The situation is similar to that presented in the previous question. Thus, the answer should be the same.
There is no need to look for—or even worse, create—a cleavage plane between the internal jugular vein and an adjacent lymph node in order to separate the node from the vein and preserve the latter. After all, the internal jugular vein is just ''a vein with a name.'' There is almost no morbidity associated with the removal of one internal jugular vein, and there may be important disadvantages from an oncological standpoint if the limits are pushed too far. Thus, in case of doubt we strongly recommend the removal of the internal jugular vein, or any other removable structure adjacent to a metastatic lymph node, if this may increase the chances for cure.
The situation is more difficult when the internal jugular vein has been sacrificed, or must also be removed, on the opposite side. In these cases the advantages and disadvantages of preserving the vein on the ''good'' side and performing a one-stage operation must be weighed against those associated with a two-stage procedure in which the second side is operated approximately 3 weeks later, and also against those derived from a simultaneous bilateral removal of the internal jugular vein. Here, the clinical scenario and the surgeon's experience are crucial to selecting the most appropriate decision for every patient.
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