Surgical management of lymph node metastases from papillary thyroid carcinoma

The published evidence and discussion of the various approaches to papillary thyroid carcinoma are reviewed. The impact of lymph node metastases on oncological results, the role of ultrasound, the central compartment approach, the lateral compartment approach, central neck dissection, lateral neck compartment dissection, complications such as hypoparathyroidism, nerve injury Recurrent larynx, thoracic duct injury, bleeding, facial and brain edema, rupture of the internal carotid artery, and management of recurrences were addressed and discussed. Customizing each decision according to the risk of local recurrence was recommended. Dissection of the central compartment with therapeutic indication was justified based on the evidence. The evidence-based debate on the prophylactic indication for central compartment dissection continues due to conflicting results. Modified radical dissection or selective dissections of lateral compartments were indicated as therapeutic use since they have solid scientific bases. The prophylactic indication for dissections of the lateral compartments of the neck lacks support in the published literature. Surgery was indicated as the treatment of choice for regional recurrences both centrally and laterally in order to achieve optimal cure rates