Compartment-mediated dissection for papillary thyroid cancer

There is considerable controversy surrounding the appropriate treatment of papillary thyroid carcinoma (PTC), most of which centers around the extent of thyroidectomy. Despite the advocation of less than total thyroidectomy by many surgeons, there is a renewed interest by others, mainly in Europe and Japan, in the performance of routine total thyroidectomy and extensive lymph-node dissection for PTC. This has been shown to be an effective strategy for medullary thyroid carcinoma, which is not responsive to thyroid suppression or radioactive iodine treatment. PTC, however, is well treated by these adjuvant modalities and, in general, has an excellent prognosis. The benefit of extensive operations for routine cases of PTC has not been proven, and this practice is not employed by most surgeons in the United States. Node dissection is reserved for those patients with palpable adenopathy.