11
Recommendation 20
A. Therapeutic central-compartment (Level VI and upper Level VII) neck
dissection for patients with clinically involved central nodes (cN1a)
should accompany thyroidectomy to clear disease from the central
neck. (S-M)
B. Therapeutic central lymph node dissection (CLND) with dissection of
the ipsilateral central compartment lymph nodes is recommended to
accompany lateral-compartment neck dissection and thyroidectomy
for patients with clinically involved lateral neck lymph nodes (cN1b).
(C-L)
C. Therapeutic lateral neck compartmental lymph node dissection,
typically including Levels IIa, III, IV and Vb, should be performed
as part of initial surgical therapy for patients with biopsy-proven
or clinically obvious metastatic lateral compartment cervical
lymphadenopathy. (S-M)
Recommendation 21
➤ Prior to surgery, the surgeon should review surgical risks with the
patient, including potential for nerve and parathyroid injury, through
the informed consent process and communicate with associated
physicians, including anesthesia colleagues, important findings
elicited during the preoperative evaluation. (GPS)
Recommendation 22
A. All patients undergoing thyroid surgery should undergo voice
assessment as part of their pre-operative physical examination.
This should include the patient's description of vocal changes and
the physician's assessment of voice. (S-M)
B. Preoperative laryngeal exam should be performed in all patients
with:
a. Preoperative dysphonia. (S-M)
b. History of cervical or upper chest surgery, which places the recurrent laryngeal
nerve or vagus nerve at risk. (S-M)
c. Known thyroid cancer with posterior extrathyroidal extension or extensive central
compartment or jugular chain nodal metastases. (S-L)
