What is the role of neck dissection in the treatment of cancer of the midline structures of the anterior lower neck?

Answer

This operation involves excision of the level VI lymph nodes (selective neck dissection [VI]). The procedure is indicated for the treatment of cancers of the thyroid gland (see image below), hypopharynx, cervical trachea, cervical esophagus, and subglottic larynx.

Selective neck dissection for thyroid cancer: selective neck dissection VI, or anterior neck dissection.

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The boundaries of the dissection are the hyoid bone superiorly, the suprasternal notch inferiorly, and the carotid sheaths on both sides. Hypoparathyroidism may be a disabling complication if care is not taken to identify and preserve the parathyroid glands, and injury to the parathyroid blood supply is a risk with this procedure. Excising and reimplanting the glands into the sternomastoid or pectoralis major muscle may be necessary. Alternatively, the dissection may be limited to one side if the lesion is not close to the midline, particularly if radiation therapy can be administered postoperatively.

A study by Song et al in which robotic selective neck dissection with total thyroidectomy was compared with conventional transcervical selective neck dissection with total thyroidectomy found that patients with papillary thyroid carcinoma who underwent the robotic surgery had higher postoperative cosmetic satisfaction. However, it was also found that length of surgery and degree of anterior chest pain were greater with the robotic technique.^[23]

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Media Gallery

Selective neck dissection levels I-III.
Selective neck dissection levels II-IV.
Selective neck dissection for thyroid cancer: selective neck dissection VI, or anterior neck dissection.
Selective neck dissection for posterior scalp and upper posterolateral neck cutaneous malignancies: selective neck dissection II-V, postauricular, suboccipital, or posterolateral neck dissection.
The 6 levels of the neck with sublevels.

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Author

Ron Mitzner, MD Resident Physician, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, Penn State University College of Medicine, Milton S Hershey Medical Center

Ron Mitzner, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Karen H Calhoun, MD, FACS, FAAOA Professor, Department of Otolaryngology-Head and Neck Surgery, Ohio State University College of Medicine

Karen H Calhoun, MD, FACS, FAAOA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, Association for Research in Otolaryngology, Southern Medical Association, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;The Physicians Edge;Sync-n-Scale;mCharts<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa;Proforma;Neosoma<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; .

Additional Contributors

Benoit J Gosselin, MD, FRCSC Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center

Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Head and Neck Society, American Academy of Facial Plastic and Reconstructive Surgery, North American Skull Base Society, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society, Ontario Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Francis P Ruggiero, MD Assistant Professor, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State University, Milton S Hershey Medical Center

Francis P Ruggiero, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Medical Association

Disclosure: Nothing to disclose.

Sandeep Samant, MBBS MS, FRCS, Chief, Division of Head and Neck and Skull Base Surgery, Associate Professor, Department of Otolaryngology-Head and Surgery, University of Tennessee Health Sciences Center

Sandeep Samant, MBBS is a member of the following medical societies: Royal College of Surgeons of England

Disclosure: Nothing to disclose.

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