Battoo Azhar Jan, Sheikh Zahoor Ahmad, Thankappan Krishnakumar, Mir Abdul Wahid, Haji Altaf Gowhar
Department of Surgical Oncology (Head and Neck Services), Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Department of Surgical Oncology, Sher i Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Int Arch Otorhinolaryngol. 2018 Oct;22(4):449-454. doi: 10.1055/s-0037-1608909. Epub 2017 Dec 13.
Papillary thyroid carcinoma has a very high rate of lateral neck node metastases, and there is almost unanimity concerning the fact that some sort of formal neck dissection must be performed to address the clinical neck disease in these cases. Although there is an agreement that levels II to IV need to be cleared in these patients, the clearance of level V is debatable. We herein have tried to analyze various papers that have documented a structured approach to neck dissection in these patients. Moreover, we have also tried to consider this issue through various aspects, like spinal accessory nerve injury and the impact of neck recurrence on survival. The PubMed, Medline, Google Scholar, Surveillance, Epidemiology, and End Results (SEER), and Ovid databases were searched for studies written in English that focused on lateral neck dissection (levels II-IV or II-V) for papillary thyroid carcinoma. Case reports with 10 patients or less were excluded. The current evidence is equivocal whether to clear level V or not, and the studies published on this issue are very heterogeneous. Level II-IV versus level II-V selective neck dissections in node-positive papillary thyroid carcinoma patients is far from categorical, with pros and cons for both approaches. Hence, we feel that there is a need for more robust homogeneous data in order to provide an answer to this question.
甲状腺乳头状癌有很高的侧颈淋巴结转移率，对于这些病例必须进行某种形式的根治性颈清扫术以处理临床颈部疾病这一事实，几乎达成了共识。虽然大家一致认为需要清扫这些患者的Ⅱ至Ⅳ区，但Ⅴ区的清扫仍存在争议。
我们在此试图分析各种记录了对这些患者进行颈清扫结构化方法的论文。此外，我们还试图从多个方面考虑这个问题，比如副神经损伤以及颈部复发对生存的影响。
我们检索了PubMed、Medline、谷歌学术、监测、流行病学和最终结果（SEER）以及Ovid数据库，以查找用英文撰写的、聚焦于甲状腺乳头状癌侧颈清扫（Ⅱ至Ⅳ区或Ⅱ至Ⅴ区）的研究。排除了患者人数为10例或更少的病例报告。
目前关于是否清扫Ⅴ区的证据并不明确，关于这个问题发表的研究非常参差不齐。在淋巴结阳性的甲状腺乳头状癌患者中，Ⅱ至Ⅳ区与Ⅱ至Ⅴ区选择性颈清扫远未形成定论，两种方法都有优缺点。因此，我们认为需要更有力的同类数据才能回答这个问题。
