Refining strategies in Central Neck Dissection in Thyroid Cancer: A Novel Paratracheal Subclassification for Precision Surgery

Abstract

Central compartment neck dissection (CCND) is a cornerstone in the surgical management of thyroid gland carcinoma, targeting level VI and VII lymph nodes as the primary lymphatic drainage sites. Despite its established role, controversies persist regarding anatomical definitions, the extent of dissection (prophylactic vs. therapeutic, unilateral vs. bilateral, level VI alone vs. VI and VII), and the balance between oncologic efficacy and morbidity, hypoparathyroidism and recurrent laryngeal nerve (RLN) injury. This review synthesizes current evidence from anatomical, clinical, and technological perspectives, addressing ambiguities in level VI and VII boundaries, the applicability of enbloc resection, and the utility of emerging tools like near-infrared autofluorescence (NIRAF) and indocyanine green (ICG) imaging. We propose refined anatomical subclassifications and advocate for tailored, precision-based strategies to optimize outcomes while minimizing complications.