Video panel 3 surgical pearls for safe thyroid surgery central compartment lymph node dissection. Sep 26, 2015 from leon xiaolong li md, phd, tianjin medical university cancer institute and hospital. The central compartment viupper vii levels is considered to be the first echelon of nodal metastases in all differentiated thyroid carcinomas. Total thyroidectomy with and without selective central. Design retrospective analysis of patients treated for ptc between 1993 and 2008. Sep 25, 2014 video panel 3 surgical pearls for safe thyroid surgery central compartment lymph node dissection american head and neck society. The mean of removed lymph nodes was 9 with a range between 1 and 22. Jul 23, 2016 chapter 38 central neck dissection technique ralph p.
Neck nodes are divided into seven different levels. Efficacy and safety of central compartment neck dissection for. Neck dissection general surgery coding ask an expert. Posterolateral neck dissection iowa head and neck protocols. Neck dissection is a major surgery done to remove lymph nodes that contain cancer. The senior authors surgical technique for central compartment and superior mediastinal neck dissection in the setting of recurrent wdtc has been published.
Prophylactic central neck lymphnodes dissection is still a topic of major debate in literature. In this topic, we discuss various neck dissection techniques and their. Robotic total thyroidectomy with central compartment neck. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Central neck dissection via the transoral approach there has been a strong impetus for the development of remote access approaches to the central neck. Apr 24, 2019 prophylactic central neck lymphnodes dissection is still a topic of major debate in literature. 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. Selective neck dissection iowa head and neck protocols. We describe a technique for central neck dissection extending into level vii, removing the the nodes extending into the anterior mediastinum. Central compartment neck dissection with thyroidectomy. Central neck dissection is commonly performed for metastatic thyroid cancer.
Chapter 37 central neck dissection indications amanda m. There is no bundling between the codes, this can be billed as it is. These procedures sacrifice the spinal accessory nerve, jugular vein and sternocleidomastoid muscles so the surgeon. Patients all patients diagnosed with ptc who underwent. 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. The central compartment of the neck is a common site of local metastasis for thyroid carcinoma.
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. Objectiveto examine the role of central neck dissection cnd in patients with. 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. A prophylacticelective central compartment dissection implies nodal metastasis is not detected clinically or by imaging clinically n0. Estimation of the ability of prophylactic central compartment. Therefore, knowledge of the surgical techniques employed during a central compartment neck dissection is important to master for any surgeon.
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. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65 years old. For right selective neck dissection removing levels 3 and 4 of the jugular chain and central compartment neck dissection cpt 38724 can be used. Central neck dissection may be limited to the compartments that describe a. The indication for central neck dissection is still debated especially in patients with cn0 disease. Central neck dissection for papillary thyroid cancer. Oct 04, 2018 radical neck dissection was the original surgical procedure described for treatment of metastatic neck cancer. Dec 03, 2012 differentiated thyroid cancers may be associated with regional lymph node metastases in 2050% of cases. Operative technique for modified radical neck dissection in papillary thyroid carcinomainvited critique. For parathyroid implantation cpt 60512 is correct, which is an addon code for cpt 60240. 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.
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. Neck dissection for differentiated thyroid cancer uptodate. Video panel 3 surgical pearls for safe thyroid surgery. Surgery provides precise pathologic staging of the neck and can also provide definitive treatment. There are two major modalities used to address the neck.
Optimal surgical extent of lateral and central neck. Level vi is the anterior, or central, compart ment of the neck. Central compartment neck dissection for thyroid cancer. 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. Central neck dissection in differentiated thyroid cancer. Central neck dissection via the transoral approach razavi.
Central compartment neck dissection refers to the bilateral removal of lymph nodes surrounding the midline visceral structures of the anterior neck. Defined by the carotid arteries laterally, the hyoid bone superiorly, and. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. 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. Total thyroidectomy with and without selective central compartment dissection. 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. Vi lymph node dissection for papillary thyroid cancer. Central compartment lymph node dissection sciencedirect. Total thyroidectomy plus central compartment neck dissection. 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. It is because i alone of all the greeks know that i know nothing. Neck dissection refers to th e surgical procedure where the lymphatics and the fibro fatty.
Central compartment neck dissection for welldifferentiated. 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. Metastasis of squamous cell carcinoma into the lymph nodes of the neck reduce survival and is the most. Before surgery, you will receive general anesthesia. Central compartment neck dissection with thyroidectomy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. 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. 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.
Level vi lymph nodes include the pretracheal, prelaryngeal, and the bilateral paratracheal lymph nodes. 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. Doherty introduction in 2010 there were an estimated 44,670 new cases of thyroid cancer despite only 1690 deaths resulting from the disease.
Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer. It is a complex operation and requires a sound knowledge of the 3dimensional anatomy of the neck. 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. A metaanalysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer.
We herein describe a basic technique for bilateral central compartment neck dissection for thyroid cancer. Although sometimes identified as a level vi dissection, true central neck dissection cnd for thyroid cancer should include level vi and vii. Video panel 3 surgical pearls for safe thyroid surgery central compartment lymph node dissection american head and neck society. Central compartment lymph node dissection is a common. Defined by the carotid arteries laterally, the hyoid bone superiorly, and the suprasternal notch inferiorly, it is. 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. Safety of central compartment neck dissection for transoral. Neck dissection techniques and complications 33 fig. 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. Total thyroidectomy plus central compartment neck dissection ptc. Central compartment lymph node dissection is a common adjunct to thyroidectomy in the treatment of papillary thyroid cancer. The primary motivation for this has been to alleviate the negative impact that some patients may perceive from a central neck scar. Estimation of the ability of prophylactic central compartment neck dissection to modify outcomes in lowrisk differentiated thyroid cancer estimabl3. The indications, surgical technique, potential benefits, and operative risks of this procedure should be clearly defined in order to provide optimal care to these.
A basic technique should be reproducible with low morbidity and teachable to surgeons in training. Commonly performed snds are illustrated in figure 2, and include lateral, posterolateral, supra omohyoid, anterolateral and central snd. 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. 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 indications, surgical technique, potential benefits, and operative risks of this. Apr 30, 2011 precisely defining and describing a technique has the advantage of providing a basis for communication and for discussion. What is the anatomy of the level vi group of lymph nodes in. It is generally done as an elective neck dissection end. What is the anatomy of the level vi group of lymph nodes. 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. For some authors, central neck dissection is recommended for lymph nodes that are suspect preoperatively either clinically or with ultrasound andor for lymph node metastases detected intraoperatively with a positive frozen section. Randolph the ancient oracle at delphi said that i was the wisest of all the greeks. Operative technique for modified radical neck dissection in.
Hence, the radical neck dissection and modified radical neck dissection would each be considered a comprehensive neck dissection. Central neck dissection at a minimum should consist of removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes. 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 via the transoral approach. 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. Socrates 470 399 bc please go to to view related video. The central compartment lymph node metastasis rate was 87. A right lateral neck dissection was also performed and included levels 2a, 2b, 3, 4, and 5. Metastases to the regional lymph nodes reduces the 5year survival rate by 50% compared with that of. Prophylactic central compartment lymph node dissection in papillary.
Sep 11, 2014 a right lateral neck dissection was also performed and included levels 2a, 2b, 3, 4, and 5. Finally, essential clinical pearls and potential pitfalls regarding a central neck dissection are explained in the video. Objective to examine the role of central neck dissection cnd in patients with papillary thyroid cancer ptc. 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. The transcervical approach has long been the primary technique for surgical access to the central neck. Operative technique for modified radical neck dissection. The description of a central neck dissection should include both the. Listing a study does not mean it has been evaluated by the u. The lymph nodes include the pre and paratracheal, precricoid and perithyroidal. This refers to lymph nodes of the anterior, or central, compartment of the neck. The role of prophylactic central compartment lymph node. Indications and extent of central neck dissection for. There are 5 levels in the lateral compartment and 2 in the central compartment. A neck dissection is a surgery to remove lymph nodes from the neck that may contain cancer.
Central neck dissection for papillary thyroid cancer jama network. Precisely defining and describing a technique has the advantage of providing a basis for communication and for discussion. Improved survival of patients with papillary thyroid cancer after surgical microdissection. The neck dissection is a surgical procedure for control of neck lymph node metastasis from squamous cell carcinoma scc of the head and neck.
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