Bilateral total thyroidectomy is the standard surgical procedure for metastatic thyroid cancers. In this section, the definition and the extent of neck dissection will be discussed for thyroid cancer patients with lateral neck metastases. Since the first description of the radical neck dissection by George Crile almost a century ago, the surgical management of thyroid cancer patients with metastatic regional lymph nodes continues to be a challenge. The level of regional lymphatic spread in thyroid cancer is independent of tumor size and its location in the thyroid. In treatment, cervical lymphatic dissection has a place only in clinically proven metastatic disease. In clinically proven cases of nodal disease with preoperative USG and fine needle aspiration cytology (FNAC) or thyroglobulin (Tg) measurements, lymph node dissection during surgery may reduce the risk of relapses and possible mortality. In proven cervical metastatic disease, compartmental lymph node dissection is effective and adequate for treatment and which is also the recommendations of the guidelines.
