Surgery for Advanced Nodal Metastasis in Thyroid Cancer

Min Woo Park; Young Soo Rho

doi:10.11106/ijt.2018.11.2.117

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Park and Rho: Surgery for Advanced Nodal Metastasis in Thyroid Cancer

Review Article

International Journal of Thyroidology 2018; 11(2): 117-122.

Published online: 30 November 2018

DOI: https://doi.org/10.11106/ijt.2018.11.2.117

Surgery for Advanced Nodal Metastasis in Thyroid Cancer

Min Woo Park, Young Soo Rho

Department of Otorhinolaryngology-Head and Neck Surgery, Kangdong Sacred Heart Hospital, Ilsong Memorial Head and Neck Thyroid Cancer Hospital, Hallym University College of Medicine, Seoul, Korea.

Correspondence: Young Soo Rho, MD, PhD, Department of Otorhinolaryngology-Head and Neck Surgery, Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea. Tel: 82-2-2240-2279, Fax: 82-2-482-2279, ys20805@chol.com

Received 20 September 2018 Revised 22 November 2018 Accepted 22 November 2018

The Korean Thyroid Association

(open-access):

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Thyroid cancer, Carotid artery, Retropharyngeal lymph node, Mediastinal lymph node, Surgery

Figures and Tables

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.

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