This is a good review of the much-debated management of the neck in thyroid cancer. It discusses oncological goals that must be achieved whilst maintaining voice, swallowing and parathyroid function. A clear description is made of the common nodal basins involved in metastatic disease, their boundaries and frequency of involvement. Therapeutic neck dissection for differentiated thyroid cancer is widely supported by the literature. The evidence for prophylactic neck dissection is less clear with a small but significant reduction in locoregional recurrence reported in some series. It is summarised that prophylactic dissection of level VI should be considered in tumours greater than 4cm in size or for those with extrathyroidal extension. Non-infiltrative types of follicular-variant of papillary thyroid cancer may however be an exception, with lower rates of reported nodal disease. Judicious dissection of level VI is also supported by the recently published British Thyroid Association guidelines that estimate approximately 20-30 patients would have to undergo prophylactic level VI dissection to convey benefit to one individual. Surgical technique is described and in particular the anatomical differences between the left and right sides along with optimum technique for the preservation of the parathyroid glands. Postoperative management of calcium is addressed, importantly the need to empirically start replacement with level VI dissection.

Management of the neck in thyroid cancer.
Schoppy DW, Holsinger FC.
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Charles Giddings

FRCS (ORL-HNS), Monash Health, Melbourne, Australia.

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