Conservative central neck dissection

Cervical lymph node metastasis in thyroid cancer is common and mostly located in the central neck compartment. Lymph node metastasis is known to significantly increase both the persistence and recurrence rate of thyroid cancer, potentially decreasing survival. The gold standard of cervical lymph node management was originally a radical en bloc neck dissection originating with Jawdynski, in 1888. Over the past century, in order to alleviate the morbidity of these radical dissections, several modifications and conservative procedures have been advocated, especially for thyroid cancer. Conservative neck dissection, preserving functional structures of the neck unrelated to the spread of thyroid cancer, has evolved as a functionally and cosmetically advantageous approach that is facilitated by earlier detection of the disease and a better understanding of primary tumor nodal drainage patterns. Radical neck dissection (RND) has thus given way to a selective compartment-oriented neck dissection when possible, preserving many crucial structures of the neck while removing only the lymph nodes involved and those most likely to be involved with disease. Selective neck dissection is also being performed for small central compartment nodal metastases and prophylactically for more accurate staging of disease and risk stratification. This chapter aims to define and discuss the conservative surgical options for approaching cervical lymph node metastasis from thyroid cancer in the central neck compartment, including recent applications of innovative technology to further assist the surgeon in accomplishing these procedures.