Lymphectomy for elderly in thyroid surgery

In papillar tyroid cancer, cervical nodal metastases are quite common and impact negatively on survival. Initial nodal spread from PTC almost always occurs in the central compartment of the ipsilateral neck in the paratracheal and pretracheal nodes in level VI. In case of macroscopic evidence level II-V are probably affected. In adults the probability of nodal metastases is 60%. In elderly the probability of nodal metastases is higher than in adults. Oncogene BRAF is a predictor for poor diagnosis and nodal spread. We can perform a prophylactic removal of lymphonodes versus a therapeutic approach. Nowaday the majority opinion is that nodal metastases do increase the risk of mortality and recurrence particulary if patient is older. Central node dissection includes pretracheal, paratracheal, precricoid, and perithyroidal from levels IV and III versus the "lateral" dissection which consists of removal the nodes in levels II, IIa, III, IV, V. In prophylaxis many surgeons opt to perform a central neck node dissection. On the other hand prophylactic lateral neck dissection is not indicated. Terapeutic lateral selective neck dissection is suggested to be effectuated up to the VI level. After surgery is possible to make a suppression of nodal metastases with radioiodine, but this therapeutic approach is not a substitute of lymphadenectomy. There is an agreement about the role of therapeutic selective functional neck dissection in the management of known macroscopic nodal metastatic disease and that prophylactic dissection in the lateral neck is not indicated. There is also agreement that prophylactic removal of the nodes in the central compartment, at least on the ipsilateral side, is beneficial in the management of node negative PTC.