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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2018; 22(04): 449-454
DOI: 10.1055/s-0037-1608909
Systematic Review
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Level V Clearance in Neck Dissection for Papillary Thyroid Carcinoma: A Need for Homogeneous Studies

Azhar Jan Battoo
1   Department of Surgical Oncology (Head and Neck Services), Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
,
Zahoor Ahmad Sheikh
2   Department of Surgical Oncology, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
,
Krishnakumar Thankappan
3   Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
,
Abdul Wahid Mir
2   Department of Surgical Oncology, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
,
Altaf Gowhar Haji
4   Department of Head Surgical Oncology, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
› Author Affiliations
Further Information

Publication History

30 January 2017

23 October 2017

Publication Date:
13 December 2017 (online)

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Abstract

Introduction Papillary thyroid carcinoma has a very high rate of lateral neck node metastases, and there is almost unanimity concerning the fact that some sort of formal neck dissection must be performed to address the clinical neck disease in these cases. Although there is an agreement that levels II to IV need to be cleared in these patients, the clearance of level V is debatable.

Objectives We herein have tried to analyze various papers that have documented a structured approach to neck dissection in these patients. Moreover, we have also tried to consider this issue through various aspects, like spinal accessory nerve injury and the impact of neck recurrence on survival.

Data Synthesis The PubMed, Medline, Google Scholar, Surveillance, Epidemiology, and End Results (SEER), and Ovid databases were searched for studies written in English that focused on lateral neck dissection (levels II–IV or II–V) for papillary thyroid carcinoma. Case reports with 10 patients or less were excluded.

Conclusions The current evidence is equivocal whether to clear level V or not, and the studies published on this issue are very heterogeneous. Level II-IV versus level II-V selective neck dissections in node-positive papillary thyroid carcinoma patients is far from categorical, with pros and cons for both approaches. Hence, we feel that there is a need for more robust homogeneous data in order to provide an answer to this question.

Keywords

papillary thyroid carcinoma - spinal accessory nerve - neck dissection

Financial Support

This research received no specific grant from any funding agency whatsoever.


Authors' Contributions

AJB designed the review, performed the literature review, drafted the manuscript, and made the evidence-based summaries. SZA and AWM revised the manuscript, reviewed the summaries, and contributed to the literature search. KT and AGH designed the review and revised the manuscript and reviewed the summaries. All authors read and approved the final manuscript.


 

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