Lymph Node Dissection in Thyroid Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Papillary thyroid cancer (PTC):
    • Has a high predilection for spread to locoregional lymph nodes (LNs):
      • Occurring in up to 40% to 90% of cases:
        • When prophylactic nodal dissection is performed:
        • Though such high rates of metastatic disease may prove enticing to recommend routine prophylactic node dissection:
          • Recurrence-free survival is not effected by the removal of sonographically normal, microscopically diseased nodes
        • Instead, prophylactic central neck dissection may be individually considered for those patients with:
          • T3 or T4 tumors, or in the presence of lateral neck metastases
        • Clinically suspicious or biopsy-proven nodal disease warrants a “therapeutic” dissection of the involved compartments
          • “Berry picking,” or selective removal of suspicious LN metastases, is not recommended:
            • As it is associated with significantly higher recurrence rates and does not lower the rate of postoperative complications compared with systematic compartmental dissections
  • The risk of surgical complications with nodal dissection should be weighed against the benefit of LN removal:
    • Central neck dissections may result in temporary or permanent injury to the RLN and hypoparathyroidism
    • Surgeon case volume predicts patient outcomes:
      • Those performing less than 10 cases compared with those performing more than 100 cases per year had complications in 24% and 14.5% of cases, respectively
    • Although dissection of the lateral neck is less often associated with adverse events:
      • Injury to the spinal accessory nerve may occur with dissection of level II or V
    • Similarly, chyle leaks may be seen after removal of nodes in level IV:
      • Particularly on the left side
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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