J Korean Surg Soc.  2011 May;80(5):307-312. 10.4174/jkss.2011.80.5.307.

Experience and analysis of level VII cervical lymph node metastases in patients with papillary thyroid carcinoma

• Choi JY
• Choi YS
• Park YH
• Kim JH

• KMID: 2212154
• DOI: http://doi.org/10.4174/jkss.2011.80.5.307

Abstract

PURPOSE
Papillary thyroid cancer with level VII (anterior superior mediastinal lymph nodes) lymph node metastasis belongs to Stage IV a according to the Americal Joint Committee on Cancer cancer staging. The aim of our study was to identify clinicopathologic factors that are related to level VII cervical lymph node metastasis and to suggest recommendations for level VII dissection.
METHODS
We reviewed 195 patients with papillary thyroid carcinoma who had their initial operation containing level VII dissection from April 2006 to June 2007. Level VII dissection involved lymph nodes in the anterior superior mediastinum and tracheoesophageal grooves, extending from the suprasternal notch to the innominate artery. Clinicophathologic factors, such as gender, age and lateral neck metastasis, related to Level VII metastasis were analyzed by tumor size, multifocality of tumor, extrathyroidal extension and lymphovascular invasion.
RESULTS
Nine (4.6%) of 195 patients with papillary thyroid carcinoma had level VII metastasis. Clinicopathologic factors that were related to level VII metastasis included lateral neck metastasis (P < 0.01), tumor size (P < 0.01) and lymphovascular invasion (P < 0.05).
CONCLUSION
If preoperatively, the tumor size is over 1.5 cm, or there is lateral neck metastasis, level VII dissection must be considered. If there is lymphovascular invasion pathologic findings postoperatively, special attention should be paid for detection of level VII recurrence.

Keyword

Level VII dissection; Papillary thyroid carcinoma

MeSH Terms

Brachiocephalic Trunk
Carcinoma
Humans
Joints
Lymph Nodes
Mediastinum
Neck
Neoplasm Metastasis
Neoplasm Staging
Recurrence
Thyroid Gland
Thyroid Neoplasms
Carcinoma
Thyroid Neoplasms

Figure

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  Fig. 1 Anatomical boundaries of nodal levels VI (central compartment group) and Vll (superior mediastinal group) (reprinted from Shah JP, Patel SG. Head and neck surgery and oncology. 3rd ed. London: Mosby; 2002. p.355, with permission of Elsevier.) [10].

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  Fig. 2 The surgical field following level Vll dissection. (A) The right innominate artery was dissected free from the level Vll lymph nodes. (B) The left innominate vein was dissected from the level Vll lymph nodes and the left common carotid artery was retracted laterally with a long-arm retractor.

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  Fig. 3 (A) Right thyroid lobectomy, along with level Vl and Vll dissection was performed as en bloc dissection. (B) We separated level Vll lymph nodes from thyroid and level Vl lymph nodes after resection.

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