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Introduction: Neck dissection forms an important component in the surgical management of head and neck cancers. By using the conventional techniques of neck dissection, a conspicuous scar is inevitable for the patients. The development of robotic assisted neck dissection provides for a scar‐free neck along with good oncological and functional outcomes. Methods: A prospective observational study was conducted in our institute from 2020 March to 2022 March, where robotic‐assisted neck dissections performed via the modified bilateral axillo‐breast insufflation technique. Results: Eighty‐two patients underwent robotic neck dissections in our institute. Notably, 79 patients were treatment‐naïve. The average docking time was 12 min and console time was 160 ± 15 min. The mean lymph node yield was 28.2. The average post‐operative stay was 5.6 days. The average follow‐up was noted to be 6.4 months. The mean cosmetic satisfaction score in our patients was 4.45. Only one patient presented with nodal recurrence, who was identified as a defaulter for adjuvant treatment. Robotic neck dissection gives similar functional and oncological outcomes as compared with conventional neck dissection. Patients had excellent cosmetic satisfaction following the procedure. The limitations of these techniques include high cost of procedure and longer operating time. This is a level IV evidence study. Conclusion: Although good oncological, functional, and cosmetic outcomes have been attained in robotic assisted neck dissection, further randomized controlled studies need to be conducted to justify the added costs, cosmetic advantage, and the time taken. Level of Evidence: IV Laryngoscope, 134:4045–4051, 2024 [ABSTRACT FROM AUTHOR]

Background: For N1b papillary thyroid carcinoma (PTC) patients, lateral neck dissection encompassing levels Ⅱ-Ⅴ is generally recommended. However, routine level Ⅱ dissection is controversial given the low incidence of metastasis, and potential complications such as increased shoulder syndrome. Methods: Retrospective analysis of consecutive patients with papillary thyroid carcinoma who underwent lateral neck dissection at a single institution from January 2019 to April 2021 was performed. Clinicopathological features such as age, gender, tumor location, tumor size, TgAb and TPOAb levels, capsular invasion, multifocality and lymph node metastases were examined to evaluate the occurrence of metastatic Level Ⅱ lymph nodes. Results: Overall and occult level Ⅱ metastases were observed in 51.83% and 34.84% of cN1b PTC patients. Multivariant analysis showed that primary tumor, location of primary tumor and positive level Ⅴ can serve as independent risk factors of metastasis in level Ⅱ. For cN1b PTC patients not suspected of level Ⅱ lymph nodes preoperatively, independent risk factors for predicting occult level Ⅱ metastases may include the location of primary tumor, positive level Ⅲ and positive level Ⅴ. Conclusion: A significant number of patients with PTC and lateral neck disease experienced Level Ⅱ metastasis, with the location of primary tumor and multilevel lymph node involvement being the independent risk factors. If the tumor is less than 1 cm and located at lower 2/3 lobe, there is minimal possibility of level Ⅱ lymph node metastasis.

Introduction: The spinal accessory nerve (SAN) is encountered during neck dissection surgeries and is at the highest risk for iatrogenic injury, which may lead to shoulder syndrome. This functional deformity can be avoided by preservation of SAN in modified radical neck dissection (MRND). Description: Many techniques are described in the literature for SAN preservation, one of which is the identification of Erb’s point and dissection in the posterior triangle where the SAN leaves the sternocleidomastoid (SCM) muscle. However, this technique for identification and preservation of SAN requires a skilled and trained surgeon to avoid any iatrogenic injury to SAN. Conclusion: Therefore, a study was carried out on 30 patients to find if the cranio-caudal dissection of SAN helps in the preservation of the nerve during MRND surgeries at the beginner’s level.

For N1b papillary thyroid carcinoma (PTC) patients, lateral neck dissection encompassing levels Ⅱ-Ⅴ is generally recommended. However, routine level Ⅱ dissection is controversial given the low incidence of metastasis, and potential complications such as increased shoulder syndrome. Retrospective analysis of consecutive patients with papillary thyroid carcinoma who underwent lateral neck dissection at a single institution from January 2019 to April 2021 was performed. Clinicopathological features such as age, gender, tumor location, tumor size, TgAb and TPOAb levels, capsular invasion, multifocality and lymph node metastases were examined to evaluate the occurrence of metastatic Level Ⅱ lymph nodes. Overall and occult level Ⅱ metastases were observed in 51.83% and 34.84% of cN1b PTC patients. Multivariant analysis showed that primary tumor, location of primary tumor and positive level Ⅴ can serve as independent risk factors of metastasis in level Ⅱ. For cN1b PTC patients not suspected of level Ⅱ lymph nodes preoperatively, independent risk factors for predicting occult level Ⅱ metastases may include the location of primary tumor, positive level Ⅲ and positive level Ⅴ. A significant number of patients with PTC and lateral neck disease experienced Level Ⅱ metastasis, with the location of primary tumor and multilevel lymph node involvement being the independent risk factors. If the tumor is less than 1 cm and located at lower 2/3 lobe, there is minimal possibility of level Ⅱ lymph node metastasis. [ABSTRACT FROM AUTHOR]

Lymphoepithelial carcinoma (LEC) is a rare entity of malignancy. It has been associated with Epstein-Barr virus (EBV), and in regions where it is endemic, such as Southeast Asia, EBV is typically associated with nasopharyngeal carcinoma. The incidence of such malignancies in the young population is unusual. Here we report a 17-year-old with a 5-year history of a painless right submandibular mass presenting with a sudden increase in size for one month before surgery. Neck examination revealed a firm right submandibular gland measuring five by five cm, with an irregular surface, non-tender with normal overlying skin. We performed a fine needle aspiration cytology (FNAC), and he underwent computed tomography (CT) scan of the neck. He underwent a right submandibulectomy. Lymph nodes from levels I and II were also removed. The final histopathology was reported as LEC. Following this tissue diagnosis, another follow-up surgery, a modified radical neck dissection, was carried out for locoregional clearance. Postoperatively, he completed chemoradiotherapy treatment and is now on regular follow-up. [ABSTRACT FROM AUTHOR]

Medullary thyroid carcinoma (MTC) is a rare primary neuroendocrine thyroid carcinoma that is distinct from other thyroid or neuroendocrine cancers. Most cases of MTC are sporadic, although MTC exhibits a high degree of heritability as part of the multiple endocrine neoplasia syndromes. RE arranged during T ransfection (RET) mutations are the primary oncogenic drivers and advances in molecular profiling have revealed that MTC is enriched in druggable alterations. Surgery at an early stage is the only chance for cure, but many patients present with or develop metastases. C-cell-specific calcitonin trajectory and structural doubling times are critical biomarkers to inform prognosis, extent of surgery, likelihood of residual disease, and need for additional therapy. Recent advances in the role of active surveillance, regionally directed therapies for localized disease, and systemic therapy with multi-kinase and RET-specific inhibitors for progressive/metastatic disease have significantly improved outcomes for patients with MTC. [ABSTRACT FROM AUTHOR]

Objectives: Different parameters have been identified in patients with oral squamous cell carcinomas (OSCC) that have a serious impact on survival, including residual tumour and extracapsular spread. Moreover, other factors, including the lymph node ratio (LNR) and lymph node yield (LNY), have been suggested as prognostic markers. Material and methods: This retrospective study included patients diagnosed with OSCC and cervical lymph node metastases during the years 2010–2020. Patients' records were evaluated regarding lymph node status, final therapy regime, tumour recurrence, time to death, tumour association with death, disease-free survival (DSF), and overall survival (OS). Results: In 242 patients with a mean age of 63.57 ± 11.24 years, treated either by selective neck dissection (SND; n = 70) or by modified radical neck dissection (MRND; n = 172), 5772 lymph nodes were detected. The LNR and LNY were identified as independent risk factors in OS and DFS. The optimal cut-off point for the LNY was ≥ 17 lymph nodes in the SND and ≥ 27 lymph nodes in the MRND group. The metastatic lymph node clearance (MLNC) was established as a score to relate the LNR and LNY to the extent of lymph node removal. Survival analysis showed statistically significant differences among score levels. Conclusions: As information about the extent of nodal dissection is excluded from LNR and LNY, we propose the use of a new scoring system comprising individual cut-off values for LNY and LNR with regard to the extent of neck dissection. Clinical Relevance: MLNC might help to identify high-risk OSCC patients with metastatic lymph nodes. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The study aimed to analyze the patterns and frequency of Level V lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC), identify its risk factors, and construct predictive models for assessment., Methods: We conducted a retrospective analysis of 325 PTC patients who underwent thyroidectomy and therapeutic unilateral bilateral modified radical neck dissection from October 2020 to January 2023. Patients were randomly allocated into a training cohort (70%) and a validation cohort (30%). The radiomics signature model was developed using ultrasound images, applying the minimum Redundancy-Maximum Relevance and Least Absolute Shrinkage and Selection Operator regression to extract high-throughput quantitative features. Concurrently, the clinic signature model was formulated based on significant clinical factors associated with Level V LNM. Both models were independently translated into nomograms for ease of clinical use., Results: The radiomics signature model, without the inclusion of clinical factors, showed high discriminative power with an area under the curve (AUC) of 0.933 in the training cohort and 0.912 in the validation cohort. Conversely, the clinic signature model, composed of tumor margin, simultaneous metastasis, and high-volume lateral LNM, achieved an AUC of 0.749 in the training cohort. The radiomics signature model exhibited superior performance in sensitivity, specificity, positive predictive value, negative predictive value across both cohorts. Decision curve analysis demonstrated the clinical utility of the radiomics signature model, indicating its potential to guide more precise treatment decisions., Conclusion: The radiomics signature model outperformed the clinic signature model in predicting Level V LNM in PTC patients. The radiomics signature model, available as a nomogram, offers a promising tool for preoperative assessment, with the potential to refine clinical decision-making and individualize treatment strategies for PTC patients with potential Level V LNM., Competing Interests: Declaration of Competing Interest This manuscript has not been published nor submitted for publication elsewhere. All authors have contributed significantly, and agree with the content of the manuscript. The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Differentiated thyroid carcinoma with lateral neck lymph node metastasis requires aggressive operative intervention, including lateral neck dissection. Although several robotic approaches have made precise surgery for thyroid cancer possible, few centers have expanded the technique for application to lateral neck dissections. This study aimed to demonstrate the technical feasibility, cosmetic effectiveness, and safety of robotic transaxillary lateral neck dissection (RTLND) using the da Vinci system. Methods: From January 2008 to July 2019, 500 patients diagnosed with thyroid cancer with lateral neck node metastasis underwent RTLND. The clinicopathologic characteristics and surgical outcomes were retrospectively reviewed. Results: All operations were performed successfully without open conversion. As the primary operation for thyroid cancer, 476 (95.2%) patients underwent unilateral or bilateral RTLND, including robotic total thyroidectomy. The remaining 24 patients (4.8%), all of whom had a recurrence, also underwent RTLND with additional procedures, if needed. The mean operation time for the 500 operations was 293.71 ± 67.22 min. Only five cases had recurrence and required further treatment. Conclusions: RTLND is technically feasible and safe through the precise manipulation of robotic instruments. While this method is thorough and provides safe and effective surgical outcomes, it also offers the additional advantage of being minimally invasive. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the long-term prognosis of contralateral central neck dissection (CND) in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We compared the actual recurrence rate according to the extent of CND-ipsilateral and contralateral sides., Methods: A total of 708 PTC patients who underwent total thyroidectomy and concomitant ipsilateral or bilateral CND with ipsilateral lateral neck dissection between January 1997 and December 2022 at Samsung Medical Center were retrospectively analyzed., Results: The median follow-up time was 118 months. Locoregional recurrence was observed in 26 patients (7.9%) and 30 patients (7.9%) in the ipsilateral and bilateral CND groups, respectively. There were 6 contralateral recurrence cases (1.8%) in the ipsilateral CND group and 6 cases (1.6%) in the bilateral CND group. There was only 1 contralateral central neck recurrence in the ipsilateral CND group. The incidence of hypocalcemia (P = 0.007) was higher in the bilateral CND group compared to the ipsilateral CND group., Conclusion: Surgeons may consider performing only unilateral CND-the side where tumor is for therapeutic purposes to reduce surgical complications., Competing Interests: Conflict of Interest: Kyorim Back, serving as an editorial board memeber of Annals of Surgical Treatment and Research, did not participate in the review process of this article. No other potential conflicts of interest pertinent to this article were reported., (Copyright © 2024, the Korean Surgical Society.)

Introduction: The spinal accessory nerve (SAN) is encountered during neck dissection surgeries and is at the highest risk for iatrogenic injury, which may lead to shoulder syndrome. This functional deformity can be avoided by preservation of SAN in modified radical neck dissection (MRND). Description: Many techniques are described in the literature for SAN preservation, one of which is the identification of Erb's point and dissection in the posterior triangle where the SAN leaves the sternocleidomastoid (SCM) muscle. However, this technique for identification and preservation of SAN requires a skilled and trained surgeon to avoid any iatrogenic injury to SAN. Conclusion: Therefore, a study was carried out on 30 patients to find if the cranio-caudal dissection of SAN helps in the preservation of the nerve during MRND surgeries at the beginner's level. [ABSTRACT FROM AUTHOR]

Acantholytic squamous cell carcinoma (ASCC) is an atypical form of squamous cell carcinoma (SCC). Although it is well known that ASCC typically appears in sun-exposed regions of the face and neck, oral cavity cases are incredibly rare. In this case report, we present a rare case of a 50-year-old male who developed an ulcer on his right mandibular alveolus, diagnosed with ASCC post-biopsy. On histopathological analysis, acantholytic cells with a pseudo-glandular appearance were observed. Subsequently, the tumor was resected by modified radical neck dissection with a split-thickness graft. The patient responded well to surgery and had no complications post-surgery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dutta et al.)

Abstract Background Papillary thyroid cancer (PTC) patients with ipsilateral neck metastatic lymph node (LN) and those with contralateral neck metastatic LN belong to N1b. Only a few studies have reported on comparisons with regard to laterality of metastatic lateral LN. The aim of this study was to evaluate predictive factors for contralateral neck LN metastasis and to determine prognostic factors for recurrence in PTC patients with N1b. Methods This retrospective study reviewed the medical records of 390 PTC patients who underwent total thyroidectomy and central LN dissection plus ipsilateral or bilateral modified radical neck dissection (MRND) between January 2004 and December 2012. Results During a median follow-up of 81 (range, 6–156) months, 84 patients had a recurrence in any lesion. Male gender, a main tumor of more than 2 cm, number of metastatic central LN, number of harvested and metastatic lateral LN, total LN ratio, multifocality, bilaterality, and gross ETE had significance in the patients who underwent bilateral MRND. In multivariate analysis according to recurrence, patients with LN ratio > 0.44 in the central compartment (hazard ratio [HR], 1.890; 95% confidence interval [CI], 1.124–3.178; p = 0.015), LN ratio > 0.29 in the lateral compartment (HR, 2.351; 95% CI, 1.477–3.743; p 0.44, lateral neck LN ratio > 0.29, and multifocality of tumors. We suggest that patients with these factors should receive short-term follow-up using image modalities like ultrasonography and computed tomography.

Aim: To compare the feasibility and outcomes of Transverse Cervical incision and Modified Schobinger's incision for neck dissection. Materials and methods: Patients having oral cavity cancer with positive metastatic nodal disease in the neck requiring ablative surgery were included. Patients requiring a lip split incision for tumor ablation were excluded from the study. A total of forty patients were selected and were randomized in two groups. Transverse Cervical incision was placed in group A for neck dissection and a standard Modified Schobinger's incision in group B. These two groups were then compared on the basis of criteria's like adequacy of surgical access, flap dehiscence or necrosis, number of lymph nodes retrieved, length of incision, wound contracture, length of hospital stay and cosmetic result. Results: Result of our study show that Transverse Cervical incision had adequate surgical access, adequate lymph node retrieval, and better cosmetic result, less postoperative complications with early discharge of patient as compared to Modified Schobinger's incision for neck dissection. Conclusion: According to our experience, we believe that this transverse cervical incision in oral cancer patients can be very useful which fulfills all the requirements for neck dissection in terms of required surgical access, adequate lymph nodes retrieval, good healing of skin flaps and better cosmetic result without any postoperative complications.

Background: There is ongoing debate about whether or not robot-assisted thyroidectomy is appropriate for modified radical neck dissection (MRND). The purpose of this study was to compare the surgical outcomes of robot-assisted MRND with those of a conventional open procedure.Methods: One hundred and forty-five patients who underwent total thyroidectomy, bilateral central neck dissection, and MRND (robotic, n = 28; open, n = 117) at our institution from June 2011 to June 2015 were enrolled in the study. The surgical completeness and complication rates in the robotic and open groups were retrospectively compared after 1:3 propensity score matching for age, sex, body mass index, tumor size, and extrathyroidal extension.Results: The complication rates, including transient or permanent hypoparathyroidism and recurrent laryngeal nerve palsy, were comparable between the study groups (p > 0.05). The operating time was significantly longer in the robotic group than in the open group (p < 0.001). There was no significant difference in the number of retrieved lymph nodes, metastatic lymph nodes, or stimulated serum thyroglobulin level between the two groups (p = 0.733, p = 0.663, and p = 0.285, respectively).Conclusions: The surgical outcomes, including complication and completeness rates, were comparable between robot-assisted MRND using a bilateral axillary breast approach and conventional open surgery. Robot-assisted MRND can be recommended as an alternative to a conventional open procedure for thyroidectomy. [ABSTRACT FROM AUTHOR]

Neck dissection is an essential component of oral cancer therapy. Based on a standardised approach to cervical lymph node management, we seek to define the relevance of neck dissection extension in cN + cases. A retrospective analysis from January 2009 to February 2017 identified 84 patients with oral squamous cell carcinoma with a cN + neck or histologically proven lymph node involvement in intraoperative frozen sectioning and who received modified radical neck dissection according to the presented neck dissection algorithm. Overall 11 patients showed lymph node metastasis level IV or V, whereas 19 developed disease recurrence, of which 5 cases were neck recurrences. A total of 30 patients died within the time of observance (overall survival of n = 54). None of those patients with pN + status in levels IV and V reached a 5-year survival. With a look to the possibility of a 5-year survival in patients with a N+ status in level IV and V, the justification for a radical approach to the neck appears questionable. However, modified radical neck dissection appears to be a suitable for a high-risk oral cancer subgroup. A randomised controlled trial is needed to define guidelines for the neck dissection extent in c/pN + cases. [ABSTRACT FROM AUTHOR]

Recent studies suggest improved outcomes for children undergoing thyroidectomy at high-volume pediatric surgery centers. We present outcomes after thyroid surgery at a single center and advocate for referral to high-volume centers for multidisciplinary management of these children. Medical records were reviewed for all pediatric patients undergoing thyroid surgery at a single institution from 2009 through 2017. Routine recurrent laryngeal nerve and parathyroid hormone monitoring was used. Lymph node dissections were performed in appropriately selected cancer patients. Data collection focused on pathologic diagnosis, surgical technique, and surgical complications, including postoperative hematoma, neurapraxia, permanent nerve damage, hypocalcemia, and transient and permanent hypoparathyroidism. From 2009 through 2017, 464 patients underwent thyroid surgery. Median age of the cohort was 15 years (range 2–24). Thirty-three percent were diagnosed with benign nodules (n = 151), 36% with papillary or follicular thyroid cancer (n = 168), 27% with Graves' disease (n = 124), 3% with medullary thyroid cancer (n = 14), and 1.5% underwent prophylactic thyroidectomy for MEN2a (n = 7). Six patients required return to the OR for hematoma evacuation including 5 patients after surgery for Graves' disease (RR 8.7, 95% CI 1.06–71.85). In sixteen cases, concern about neurapraxia resulted in laryngoscopy, revealing eleven patients with vocal cord paresis. Two of these patients demonstrated a persistent deficit at 6 months postoperatively (0.4%). Thirty-seven percent of patients had transient hypoparathyroidism (n = 137), and two patients had persistent hypoparathyroidism 6 months after total thyroidectomy (0.6%). There was no significant difference in either hypocalcemia or hypoparathyroidism after total thyroidectomy based on age or diagnosis. Characterizing outcomes for pediatric patients based on diagnosis will assist in preoperative counseling for patients and their families. This high-volume center reports low complication rates after pediatric thyroid surgery, highlighting that referral to high-volume centers should be considered for children and adolescents with thyroid disease requiring surgery. Level IV [ABSTRACT FROM AUTHOR]

Background and objectives: Currently, few studies have been conducted on postoperative chylothorax, specifically in total thyroidectomy with modified radical neck dissection (MRND) in papillary thyroid carcinoma patients. This study provides the actual incidence, etiology, and clinical features of postoperative chylothorax and reports the clinical outcomes after treatment, which were dependent upon the severity of the complications. Materials and Methods: The medical charts of 111 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy with modified radical neck dissection from January 2016 to December 2018 were reviewed retrospectively. The results were compared in three groups: the no chylothorax group, the subclinical (asymptomatic) group, and the clinical (symptomatic) group. Results: Chylothorax occurred in 23 patients (20.7%, 23/111). Nineteen (82.6%, 19/23) were subclinical chylothorax cases, which implies a small amount of chyle leakage with no respiratory symptoms. Four (17.4%, 4/23) were clinical, meaning they had either respiratory symptoms, such as dyspnea, desaturation, or a large amount of chylothorax in the images. The incidence was significantly higher in patients who underwent left modified radical neck dissection, and this corresponds to the side in which chylothorax occurred. There were also statistical differences in the drainage color, peak amount, or drain removal time. Conclusions: Postoperative chylothorax is a rare complication following neck dissection. However, it can be fatal if the condition progresses. Therefore, patients who undergo total thyroidectomy with modified radical neck dissection, especially on the left side, should be monitored for respiratory symptoms, and serial chest x-ray images obtained.

Background: Although safe in patients with papillary thyroid carcinoma (PTC), robotic thyroidectomy using a bilateral axillo-breast approach (BABA) has not been frequently performed in patients with advanced PTC. This study describes surgical outcomes in patients with PTC and lymph node metastasis (LNM) in lateral neck compartment who underwent robotic-assisted modified radical neck dissection with BABA (robotic BABA MRND).Methods: The medical records of patients with PTC and lateral LNM who underwent robotic BABA MRND from March 2010 to July 2016 were retrospectively reviewed.Results: Fifteen patients, 14 women and 1 man, of mean age 37.1 ± 9.3 years, were enrolled. Mean operation time was 272.7 ± 33.8 min. A mean 20.7 ± 7.2 lymph nodes were retrieved from the lateral neck compartment, with a mean 5.3 ± 4.4 lymph nodes being metastatic. The rates of transient and permanent hypocalcemia were 46.7 and 0%, respectively, and the rates of transient and permanent vocal cord palsy were 6.7 and 0%, respectively. Fourteen patients (93.3%) had stimulated thyroglobulin concentrations below 2 ng/mL after the first treatment with radioactive iodine.Conclusions: Robotic BABA MRND could be safely performed and may be a good surgical option in selected patients with PTC and lateral LNM. [ABSTRACT FROM AUTHOR]

We report a case of a 12-year old who presented with a large neck mass. She underwent a total thyroidectomy with right modified radical neck dissection. The pathology revealed papillary cancer of the thyroid with a large anaplastic component. She underwent a total thyroidectomy and modified radical neck dissection. Postoperatively, she was treated with a customized regimen of chemotherapy and radiation. She is disease-free three years after diagnosis.

Background: Robotic modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported to be a safe and meticulous technique in patients with papillary thyroid carcinoma (PTC) and lateral neck node metastasis (N1b). Few studies, however, have attempted to assess the long-term oncologic outcomes of robotic MRND in these patients. This study aimed to compare perioperative and 5-year oncologic outcomes of robotic MRND with conventional open procedures in patients with N1b PTC.Methods: Between September 2007 and February 2010, 193 patients with N1b PTC underwent total thyroidectomy and MRND by a single surgeon. Of these, 42 (21.8 %) underwent robotic procedures and 151 (78.2 %) underwent conventional open procedures. All patients received 3.7- to 5.5-GBq radioactive iodine (RAI) ablation, post-therapy whole-body scans (TxWBSs), and diagnostic WBS (DxWBSs) during follow-up. An exact 1:3 matching for age and stage was performed to minimize selection bias, and perioperative and 5-year oncologic outcomes were compared in the matched groups.Results: The mean follow-up period was 66.0 months (range 60-90 months). Number of retrieved cervical lymph nodes (LNs) (p = .102) and postoperative ablation success rates (p = .864) were similar between the two groups. TSH-suppressed serum Tg concentrations after 5 years (0.7 ± 1.5 vs. 2.4 ± 14.1 ng/ml; p = .471) and recurrence rates in the robotic and open groups (1/41 [2.4 %] vs. 3/102 [2.9 %]; p = .864) were similar for the 5-year follow-up period. Four patients experienced recurrence: Three exhibited regional lymph node metastasis, and one showed bilateral lung metastases.Conclusion: The perioperative and 5-year oncologic outcomes were similar after robotic and conventional open MRND. Large, prospective randomized controlled trials with long-term follow-up data are needed to validate these results. [ABSTRACT FROM AUTHOR]

Background: For N1b papillary thyroid carcinoma (PTC) patients, modified radical neck dissection (MRND) encompassing levels II-V is generally recommended. However, routine level V dissection is controversial because of the low incidence of metastasis/recurrence in level V and the increased morbidities associated with level V dissection. Methods: This study retrospectively reviewed 646 N1b PTC patients who underwent unilateral MRND between January 1997 and June 2015. Specifically, to assess surgery-related outcomes of level V dissection, outcomes from N1b PTC patients who underwent unilateral MRND (levels II-V) were compared with those who underwent unilateral selective neck dissection (SND; levels II-IV) using propensity score matching. Results: Overall and occult level V metastases were observed in 13.9% and 8.6% of patients, respectively. Level V recurrences were observed in only 2.26 (7.7%) recurred N1b PTC patients who underwent unilateral MRND. In multivariate analysis, three-level (II, III, and IV) simultaneous metastasis (adjusted odds ratio = 3.079, p = 0.003) was an independent predictor for level V metastasis. Under a matched condition, 'shoulder syndrome' encompassing shoulder dysfunction and pain (9.1% vs. 2.7%, p = 0.002) was significantly more frequent in the MRND group than it was in the SND group. Conclusions: Because of the low incidence of metastasis/recurrence in level V and the clear evidence of increased morbidities, level V dissection in N1b PTC patients may be reserved for those with three-level simultaneous metastasis or clinically/radiologically evident level V metastasis. [ABSTRACT FROM AUTHOR]