Refining strategies in Central Neck Dissection in Thyroid Cancer: A Novel Paratracheal Subclassification for Precision Surgery
Main Article Content
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.
Keywords:
Central compartment neck dissection (CCND), Thyroid cancer, Precision surgery, Lymph node dissection, Hypoparathyroidism, Recurrent laryngeal nerve (RLN) injury, Near-infrared autofluorescence (NIRAF), Indocyanine green (ICG) imaging, Oncologic efficacy, Surgical morbidity
Article Details
How to Cite
SAHARAN, Deepak et al.
Refining strategies in Central Neck Dissection in Thyroid Cancer: A Novel Paratracheal Subclassification for Precision Surgery.
Medical Research Archives, [S.l.], v. 13, n. 3, apr. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6429>. Date accessed: 15 may 2025.
doi: https://doi.org/10.18103/mra.v13i3.6429.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Xing Z, Qiu Y, Yang Q et al. Thyroid cancer neck lymph nodes metastasis: Meta-analysis of US and CT diagnosis. Eur J Radiol. 2020 Aug;129:109103. doi: 10.1016/j.ejrad.2020.109103. Epub 2020 Jun 13. PMID: 32574937.
2. Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, Som PM, Day TA; Committee for Neck Dissection Classification, American Head and Neck Society. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008 May;134(5):536-8. doi: 10.1001/archotol.134.5.536. PMID: 18490577
3. Takahashi T, Yamazaki K, Shodo R, Ueki Y, Horii A. Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study. Endocrine. 2022 Oct;78(1):151-158. doi: 10.1007/s12020-022-03153-1. Epub 2022 Aug 1. PMID: 35913569
4. Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, Barbieri V. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. 2012 Sep;22(9):911-7. doi: 10.1089/thy.2012.0011. Epub 2012 Jul 24. PMID: 22827494.
5. Randolph GW, Duh QY, Heller KS et al; American Thyroid Association Surgical Affairs Committee’s Taskforce on Thyroid Cancer Nodal Surgery. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012 Nov;22(11):1144-52. doi: 10.1089/thy.2012.0043. Epub 2012 Oct 19. PMID: 23083442.
6. Rao KN, Rajguru R, Dange P et al. Lower Rates of Hypocalcemia Following Near-Infrared Autofluorescence Use in Thyroidectomy: A Meta-Analysis of RCTs. Diagnostics (Basel). 2024 Feb 27;14(5):505. doi: 10.3390/diagnostics14050505. PMID: 38472977; PMCID: PMC10931323.
7. Yin, S.,Pan, B.,Yang, Z. et al. Combined use of autofluorescence and indocyanine green fluorescence imaging in the identification and evaluation of parathyroid glands during total thyroidectomy: A randomized controlled trial. Front. Endocrinol. 2022, 13, 897797.
8. Lykke E, Christensen A, Juhl K et al. Effect of near infrared autofluorescence guided total thyroidectomy on postoperative hypoparathyroidism: a randomized clinical trial. Eur Arch Otorhinolaryngol. 2023 May;280(5):2593-2603. doi: 10.1007/s00405-023-07867-4. Epub 2023 Feb 28. PMID: 36853388; PMCID: PMC9971666.
9. Shaphaba K, Thakar A, Sakthivel P et al. Incremental value of magnification and indocyanine green for parathyroid preservation in thyroid surgery. Head Neck. 2023 Jul;45(7):1753-1760. doi: 10.1002/hed.27387. Epub 2023 May 5. PMID: 37144335.
10. Rossi, L.; Vasquez, M.C.; Pieroni, E.; Ambrosini, C.E.; Miccoli, M.; Cetani, F.; Elisei, R.; Materazzi, G. Indocyanine green fluorescence and near-infrared autofluorescence may improve post-thyroidectomy parathyroid function. Surgery 2023, 173, 124–131.
11. Tartaglia F, Blasi S, Giuliani A et al. Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study. Int J Surg. 2016 Apr;28 Suppl 1:S79-83. doi: 10.1016/j.ijsu.2015.05.059. Epub 2015 Dec 18. PMID: 26708849.
12. Su A, Gong Y, Wu W, Gong R, Li Z, Zhu J (2018) Does the number of parathyroid glands autotransplanted affect the incidence of hypoparathyroidism and recovery of parathyroid function? Surgery 164:124–129.
13. Ozgüner G, Sulak O. Arterial supply to the thyroid gland and the relationship between the recurrent laryngeal nerve and the inferior thyroid artery in human fetal cadavers. Clin Anat. 2014 Nov;27(8):1185-92. doi: 10.1002/ca.22448. Epub 2014 Aug 8. PMID: 25130905.
14. Wang JB, Wu K, Shi LH, Sun YY, Li FB, Xie L. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma. Br J Surg. 2017 Oct;104(11):1514-1522. doi: 10.1002/bjs.10581. Epub 2017 Aug 7. PMID: 28782797.
15. Saber, A.; Rifaat, M.; Ellabban, G.M.; Gad, M.A. Total thyroidectomy by loupe magnification: A comparative study. Eur. Surg. 2011, 43, 49–54.
16. Pata, G.; Casella, C.; Mittempergher, F.; Cirillo, L.; Salerni, B. Loupe magnification reduces postoperative hypocalcemia after total thyroidectomy. Am. Surg. 2010, 76, 1345–1350.
17. Huang J, He Y, Wang Y et al. Prevention of hypoparathyroidism: A step-by-step near-infrared autofluorescence parathyroid identification method. Front Endocrinol (Lausanne). 2023 Jan 30;14:1086367. doi:10.3389/fendo.2023.1086367. PMID: 36793275; PMCID: PMC9922903.
2. Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, Som PM, Day TA; Committee for Neck Dissection Classification, American Head and Neck Society. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008 May;134(5):536-8. doi: 10.1001/archotol.134.5.536. PMID: 18490577
3. Takahashi T, Yamazaki K, Shodo R, Ueki Y, Horii A. Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study. Endocrine. 2022 Oct;78(1):151-158. doi: 10.1007/s12020-022-03153-1. Epub 2022 Aug 1. PMID: 35913569
4. Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, Barbieri V. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. 2012 Sep;22(9):911-7. doi: 10.1089/thy.2012.0011. Epub 2012 Jul 24. PMID: 22827494.
5. Randolph GW, Duh QY, Heller KS et al; American Thyroid Association Surgical Affairs Committee’s Taskforce on Thyroid Cancer Nodal Surgery. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012 Nov;22(11):1144-52. doi: 10.1089/thy.2012.0043. Epub 2012 Oct 19. PMID: 23083442.
6. Rao KN, Rajguru R, Dange P et al. Lower Rates of Hypocalcemia Following Near-Infrared Autofluorescence Use in Thyroidectomy: A Meta-Analysis of RCTs. Diagnostics (Basel). 2024 Feb 27;14(5):505. doi: 10.3390/diagnostics14050505. PMID: 38472977; PMCID: PMC10931323.
7. Yin, S.,Pan, B.,Yang, Z. et al. Combined use of autofluorescence and indocyanine green fluorescence imaging in the identification and evaluation of parathyroid glands during total thyroidectomy: A randomized controlled trial. Front. Endocrinol. 2022, 13, 897797.
8. Lykke E, Christensen A, Juhl K et al. Effect of near infrared autofluorescence guided total thyroidectomy on postoperative hypoparathyroidism: a randomized clinical trial. Eur Arch Otorhinolaryngol. 2023 May;280(5):2593-2603. doi: 10.1007/s00405-023-07867-4. Epub 2023 Feb 28. PMID: 36853388; PMCID: PMC9971666.
9. Shaphaba K, Thakar A, Sakthivel P et al. Incremental value of magnification and indocyanine green for parathyroid preservation in thyroid surgery. Head Neck. 2023 Jul;45(7):1753-1760. doi: 10.1002/hed.27387. Epub 2023 May 5. PMID: 37144335.
10. Rossi, L.; Vasquez, M.C.; Pieroni, E.; Ambrosini, C.E.; Miccoli, M.; Cetani, F.; Elisei, R.; Materazzi, G. Indocyanine green fluorescence and near-infrared autofluorescence may improve post-thyroidectomy parathyroid function. Surgery 2023, 173, 124–131.
11. Tartaglia F, Blasi S, Giuliani A et al. Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study. Int J Surg. 2016 Apr;28 Suppl 1:S79-83. doi: 10.1016/j.ijsu.2015.05.059. Epub 2015 Dec 18. PMID: 26708849.
12. Su A, Gong Y, Wu W, Gong R, Li Z, Zhu J (2018) Does the number of parathyroid glands autotransplanted affect the incidence of hypoparathyroidism and recovery of parathyroid function? Surgery 164:124–129.
13. Ozgüner G, Sulak O. Arterial supply to the thyroid gland and the relationship between the recurrent laryngeal nerve and the inferior thyroid artery in human fetal cadavers. Clin Anat. 2014 Nov;27(8):1185-92. doi: 10.1002/ca.22448. Epub 2014 Aug 8. PMID: 25130905.
14. Wang JB, Wu K, Shi LH, Sun YY, Li FB, Xie L. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma. Br J Surg. 2017 Oct;104(11):1514-1522. doi: 10.1002/bjs.10581. Epub 2017 Aug 7. PMID: 28782797.
15. Saber, A.; Rifaat, M.; Ellabban, G.M.; Gad, M.A. Total thyroidectomy by loupe magnification: A comparative study. Eur. Surg. 2011, 43, 49–54.
16. Pata, G.; Casella, C.; Mittempergher, F.; Cirillo, L.; Salerni, B. Loupe magnification reduces postoperative hypocalcemia after total thyroidectomy. Am. Surg. 2010, 76, 1345–1350.
17. Huang J, He Y, Wang Y et al. Prevention of hypoparathyroidism: A step-by-step near-infrared autofluorescence parathyroid identification method. Front Endocrinol (Lausanne). 2023 Jan 30;14:1086367. doi:10.3389/fendo.2023.1086367. PMID: 36793275; PMCID: PMC9922903.