Fascial versus standard neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases

Abstract

Background: Optimal surgical technique for lateral neck dissection (LND) in thyroid carcinoma remains a subject of debate. Fascial Neck Dissection (FND) implies the removal of the superficial and middle layers of the deep cervical fascia en bloc with lymph-nodes containing fibro-fatty tissue (levels IIa-Vb and VI-VII). This non-randomized controlled trial was designed to compare FND with standard, non-fascial, selective Neck Dissection (SND). Methods: Among 293 LNDs performed between January 2018 and December 2021, 89 and 106 pN1b PTC patients who underwent primary lateral and central FND or SND, respectively, were identified. Eighty-six patients of each group were matched with propensity score. Demographics data, perioperative information, histology, voice and swallowing impairment, cosmetic result and follow-up were compared. Results: Total and positive lymph nodes harvested were significantly higher in FND in both central and lateral compartments (central: 20.58 ± 9.9 vs 15.69 ± 8.9, p = 0.0136; lateral: 56.53 ± 28.1 vs 43.24 ± 21.56, p = 0.0015). Recurrence within 1-year was observed in six versus zero SND and FND patients respectively after matching (p = 0.028). A significant difference in favor of SND was observed only in transient hypoparathyroidism (p = 0.018). No other significant differences were observed in complication rates, voice or swallowing scores and cosmetic outcomes. Conclusion: FND was associated with reduced early recurrence rates, and a significantly higher nodal yield, without deteriorating voice and swallowing performance, or affecting the cosmetic outcome. Longer follow-up is required to assess its long-term outcomes in disease-free survival.

Keywords

• Lymph node metastasis
• Neck dissection
• Papillary thyroid cancer
• Recurrence