck, levels iv may be associated with a worse prognosis 14. Central neck dissection in papillary thyroid carcinoma. By comparing bilateral and unilateral thymectomy during total thyroidectomy with central lymph node dissection for postoperative compli. The neck dissection is a surgical procedure for control of neck lymph node metastasis from squamous cell carcinoma scc of the head and neck. Level vi lymph nodes include the pretracheal, prelaryngeal, and the bilateral paratracheal lymph nodes.
How do you code a level 6 neck dissection, also known as a central neck dissection. Elective treatment of n0 neck with significant risk of regional metastasis. While the terminology may now be standardized, controversy remains surrounding treatment. Revision central neck dissection operative techniques in. Selective neck dissection iowa head and neck protocols. The radical neck dissection was designed to ensure complete cancer removal in individuals with very advanced cancers in the neck. Consensus statement on the terminology and classification. While no controversy exists on the role of therapeutic central lymph node dissection cnd, concomitant with thyroidectomy. It is the core of diagnosis, treatment planning, application of therapeutics from multiple disciplines, recovery, followup, and scientific investigation. Although the central neck dissection cnd is recommended in differentiated thyroid carcinoma, the indication for lateral neck dissection lnd remains controversial. Total thyroidectomy with bilateral modified radical neck dissections. There is a clear association between central neck involvement and the likelihood of lateral neck disease, as an. Chyle extravasation can result in delayed wound healing, dehydration. The inclusion of comprehensive ipsilateral central and lateral neck dissection in the reoperation for patients with lateral neck recurrence of ptc is an optimal surgical strategy.
Reoperative central nodal dissection can be a challenging procedure with increased complication rates but with good outcomes in experienced centers. Central neck dissection at a minimum should consist of removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes. The classic radical neck dissection effectively removes. The primary endpoint is newly identified structural disease, which may include persistent, recurrent, or distant metastatic disease. Randolph the ancient oracle at delphi said that i was the wisest of all the greeks. Pdf differentiated thyroid cancers may be associated with regional lymph node metastases in 2050% of cases. Central neck dissection may be limited to the compartments that describe a predictable territory of regional recurrences in order to reduce associated morbidities. Central neck dissection via the transoral approach there has been a strong impetus for the development of remote access approaches to the central neck. Cervical nodal dissection for papillary thyroid cancer should include a systematic or en bloc. It is because i alone of all the greeks know that i know nothing.
It is a complex operation and requires a sound knowledge of the 3dimensional anatomy of the neck. The central compartment viupper vii levels is considered to be the first echelon of nodal metastases in all differentiated thyroid carcinomas. Therapeutic central neck dissection for papillary thyroid cancer is clearly indicated, while routine prophylactic central neck dissection for papillary thyroid cancer is controversial. Preoperatively, all patients should undergo comprehensive neck ultrasound with fine needle aspiration biopsy of any suspicious lymph nodes.
Objectiveto examine the role of central neck dissection cnd in patients. Total thyroidectomy with ipsilateral radical neck dissection d. Central neck dissection for papillary thyroid cancer jama network. Differentiated thyroid cancers may be associated with regional lymph node metastases in 2050% of cases. Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. For some authors, central neck dissection is recommended for lymph nodes that. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Marginal mandibular nerve weakness ramus mandibularis level i neck dissection extended recurrent pleomorphic adenoma. Pdf central neck dissection in differentiated thyroid. Indications and extent of central neck dissection for papillary thyroid. The importance of central neck dissection cnd in patients with metastatic paratracheal lymph nodes is well established, but its role as an elective procedure is still debatable.
Central neck dissection for papillary thyroid cancer. Correlation between central and lateral neck dissection in. Frozen section examination fse of removed ipsilateral nodes has been proposed to intraoperatively assess nodal status. For some authors, central neck dissection is recommended for lymph nodes that are suspect preoperatively either clinically or with ultrasound andor for lymph node metastases detected intraoperatively with a positive frozen section. Modified radical neck dissection modified radical neck dissection figures 5ac refers to the excision of all. Papillary thyroid cancer ptc has the peculiar tendency to spread to central and lateral neck lymph nodes. Central neck lymph node dissection also results in increased operating time. Patients all patients diagnosed with ptc who underwent. Ipsilateral central compartment node dissection ipsiccd can reduce the morbidity of prophylactic bilateral central compartment node dissection bilccd in papillary thyroid carcinoma ptc but it carries the risk of contralateral metastases being overlooked.
Ptc recurrences typically involve cervical lymph nodes in 6075% of cases, with the central compartment being the most frequently involved site. Neck dissection for differentiated thyroid cancer uptodate. Advocates cite a lower risk of later reoperation, since reoperations for recurrence can lead. The major complication from radical neck dissection was very apparent to most clinicians. Central neck dissection for papillary thyroid cancer sage journals. Chapter 38 central neck dissection technique ralph p. Objective to examine the role of central neck dissection cnd in patients with papillary thyroid cancer ptc. Design retrospective analysis of patients treated for ptc between 1993 and 2008. American thyroid association design and feasibility of a. Redefining classification of central neck dissection in.
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