CA: A Cancer Journal for Clinicians, Vol 20, 86-93, Copyright
© 1970 by American Cancer Society
Elective Radical Neck Dissection: An Assessment of Its Use in the Management of Papillary Thyroid Cancer
Robert V. P. Hutter M.D.1,
Edgar L. Frazell M.D.2, and
Frank W. Foote Jr. M.D.3
1 Professor and Director of Anatomical Pathology and Cytopathology, Yale University School of Medicine; Chief of Pathology, Yale-New Haven Hospital, New Haven, Connecticut.
2 Attending Surgeon and Chief, Head and Neck Service, Memorial Hospital for Cancer and Allied Diseases, New York, New York.
3 Chairman, Department of Pathology, and Attending Pathologist, Memorial Hospital for Cancer and Allied Diseases.
Papillary thyroid cancer kills relatively infrequently. The indolent nature of the disease allows for great variability in treatment methods without any appreciable change in mortality. Occult cervical lymph node spread has been demonstrated in approximately one half of patients judged clinically free of such involvement. Elective neck dissection in such cases may on superficial review appear beneficial. However, when the specific differences attributable to the neck dissection are scrutinized, it is apparent that the "prophylaxis" only prevents the appearance of neck nodes which can be effectively treated when they become clinically apparent. It would appear that at least eight elective dissections would have to be done to prevent the later appearance of cervical metastases in one patient, who would probably be cured by therapeutic dissection at a later date. Finally, we must emphasize that our comments about elective neck dissection are limited to the clinically negative neck and should not be construed to include patients with clinically evident, cervical metastases.
With all of the above considered, we find no real evidence to support the philosophy of radical neck dissection for patients with papillary carcinoma of the thyroid who have no clinical evidence of cervical lymph node metastases.
