The effect of neck dissection on quality of life in patients with differentiated thyroid cancer

Abstract

Cervical lymph node metastases are very common in patients with differentiated thyroid cancer (DTC). The overall long term survival rate in patients with DTC is higher than 90%, with variations in subsets of groups. Despite that DTC has an excellent prognosis, lymphatic spread is associated with increased risk of loco-regional recurrence, which significantly impairs quality-of-life (QOL) and can alter prognosis of the patient. As a result, a rapid shift in patient care from a focus on overall survival to a focus on recurrence-free survival has recently noted. The appropriate lymph node dissection is of great importance in order to achieve this goal. This surgical strategy will prevent disease recurrence, which may require an additional and more morbid surgery. Traditionally, the main outcome measure in oncology patients has been survival, based on tumor control, but recently it has been increasingly recognized that the diagnosis and management of cancer can have a major effect on every aspect of the QOL of a patient. The aims of cancer treatment became not only to increase survival but also to preserve QOL, and measuring these changes has been considered to be of paramount importance.

Keywords: Differentiated thyroid cancer (DTC); lymph node dissection; quality of life (QOL).

Figure 1

Division of neck nodes according to Memorial Sloan-Kettering Cancer Center (6). Reproduced from American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-214.