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August 2013 - Symposium on the management of central compartment lymph node disease

Friday, August 09, 2013

THE ROLE OF LYMPH NODE SURGERY IN THE MANAGEMENT OF CENTRAL COMPARTMENT NODAL METASTASIS IN PAPILLARY THYROID CARCINOMA

 

The following document summarizes a presentation given by A/Prof Mark Sywak at a Clinical Symposium on the management of central compartment lymph node disease. The symposium was held at the recent International Surgical Week, Helsinki FINLAND in August 2013.

 

The surgical approach to central compartment lymph node disease in papillary thyroid cancer (PTC) remains one of the most controversial and enthusiastically debated topics in Endocrine Surgery. Those in favor of a more liberal approach to lymph node dissection argue that the routine removal of central compartment lymph nodes (CLND) helps to accurately stage papillary thyroid cancer, aids in decision-making regarding radio-iodine therapy, reduces recurrence rates and minimizes the need for technically challenging re-operative surgery in the central compartment. Those in favor of lymph node surgery only when nodal disease is clinically apparent argue that the identification of microscopic disease does not have any long term clinical implications for the patient and that more extensive surgery increases complication rates with little clinical gain. The aim of this presentation is to describe the rationale, the surgical technique and the outcomes associated with routine central compartment lymphadenectomy.

 

The central neck compartment has been clearly defined as the space in the anterior neck which extends from the hyoid bone superiorly, laterally to the carotid arteries and inferiorly to the level of the innominate artery on the right with this same inferior plane extending to the left side.


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