Overview
Central neck dissection is a surgical procedure aimed at removing lymph nodes from the central compartment of the neck. It is typically performed as part of the treatment for thyroid cancer to ensure that any cancerous cells in the lymph nodes are also removed, thereby reducing the risk of recurrence and spread of the disease. This surgery isn't for everyone with thyroid cancer- and should not be done too often or by surgeons with limited experience. Check out Dr Russell's instagram page for more info about this.
Procedure
During a central neck dissection, the surgeon makes an incision in the neck to access the thyroid gland and surrounding lymph nodes. The lymph nodes in the central compartment, which includes the area around the trachea and esophagus, are carefully removed. This procedure is often performed in conjunction with a thyroidectomy, the removal of the thyroid gland. In appropriate patients, this procedure can be done in conjunction with a "scarless" or transoral thyroidectomy.
Benefits and Risks
The primary benefit of central neck dissection is the comprehensive removal of potentially cancerous lymph nodes near the thyroid, which can decrease the risk of recurrence and thus improve long-term outcomes for patients with thyroid cancer. However, the procedure carries risks such as damage to the recurrent laryngeal nerve, which can affect vocal cord function, and damage to the parathyroid glands, which regulate calcium levels in the body. These risks are discussed with the patient prior to surgery.
Not all patients with thyroid cancer should have a central neck dissection according to the American Thyroid Association guidelines. This is primarily because of the parathyroid glands or calcium risk, as stated above. When done correctly, the risk of permanent hypoparathyroidism is higher because the blood supply to the inferior parathyroid glands is disrupted. In some cases, these parathyroid glands can be autotransplanted, but there is no guarantee that calcium levels will be fine after surgery. For this reason, most surgeons are very thoughtful about when to offer a central neck dissection. It is usually most appropriate for patients with obvious nodal disease, those with aggressive types of cancer, or those with very large primary cancers.
Ask your surgeon how often they perform a central neck dissection. Too often suggests that your surgeon is placing under unnecessary risk. Not often enough suggests that your surgeon may not have the technical skill to do this competently.
Recovery and Follow-Up
Recovery after a central neck dissection is nearly identical to recovery after normal thyroid surgery. We will monitor your calcium levels closely to make sure that you do not have calcium problems, and will usually discharge you the same day or the next after surgery.
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