Safety of central compartment neck dissection for transoral endoscopic thyroid surgery in papillary thyroid carcinoma tiantian wang. The central compartment lymph node metastasis rate was 87. Total thyroidectomy plus central compartment neck dissection ptc. Doherty introduction in 2010 there were an estimated 44,670 new cases of thyroid cancer despite only 1690 deaths resulting from the disease. Jun 26, 2018 estimation of the ability of prophylactic central compartment neck dissection to modify outcomes in lowrisk differentiated thyroid cancer estimabl3 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Neck nodes are divided into seven different levels. Safety of central compartment neck dissection for transoral.
Central neck dissection at a minimum should consist of removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes. Neck dissection performed 68 weeks after completion of radiation therapy or chemoradiation therapy there is controversy as to whether to perform this procedure in patients with n2 or n3 disease when complete response is noted both clinically and radiographically. What is the anatomy of the level vi group of lymph nodes. The thyroid upper pole is pulled toward the medioinferior direction with the prograsp forceps, and the superior thyroidal vessels are identified and individually ligated by harmonic curved shears. Video panel 3 surgical pearls for safe thyroid surgery central compartment lymph node dissection american head and neck society. Optimal surgical extent of lateral and central neck.
Estimation of the ability of prophylactic central compartment neck dissection to modify outcomes in lowrisk differentiated thyroid cancer estimabl3. Vi lymph node dissection for papillary thyroid cancer. Evidence of extracapsular spread by clinical or radiographic evaluation ie, fixed nodes, involvement of deep neck muscles, cranial nerves, sternocleidomastoid muscle, internal jugular vein, carotid artery would require more radical dissection than a selective neck dissection extent of neck dissection. Central neck dissection may be limited to the compartments that describe a. Central neck dissection for papillary thyroid cancer jama network. Shah ian ganly introduction the single most important factor affecting prognosis of squamous cell carcinoma of the head and neck, the sixth most common cancer worldwide, is the status of the cervical lymph nodes. Oct 04, 2018 radical neck dissection was the original surgical procedure described for treatment of metastatic neck cancer. A prophylacticelective central compartment dissection implies nodal metastasis is not detected clinically or by imaging clinically n0. Although a published classification of neck dissections has suggested the term selective neck dissection be applied when 1 or more lymph node groups are preserved that would normally be included in the level i through v radical neck dissection, 15 modified radical neck dissection or functional neck dissection are terms still widely used to. Apr 24, 2019 prophylactic central neck lymphnodes dissection is still a topic of major debate in literature. Central neck dissection in differentiated thyroid cancer. Central compartment neck dissection for thyroid cancer.
Central compartment lymph node dissection sciencedirect. Crile described the operation in 1906, and until recently, radical neck dissection was considered the standard procedure for management of both occult and clinically positive neck disease. Central neck dissection is commonly performed for metastatic thyroid cancer. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Outside of operative time, it is critical that any new technique be at least equivalent to the standard of care in terms of pathological outcome. Central compartment neck dissection for welldifferentiated. The mean of removed lymph nodes was 9 with a range between 1 and 22. Surgery provides precise pathologic staging of the neck and can also provide definitive treatment. Jul 23, 2016 chapter 38 central neck dissection technique ralph p. A basic technique should be reproducible with low morbidity and teachable to surgeons in training. Central compartment neck dissection with thyroidectomy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Central neck dissection via the transoral approach razavi.
Operative technique for modified radical neck dissection in. What is the anatomy of the level vi group of lymph nodes in. Metastases to the regional lymph nodes reduces the 5year survival rate by 50% compared with that of. Total thyroidectomy with and without selective central. Estimation of the ability of prophylactic central compartment. The central compartment viupper vii levels is considered to be the first echelon of nodal metastases in all differentiated thyroid carcinomas. We herein describe a basic technique for bilateral central compartment neck dissection for thyroid cancer. Before surgery, you will receive general anesthesia. Selective neck dissection iowa head and neck protocols. The central compartment of the neck is a common site of local metastasis for thyroid carcinoma. Socrates 470 399 bc please go to to view related video. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence.
The role of prophylactic central compartment lymph node. Codes 415 glossectomy, partial, with unilateral radical neck dissection and 41145 complete or total, with or without tracheostomy, with unilateral radical neck dissection refer to glossectomies with radical neck dissection. Academys classification 3 any neck dissection that preserves one or more groups or levels of lymph nodes is referred to as a selective neck dissection snd 4 an extended neck dissection refers to the removal of additional lymph node groups or non lymphatic structures relative to the rnd 65. Therefore, knowledge of the surgical techniques for performing a central compartment neck dissection is important for any surgeon who manages patients with thyroid cancer. The indication for central neck dissection is still debated especially in patients with cn0 disease. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer. Video panel 3 surgical pearls for safe thyroid surgery central compartment lymph node dissection. A metaanalysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Although sometimes identified as a level vi dissection, true central neck dissection cnd for thyroid cancer should include level vi and vii. Therefore, knowledge of the surgical techniques employed during a central compartment neck dissection is important to master for any surgeon. Objective to examine the role of central neck dissection cnd in patients with papillary thyroid cancer ptc.
Neck dissection techniques and complications 33 fig. Prophylactic central neck lymphnodes dissection is still a topic of major debate in literature. The indications, surgical technique, potential benefits, and operative risks of this. Posterolateral neck dissection iowa head and neck protocols. Neck dissection is an operation designed to remove groups of neck lymph nodes for treatment of cancer that has spread from a primary site elsewhere in the head and neck region. The senior authors surgical technique for central compartment and superior mediastinal neck dissection in the setting of recurrent wdtc has been published. Chapter 37 central neck dissection indications amanda m. Central neck dissection via the transoral approach. Thyroidectomies, glossectomies, and neck dissections. Central neck dissection for papillary thyroid cancer.
Dec 03, 2012 differentiated thyroid cancers may be associated with regional lymph node metastases in 2050% of cases. This video illustrates the technique of total thyroidectomy and right central compartment neck dissection with preservation of the right superior and inferior parathyroid glands and the right recurrent laryngeal nerve. Operative technique for modified radical neck dissection. Patients all patients diagnosed with ptc who underwent. Apr 30, 2011 precisely defining and describing a technique has the advantage of providing a basis for communication and for discussion.
Commonly performed snds are illustrated in figure 2, and include lateral, posterolateral, supra omohyoid, anterolateral and central snd. The description of a central neck dissection should include both the. This term describes a variety of neck dissections that preserve structures that are usually sacrificed in the radical neck dissection such as the spinal accessory nerve, the internal jugular vein or sternocleidomastoid muscle. Medina et al has suggested that the termcomprehensive neck dissection be used whenever all of the lymph nodes contained in levels i through v have been removed. Robotic neck dissection nd for the thyroid cancer with lateral neck metastasis case is one of the emerging surgical techniques, and has been highlighted as minimally invasive surgical technique recently. These procedures sacrifice the spinal accessory nerve, jugular vein and sternocleidomastoid muscles so the surgeon. Central compartment neck dissection refers to the bilateral removal of lymph nodes surrounding the midline visceral structures of the anterior neck. A neck dissection is a surgery to remove lymph nodes from the neck that may contain cancer. Defined by the carotid arteries laterally, the hyoid bone superiorly, and. Operative technique for modified radical neck dissection in papillary thyroid carcinomainvited critique. Prophylactic central compartment lymph node dissection in papillary.
Finally, essential clinical pearls and potential pitfalls regarding a central neck dissection are explained in the video. Level vi lymph nodes include the pretracheal, prelaryngeal, and the bilateral paratracheal lymph nodes. Improved survival of patients with papillary thyroid cancer after surgical microdissection. Central compartment lymph node dissection is a common. There are two major modalities used to address the neck. In other words, despite not being able to demonstrate metastatic involvement at the time of the operation, our sln technique was in and of itself effective in rendering a diseasefree neck compartment in 9 of table 1 distribution of final thyroid gland pathology. Sep 25, 2014 video panel 3 surgical pearls for safe thyroid surgery central compartment lymph node dissection american head and neck society. Indications and extent of central neck dissection for. Although it provides excellent access to the field of interest, it can result in prominent midline neck scarring. For parathyroid implantation cpt 60512 is correct, which is an addon code for cpt 60240. It is because i alone of all the greeks know that i know nothing.
It is generally done as an elective neck dissection end. Neck dissection general surgery coding ask an expert. Efficacy and safety of central compartment neck dissection for. Radical neck dissection is a surgical approach in head and neck cancer to treat the metastasis on the neck and had been done since 1906 in america by george crile. Total thyroidectomy with and without selective central compartment dissection. Central compartment neck dissection with thyroidectomy. Robotic total thyroidectomy with central compartment neck. Chapter 38 central neck dissection technique ralph p. Level vi is the anterior, or central, compart ment of the neck. Total thyroidectomy plus central compartment neck dissection. The lymph nodes include the pre and paratracheal, precricoid and perithyroidal.
Precisely defining and describing a technique has the advantage of providing a basis for communication and for discussion. We describe a technique for central neck dissection extending into level vii, removing the the nodes extending into the anterior mediastinum. In this topic, we discuss various neck dissection techniques and their. The neck dissection is a surgical procedure for control of neck lymph node metastasis from squamous cell carcinoma scc of the head and neck. Sep, 2018 in this video article, we present an interesting clinical case as a vehicle for discussing the indications for a central neck dissection and the important technical points, including the five key steps for achieving a safe and thorough dissection. Hence, the radical neck dissection and modified radical neck dissection would each be considered a comprehensive neck dissection. For right selective neck dissection removing levels 3 and 4 of the jugular chain and central compartment neck dissection cpt 38724 can be used. The indications, surgical technique, potential benefits, and operative risks of this procedure should be clearly defined in order to provide optimal care to these. Neck dissection for differentiated thyroid cancer uptodate. Sep 11, 2014 a right lateral neck dissection was also performed and included levels 2a, 2b, 3, 4, and 5. This refers to lymph nodes of the anterior, or central, compartment of the neck. Neck dissection is a major surgery done to remove lymph nodes that contain cancer. Neck dissection refers to th e surgical procedure where the lymphatics and the fibro fatty.
It is a complex operation and requires a sound knowledge of the 3dimensional anatomy of the neck. Video panel 3 surgical pearls for safe thyroid surgery. There is no bundling between the codes, this can be billed as it is. The pros and cons of routine central compartment neck. Apr 27, 2017 although preoperative neck ultrasound is significantly more sensitive for the detection of abnormal lateral neck lymph nodes than central neck lymph nodes, 97 it is generally accepted that high. Metastasis of squamous cell carcinoma into the lymph nodes of the neck reduce survival and is the most. Although preoperative neck ultrasound is significantly more sensitive for the detection of abnormal lateral neck lymph nodes than central neck lymph nodes, 97 it is generally accepted that high.
A right lateral neck dissection was also performed and included levels 2a, 2b, 3, 4, and 5. Thyroidectomy vestibular approachcompartment lymph node dissection is a feasible and safe option for select patients with papillary thyroid carcinoma who require central node dissection compared with opencompartment lymph node dissection, and can be a viable alternative for patients wishing to avoid a visible scar. Objectiveto examine the role of central neck dissection cnd in patients with. The primary motivation for this has been to alleviate the negative impact that some patients may perceive from a central neck scar. Sep 26, 2015 from leon xiaolong li md, phd, tianjin medical university cancer institute and hospital. In ptc patients with clinical lateral lymph node metastasis, the optimal extent of lateral and central neck dissection should include levels ii, iii, iv and v as well as the bilateral central compartment. Design retrospective analysis of patients treated for ptc between 1993 and 2008. Randolph the ancient oracle at delphi said that i was the wisest of all the greeks.
Central compartment neck dissection with thyroidectomy full. Robotic total thyroidectomy with central compartment neck dissection ccnd the harmonic curved shears is used for dissection and the vessel ligation. The transcervical approach has long been the primary technique for surgical access to the central neck. Listing a study does not mean it has been evaluated by the u. Central compartment lymph node dissection is a common adjunct to thyroidectomy in the treatment of papillary thyroid cancer. Central neck dissection via the transoral approach there has been a strong impetus for the development of remote access approaches to the central neck. Defined by the carotid arteries laterally, the hyoid bone superiorly, and the suprasternal notch inferiorly, it is.
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