Surgical Timing in Thyroid Cancer with Lateral Neck Metastases: Delayed Versus Contemporary Lateral Neck Dissection

<b>Backgrounds.</b> Lateral neck dissection (LND) is standard for thyroid cancer patients with neck metastases, mostly performed at the same time as total thyroidectomy (cLND). We introduced a new delayed LND (dLND), 4 weeks after thyroidectomy to reduce surgical morbidity. This study aims to compare the oncologic/complication outcomes between the two strategies, based on a large retrospective cohort of patients. <b>Methods.</b> Between 1996 and 2024, 215 patients were treated with total thyroidectomy, central neck dissection (CND) and LND, and grouped by surgical strategy (cLND vs. dLND); survival/complication outcomes were analyzed and compared between the two groups. <b>Results.</b> The overall and disease-free survival were comparable between groups. Age, extracapsular extension, and nodal burden predicted recurrence. dLND was associated with a significantly lower risk of vocal fold palsy. Extranodal extension (ECE) strongly predicted nerve injury. <b>Conclusions.</b> dLND offers similar oncologic outcomes to cLND, with reduced risk of vocal fold palsy. A staged approach enhances nerve preservation and might be considered in treatment planning.