Neck dissection for thyroid malignancy - Khobragade Multispeciality Hospital

What is Neck Dissection?

Neck dissection is a surgical procedure performed to remove lymph nodes and surrounding tissue in the neck to treat or prevent the spread of cancer. In thyroid malignancy, especially papillary and medullary thyroid cancers, cancer cells can spread to nearby lymph nodes. Neck dissection helps remove these potentially affected nodes to improve treatment outcomes and reduce recurrence.

Neck dissection is a crucial part of managing thyroid malignancy, especially when lymph node involvement is present. It enhances the effectiveness of treatment, improves prognosis, and helps patients achieve better disease-free survival. If you notice any neck swelling or have been diagnosed with thyroid cancer, consult your endocrine surgeon to understand the best surgical approach for your condition.

Symptoms Indicating Neck Dissection May Be Needed

Patients with thyroid cancer may experience:

Swelling or lump in the neck
Enlarged lymph nodes
Hoarseness of voice
Difficulty swallowing
Persistent throat pain
Changes in breathing
Cough not related to cold

If cancer spreads to lymph nodes, these symptoms may worsen or new lumps may appear in the neck.

Procedure / Treatment

Preoperative Evaluation:

Ultrasound neck
Fine needle aspiration cytology (FNAC) of suspicious lymph nodes
CT or MRI if required

During Surgery:

Performed under general anesthesia
Incision is made along natural neck creases for minimal visible scarring
Removal of lymph nodes in specific neck compartments (levels I-VI) depending on cancer spread
Types include:
- Central neck dissection (Level VI): for nodes near thyroid
- Lateral neck dissection (Levels II-V): for spread to side neck nodes
- Selective neck dissection: removes only specific lymph node groups
- Modified radical neck dissection: removes lymph nodes with preservation of key structures like nerves and muscles
- Radical neck dissection: removes all lymph nodes along with sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve (rarely required now)

Postoperative Care

Hospital stay of 2-3 days
Drain removal within 48 hours
Pain management and antibiotics
Monitoring for complications like nerve injury or hypocalcemia
Follow-up with oncologist or endocrine surgeon for further treatment like radioactive iodine therapy if needed

Prevention

While neck dissection itself is a treatment, prevention of lymph node spread includes:

Early detection and treatment of thyroid cancer
Regular neck ultrasound in known thyroid malignancy patients
Fine needle aspiration of suspicious lymph nodes for early intervention

Benefits of Neck Dissection

Removes cancerous lymph nodes, reducing risk of recurrence
Improves long-term survival rates
Provides accurate cancer staging to guide further treatment
May improve cosmetic outcomes by preventing visible nodal swelling
Increases chances of complete cancer removal when combined with thyroidectomy

Types of Neck Dissection

Central Neck Dissection (Level VI)
- Removes lymph nodes between carotid arteries and from hyoid bone to sternal notch
Lateral Neck Dissection (Levels II-V)
- Removes nodes along side of the neck where cancer often spreads
Selective Neck Dissection
- Only specific lymph node groups removed based on cancer spread pattern
Modified Radical Neck Dissection
- Removes lymph nodes and surrounding fat while preserving key nerves and muscles for better function
Radical Neck Dissection
- Extensive removal including muscles, veins, and nerves (rarely used now due to advanced targeted approaches)