Abstract
The present standard in surgical treatment of papillary carcinoma is a total thyroidectomy and therapeutic block dissection in patients with nodal metastases proved clinically or by imaging methods. However, opinion exist recommending elective central cervical dissection.
The favoring arguments include a high incidence or nodal metastases in central cervical compartment, lower sensitivity of sonography in this area, more precise establishment of the disease stage and the help in decision making about indication of adjuvant treatment with radioactive iodine. The execution of central block dissection at the same time as the intervention on the thyroid gland decrease the potential risk of reoperation in the central cervical compartment.
In the therapy of metastases in the lateral cervical region the recommended intervention include therapeutic selective modified cervical dissections. All discussion concerning the extent and indication (elective/therapeutic) of cervical dissection during one intervention must be the evaluation of a potential benefit of cervical dissection performed together with total thyroidectomy as well as the consideration, whether the there is not any risk of increased morbidity of the intervention.
This communication summarizes the present knowledge about lymphatic drainage of thyroid vein and metastases of papillary carcinoma. The attention is devoted to risk prognostic factors and prognostic importance of lymph node metastases.
Opinion on indications and extent of elective and therapeutic cervical dissections in various parts of the world are described. In the Czech Republic the recommendations of the European Thyroid Association should be adhered.