Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients

Background: Prognostic value of prophylactic level VII nodal dissection in papillary thyroid carcinomahas been highlighted. Materials and
Methods: A total of 27 patients with papillary thyroid carcinoma with N0neck underwent total thyroidectomy with level VI and VII nodal dissection through same collar neck incision.Multicentricity, bilaterality, extrathyroidal extension, level VI and VII lymph nodes were studied as separateand independent prognostic factors for DFS at 24 months.
Results: 21 females and 6 males with a mean ageof 34.6 years old, tumor size was 5-24 mm. (mean 12.4 mm.), multicentricity in 11 patients 2-4 foci (mean 2.7),bilaterality in 8 patients and extrathyroidal extension in 8 patients. Dissected level VI LNs 2-8 (mean 5 LNs) andlevel VII LNs 1-4 (mean 1.9). Metastatic level VI LNs 0-3 (mean 1) and level VII LNs 0-2 (mean 0.5). Follow-upfrom 6-51 months (mean 25.6) with 7 patients showed recurrence (3 local and 4 distant). Cumulative DFS at24 months was 87.8% and was significantly affected in relation to bilaterality (p-value <0.001), extrathyroidalextension (p-value <0.001), level VI positive ((p-value <0.001) and level VII positive ((p-value <0.001) LNs. Norecurrences were detected during the follow-up period in the absence of level VI and level VII nodal involvement.
Conclusions: Level VII prophylactic nodal dissection is an important and integral prognostic factor in papillarythyroid carcinoma. A larger multicenter study is crucial to reach a satisfactory conclusion about the necessityand safety of this approach.