Abstract: The development of lateral cervical lymph node metastasis is closely related to the prognosis of papillary thyroid carcinoma; however, the rates of lymph node metastasis and recurrence after level Ⅴ dissection are low. Dissection of level Ⅴ lymph nodes is likely to damage the accessory nerve and cause shoulder dysfunction. In patients with papillary thyroid carcinoma with metastasis to level Ⅴ lymph nodes confirmed by clinical evidence, performing lymph node dissection, including level Ⅴ lymph nodes, is necessary. However, the surgical scope is controversial in N1b patients in whom level Ⅴ lymph node metastasis cannot be found after the preoperative evaluation. The strategies for sub-levels Va and Vb of level Ⅴ are yet to be explained. In this report, we retrospectively review the literature related to papillary thyroid carcinoma in recent years. Further, we discuss and summarize the risk factors and surgical treatment strategies for metastasis to level Ⅴ lymph nodes (posterior triangle of the neck) from papillary thyroid carcinoma.