Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Papillary thyroid cancer (PTC) is the most common thyroid malignancy, with frequent metastasis to regional lymph nodes, particularly the lateral compartment. While the role of lateral lymph node dissection in reducing recurrence is well-established, the necessity of routine level IIb dissection remains controversial due to potential complications, including spinal accessory nerve (SAN) injury.
Objective: This systematic review and meta-analysis aims to evaluate the prevalence and clinical significance of level IIb lymph node metastasis in PTC and to provide evidence-based recommendations on whether routine level IIb dissection is warranted.
Methods: A comprehensive literature search was conducted following PRISMA guidelines, focusing on studies published between 2018 and 2024. Data from previous meta-analyses were also included. Statistical analyses were performed using a random-effects model to determine pooled effect sizes and assess heterogeneity.
Results: Out of 3312 neck dissections, the pooled rate of level IIb lymph node metastasis was 11% (95% CI, 0.08-0.15). The I² value of 89.82% indicated significant heterogeneity across the studies. Despite this, the findings suggest that routine level IIb dissection may not be necessary in all cases, particularly when there is no evidence of disease in level IIa.
Conclusion: The findings support selective omission of level IIb dissection in PTC patients without level IIa involvement or aggressive disease features. Given the risk of SAN injury, careful patient selection and shared decision-making between surgeons and patients are essential. Further research is needed to refine clinical guidelines and assess long-term outcomes.