{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:20:45Z","timestamp":1788344445353,"version":"build-2803163510"},"reference-count":52,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Parapharyngeal space (PPS) metastases from thyroid carcinoma are rare, and evidence guiding their surgical management, particularly the role of concomitant lateral neck dissection (LND) in patients with a clinically node-negative (cN0) neck, remains limited. This systematic review and patient-level analysis evaluated the clinicopathological characteristics, surgical management, and oncologic outcomes of PPS metastases, with particular emphasis on the management of the cN0 neck. Methods: A PRISMA 2020-compliant systematic review of PubMed, Scopus, and the Cochrane Library was performed. Patient-level data were analyzed according to clinical neck status and timing of PPS metastasis presentation. Results: Thirty-two studies including 162 patients were analyzed. Papillary thyroid carcinoma accounted for 94.4% of cases, while PPS metastases presented as primary disease in 48.8% and recurrent disease in 51.2% of patients. The transcervical approach (TCA) was the predominant surgical technique (79.1%), whereas LND was performed in 70.2% of patients with available data. Among the 19 patients with a cN0 neck, 10 had a previously undissected lateral neck; of these, 6 underwent elective LND and 4 underwent isolated PPS metastasectomy. No occult cervical lymph node metastases were identified following elective LND. Patients with recurrent PPS metastases had significantly higher overall recurrence (47.5% vs. 13.2%, p &lt; 0.001) and disease-specific mortality (22.8% vs. 5.6%, p = 0.003) than those with primary PPS metastases. Conclusions: TCA remains the reference surgical strategy for PPS metastases from thyroid carcinoma. Although based on a very limited cN0 subgroup, current evidence suggests that routine elective LND may not be necessary in carefully selected patients presenting with isolated PPS metastases and a cN0 neck. Recurrent PPS metastases are associated with poorer oncologic outcomes.<\/jats:p>","DOI":"10.3390\/cancers18172799","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:33:52Z","timestamp":1787942032000},"page":"2799","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Management of Parapharyngeal Metastases from Thyroid Carcinoma: A Systematic Review and Patient-Level Analysis of the Role of Lateral Neck Dissection"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5600-3938","authenticated-orcid":false,"given":"Francesco","family":"Chiari","sequence":"first","affiliation":[{"name":"Otolaryngology Head and Neck Unit, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika","family":"Reppucci","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-Universit\u00e0 di Bologna, 40126 Bologna, Italy"},{"name":"Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2727-0321","authenticated-orcid":false,"given":"Matteo","family":"Fermi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9213-8039","authenticated-orcid":false,"given":"Giulia","family":"Di Dalmazi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Palatino","sequence":"additional","affiliation":[{"name":"Department of Radiology, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria Maria","family":"Filippini","sequence":"additional","affiliation":[{"name":"Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4570-4899","authenticated-orcid":false,"given":"Giovanni","family":"Motta","sequence":"additional","affiliation":[{"name":"Head and Neck Surgery Unit, University of Campania \u201cLuigi Vanvitelli\u201d, 81100 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1009-7892","authenticated-orcid":false,"given":"Giuseppe","family":"Mercante","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-Universit\u00e0 di Bologna, 40126 Bologna, Italy"},{"name":"Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livio","family":"Presutti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-Universit\u00e0 di Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Donadio","family":"Caporale","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Unit, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3796-9483","authenticated-orcid":false,"given":"Pierre","family":"Guarino","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Unit, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"},{"name":"Department of Innovative Technologies in Medicine & Dentistry, University \u201cG. d\u2019Annunzio\u201d Chieti-Pescara, 66100 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s11701-019-00930-5","article-title":"A novel combined transoral and transcervical surgical approach for recurrent metastatic medullary thyroid cancer to the parapharyngeal space","volume":"14","author":"Lajud","year":"2020","journal-title":"J. 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