Functional neck dissection (FND) reduces recurrence and increases overall survival in papillary thyroid cancer (PTC) patients with macroscopic lymph node metastases. However, the extent of lymph node dissection is controversial.

Patients who underwent FND with the diagnosis of metastatic PTC between June-2020 and November-2023 were retrospectively evaluated. Groups were created according to tumor location of the thyroid as upper, middle and lower pole and evaluated which stations in the neck these groups metastasized to most.

Seventy patients with lateral neck metastases which were proved by biopsy underwent FND. Twenty-one of these patients were excluded from the study because they had lateral region recurrence and their initial surgery was not performed in our center. Bilateral FND was performed in 9 patients due to the presence of metastases in both lateral neck regions. Lymph node positivity rates in the lateral region were evaluated according to tumor location. In 12 patients with upper pole tumors, the lymph node positivity rate at level 2a,2b,3,4,5b stations were 58.3%,16%,66.6%,75%,25%; in 32 patients with middle pole tumors, the lymph node positivity rate at level 2a,2b,3,4,5b stations were 59.3%,6.25%,84.3%,87.5%,9.3% and in 5 patients with lower pole tumors, the lymph node positivity rate at level 2a,2b,3,4,5b stations were 100%,0%,100%,80%,20% respectively.

It should not be forgotten that PTC is a systemic disease that spreads via the lymphatic route. In cases of PTC with proven lateral metastasis, at least 2a,3 and 4 regions should be included in the dissection. Dissection of 2b and 5b should also be considered in selected cases.