Lateral Neck Dissection

Overview

‍Lateral neck dissection is a surgical procedure to remove lymph nodes from the lateral (side) compartment of the neck. It is also known as a modified radical neck dissection, selective neck dissection, or (formerly) a radical neck dissection. Each of these means something slightly different to a surgeon, so please clarify what procedure you are discussing. Lateral neck surgery is often performed to reduce the risk of cancer causing injury to the critical structures in the neck. Because lateral neck surgery is so involved, it is very important that you have an experienced surgeon to do this surgery. The goal is to remove cancerous lymph nodes and reduce the risk of cancer spreading to other parts of the body. Usually, a surgeon who has trained as an otolaryngology-head and neck surgeon will have the most experience at performing this type of surgery.

Lateral neck surgery is usually best done by someone with extensive experience doing these surgeries. In general, a head and neck cancer surgeon will have done many more of these surgeries than a general endocrine surgeon. Because there are two pathways to becoming a thyroid surgeon, it is important to know which pathway your surgeon has taken. Due to differences in training and experience, Otolaryngology-Head and Neck surgeons are usually much more comfortable doing lateral neck surgery (although there are exceptions). If you have thyroid cancer that has spread to the side of your neck, you need a surgeon who has trained extensively in doing this surgery so that you have fewer complications and a lower risk of needing more surgery in the future. Make sure to ask your surgeon about their training and experience doing this surgery. An experienced surgeon should have done hundreds of these procedures since training.

Procedure

‍The surgeon makes an incision along the side of the neck to access and remove the affected lymph nodes. The location of this incision can be unsightly if your surgeon is not experienced in treating metastatic thyroid cancer. The extent of the dissection depends on the number and location of the cancerous nodes, but an experienced surgeon will know that once you enter one side of the neck, you should remove all potential cancer instead of just a few nodes. Failure to do so will more likely result in the need for more surgery in the future. The procedure may involve removing additional tissues or structures if the cancer has spread extensively. This surgery is also more involved than typical head and neck cancer surgery because the lymph nodes of thyroid cancer are often behind the carotid artery or in the parapharyngeal space. Failure to appreciate these nodes can result in recurrence. Lateral neck dissection is typically performed under general anesthesia.

Benefits and Risks

‍Lateral neck dissection can significantly improve cancer control and patient outcomes by removing cancerous lymph nodes. Temporary numbness of the neck is common, and can also include the ear lobe. Other risks include infection, bleeding, a chyle leak, nerve injuries that can affect the shoulder or neck, and complications from anesthesia. Your surgeon will provide a detailed discussion of these risks and the expected benefits.

Recovery and Follow-Up

‍Recovery from lateral neck dissection usually involves an overnight hospital stay. Pain and swelling in the neck are common and can be managed with medications. Physical therapy may be recommended to help restore shoulder and neck function, especially if nerves are affected. Regular follow-up appointments are crucial to monitor for any signs of cancer recurrence and to assess overall recovery.

Radioactive Iodine (RAI) is often needed after lateral neck surgery, but should be offered judiciously. (hyperlink to RAI)