Tailoring the Extent of Therapeutic Lateral Neck Dissection in Papillary Thyroid Carcinoma With Lateral Cervical Lymph Node Metastases: A Systematic Review

The optimal extent of therapeutic lateral neck dissection (LND) in patients with papillary thyroid carcinoma (PTC) and lateral cervical lymph node metastases remains debated, particularly regarding the inclusion of levels IIb, Va, and Vb.This systematic review synthesized evidence on level-specific metastatic involvement, oncological outcomes, and morbidity associated with different extents of therapeutic LND.PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched from database inception to August 2026.Studies evaluating therapeutic LND in patients with documented lateral cervical lymph node metastases were eligible.Eleven observational studies published between 2008 and 2025 were included.Metastatic involvement was most frequently reported in levels III and IV, with reported rates ranging from 65.5% to 84.3% and 50.0% to 83.1%, respectively.Reported involvement of level IIb ranged from 7.9% to 16.7%, whereas level Vb involvement varied from 3.7% to 40.0%.Several studies identified associations between level V metastasis and multilevel lateral nodal involvement, particularly simultaneous disease in levels II, III, and IV.Comparative studies reported inconsistent oncological outcomes: some found similar regional control following selective and comprehensive dissection, whereas others reported higher recurrence rates after selective dissection.Selected studies also reported lower postoperative shoulder morbidity with less extensive dissection.Overall, metastatic involvement was generally concentrated in levels III and IV, while reported level IIb involvement was lower and findings for level V were heterogeneous.These patterns may inform individualized surgical planning but do not independently establish the safety of omitting specific nodal levels.The available observational evidence does not demonstrate the equivalence of selective and comprehensive LND or establish validated criteria for level-sparing surgery.Prospective, standardized comparative studies with adequate follow-up are needed to determine whether tailored dissection can reduce morbidity without compromising regional control.