To summarize the data of papillary thyroid carcinoma (PTC) with superior mediastinal metastasis, so as to guide clinical diagnosis and treatment.

The clinical data of two PTC patients with superior mediastinal metastasison in Tianjin Medical University Cancer Hospital were retrospectively analyzed. Combined with literature retrieval, different approaches of mediastinal lymph node dissection were analyzed and compared.

Both cases were female with deep metastatic lymph nodes and underwent endoscopic-assisted superior mediastinal lymph node dissection (EASMLND). A total of 13 articles of PTC with superior mediastinal (or Ⅶ) lymph node metastasis were retrieved in the past 13 years. There were a total of 1 361 cases, including 1 320 cases with PTC. Cervical approach was adopted in 1 164 patients, including 286 cases with EASMLND. Sternal split approach was adopted in 197 patients with deep metastatic lymph nodes or close to blood vessels.

For PTC patients with superior mediastinal lymph node metastasis, enhanced CT examination is necessary for the deficiency of ultrasound examination. Dissection of superior mediastinal lymph nodes by cervical approach is restricted by visual field, which easily leads to incomplete dissection. For patients with deep metastatic lymph nodes, the sternum split is required, which results in large trauma and more perioperative complications. EASMLND is a good surgical scheme, which can not only achieve radical cure, but also reduce the patients’ injuries and shorten the operation time.