Super-Superselective Level VB Neck Dissection for Papillary Thyroid Cancer.

OBJECTIVE

Therapeutic lateral neck dissection is recommended for papillary thyroid cancer with metastatic lymph nodes detected on palpation or on preoperative imaging. Current guidelines recommend systematic dissection of levels IIA, III, IV and VB in these patients. Despite this recommendation, management of level V remains controversial due to a varying degree of clinical and occult lymph node involvement reported in published retrospective studies, but also due to the functional risk involved in level V dissection in which the spinal accessory nerve may be temporarily or permanently injured. The aim of this review was to address the issues involved in level VB dissection and to provide our view of surgical management of level VB.

METHOD: Narrrative review.

RESULT: We propose a new concept of a partial or "super-superselective" level VB dissection in patients with clinical disease in levels IIA, III and IV.