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Modified Radical Neck Dissection Improves Prognosis

Shiro Noguchi, MD, PhD; Nobuo Murakami, MD; Hiroto Yamashita, MD, PhD; Masakatsu Toda, MD, PhD; Hitoshi Kawamoto, PhD

Arch Surg. 1998;133:276-280.

Objective  To ascertain whether modified radical neck dissection offers a survival advantage for some subsets of patients with papillary cancer of the thyroid.

Design  A retrospective cohort study of 2966 patients curatively treated at the Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan, between 1946 and 1991.

Setting  A center for the treatment of thyroid disease, where about 1400 thyroid operations are performed per year.

Patients  Between 1946 and 1991, patients with papillary cancer whose primary tumor was 1 cm or larger and who were curatively treated were studied. Of the 2859 patients, 72.1% underwent modified radical neck dissection, 8.5% underwent partial node excision, and 19.4% underwent no node excision.

Results  A univariate analysis revealed a subset of patients who benefited from modified radical neck dissection. A multivariate analysis revealed that sex (P<.001), age at the time of the operation (P<.001), size of the primary tumor (P<.001), extrathyroidal invasion (P<.001), and the presence of nodal metastasis (P<.01) are significant risk factors.

Conclusion  Patients with nodal metastasis, patients in whom the primary tumor invades beyond the thyroid capsule, and women older than 60 years can benefit from modified radical neck dissection.

From the Noguchi Thyroid Clinic and Hospital Foundation (Drs Noguchi, Murakami, Toda, and Kawamoto) and the Department of Pathology, Oita Medical University (Dr Yamashita), Oita, Japan.

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