Int J Thyroidol.  2018 Nov;11(2):117-122. 10.11106/ijt.2018.11.2.117.

Surgery for Advanced Nodal Metastasis in Thyroid Cancer

• Park MW
• Rho YS

• KMID: 2448981
• DOI: http://doi.org/10.11106/ijt.2018.11.2.117

Abstract

Metastases to regional cervical lymph nodes occur frequently in patients with thyroid cancer. The appropriate management of regional lymph node is important to achieve good disease control and to classify risk stratification for adjuvant radioactive iodine. However, there are some occasions that neck dissection is difficult and embarrassing in thyroid cancer. Especially, extensive or unusual nodal metastases bring challenges and makes neck dissection more difficult. Carotid artery management is one of the most difficult procedure in neck dissection. The management of patients who have persistent or recurrent cervical metastasis involving the carotid artery has been controversial and treatment dilemma to the surgeon. Metastasis of well differentiated thyroid cancer to the retropharyngeal lymph nodes is rare but occasionally encountered. The complete surgical excision is usually recommended for retropharyngeal lymph node metastasis of well differentiated thyroid cancer. An extensive mediastinal dissection in advanced differentiated thyroid carcinoma is occasionally required. This paper will review recent reports of management of advanced nodal metastasis of thyroid cancer and share the author's personal experience.

Keyword

Thyroid cancer; Carotid artery; Retropharyngeal lymph node; Mediastinal lymph node; Surgery

MeSH Terms

Carotid Arteries
Humans
Iodine
Lymph Nodes
Neck Dissection
Neoplasm Metastasis*
Thyroid Gland*
Thyroid Neoplasms*
Iodine

Figure

• 

  Fig. 1 Evaluation of internal carotid artery collaterals.

• 

  Fig. 2 (A) Peeling off, (B) resection and reconstruction with saphenous vein graft, (C) resection and reconstruction with ePTEE.

• 

  Fig. 3 (A) Medial retropharyngeal lymph node dissection. (B) Lateral retropharyngeal lymph node dissection.

• 

  Fig. 4 (A) Partial sternotomy, (B) full sternotomy.

Reference

1. Gambardella C, Tartaglia E, Nunziata A, Izzo G, Siciliano G, Cavallo F, et al. Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients. World J Surg Oncol. 2016; 14(1):247.

2. Conzo G, Tartaglia E, Avenia N, Calo PG, de Bellis A, Esposito K, et al. Role of prophylactic central compartment lymph node dissection in clinically N0 differentiated thyroid cancer patients: analysis of risk factors and review of modern trends. World J Surg Oncol. 2016; 14:149.

3. Liang J, Li Z, Fang F, Yu T, Li S. Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature. Acta Otorhinolaryngol Ital. 2017; 37(1):1–8.

4. Hughes DT, Rosen JE, Evans DB, Grubbs E, Wang TS, Solorzano CC. Prophylactic central compartment neck dissection in papillary thyroid cancer and effect on locoregional recurrence. Ann Surg Oncol. 2018; 25(9):2526–2534.

5. Goyal N, Pakdaman M, Kamani D, Caragacianu D, Goldenberg D, Randolph GW. Mapping the distribution of nodal metastases in papillary thyroid carcinoma: Where exactly are the nodes? Laryngoscope. 2017; 127(8):1959–1964.

6. Lodder WL, Lange CA, Teertstra HJ, Pameijer FA, van den Brekel MW, Balm AJ. Value of MR and CT imaging for assessment of internal carotid artery encasement in head and neck squamous cell carcinoma. Int J Surg Oncol. 2013; 2013:968758.

7. Mourad M, Saman M, Stroman D, Lee T, Ducic Y. Carotid artery sacrifice and reconstruction in the setting of advanced head and neck cancer. Otolaryngol Head Neck Surg. 2015; 153(2):225–230.

8. Back LJJ, Aro K, Tapiovaara L, Vikatmaa P, de Bree R, Fernandez-Alvarez V, et al. Sacrifice and extracranial reconstruction of the common or internal carotid artery in advanced head and neck carcinoma: review and meta-analysis. Head Neck. 2018; 40(6):1305–1320.

9. Katsuno S, Takemae T, Ishiyama T, Usami SI. Is carotid reconstruction for advanced cancer in the neck a safe procedure? Otolaryngol Head Neck Surg. 2001; 124(2):222–224.

10. Ozer E, Agrawal A, Ozer HG, Schuller DE. The impact of surgery in the management of the head and neck carcinoma involving the carotid artery. Laryngoscope. 2008; 118(10):1771–1774.

11. Miao B, Lu Y, Pan X, Liu D. Carotid artery resection and reconstruction with expanded polytetrafluoroethylene for head and neck cancer. Laryngoscope. 2008; 118(12):2135–2138.

12. Otsuki N, Nishikawa T, Iwae S, Saito M, Mohri M, Nibu K. Retropharyngeal node metastasis from papillary thyroid carcinoma. Head Neck. 2007; 29(5):508–511.

13. Hartl DM, Leboulleux S, Velayoudom-Cephise FL, Mirghani H, Deandreis D, Schlumberger M. Management of retropharyngeal node metastases from thyroid carcinoma. World J Surg. 2015; 39(5):1274–1281.

14. Reddy A, Verma AK, Mayilvaganan S. Management of retropharyngeal node metastases from thyroid carcinoma. World J Surg. 2016; 40(2):488.

15. Togashi T, Sugitani I, Toda K, Kawabata K, Takahashi S. Surgical management of retropharyngeal nodes metastases from papillary thyroid carcinoma. World J Surg. 2014; 38(11):2831–2837.

16. American Thyroid Association Surgery Working Group. American Association of Endocrine Surgeons. American Academy of Otolaryngology-Head and Neck Surgery. American Head and Neck Society. Carty SE, Cooper DS, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009; 19(11):1153–1158.

17. Machens A, Dralle H. Prediction of mediastinal lymph node metastasis in papillary thyroid cancer. Ann Surg Oncol. 2009; 16(1):171–176.

18. Ito Y, Miyauchi A. Lateral and mediastinal lymph node dissection in differentiated thyroid carcinoma: indications, benefits, and risks. World J Surg. 2007; 31(5):905–915.

19. Kikumori T, Imai T. Insignificance of prophylactic upper mediastinal lymph node dissection by sternotomy for papillary thyroid carcinoma. Endocr J. 2011; 58(12):1093–1098.

20. Clayman GL, Shellenberger TD, Ginsberg LE, Edeiken BS, El-Naggar AK, Sellin RV, et al. Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma. Head Neck. 2009; 31(9):1152–1163.

21. Liu J, Wang X, Liu S, Liu X, Tang P, Xu Z. Superior mediastinal dissection for papillary thyroid carcinoma: approaches and outcomes. ORL J Otorhinolaryngol Relat Spec. 2013; 75(4):228–239.

22. Wang LY, Versnick MA, Gill AJ, Lee JC, Sidhu SB, Sywak MS, et al. Level VII is an important component of central neck dissection for papillary thyroid cancer. Ann Surg Oncol. 2013; 20(7):2261–2265.