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Updated: Aug 2, 2026
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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Lymphadenectomy for papillary thyroid cancer: changes in practice over four decades
F F Palazzo1, J Gosnell, R Savio
1Endocrine Surgical Unit, Department of Surgery, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, NSW 2065, Australia.
Summary
The management of papillary thyroid cancer (PTC) neck dissection has shifted towards selective lymph node dissection (SLND). This tailored approach offers improved staging and local disease control with minimal complications.
Area of Science:
- Endocrinology
- Surgical Oncology
- Head and Neck Surgery
Background:
- The role of lymphadenectomy in papillary thyroid cancer (PTC) management has evolved over time.
- Understanding temporal trends in neck dissection practices is crucial for optimizing patient care.
Purpose of the Study:
- To analyze the changing trends in neck dissection for papillary thyroid cancer over four decades.
- To evaluate the shift in surgical management strategies for regional lymph nodes in PTC.
Main Methods:
- Retrospective cohort study of 900 patients undergoing primary thyroid surgery for PTC between 1958 and 2002.
- Analysis of lymph node dissection (LND) practices across nine 5-year periods.
- Comparison of complication rates between patients with and without neck dissection.
Main Results:
- The utilization of LND increased from 21.4% (1958-1962) to 48.1% (1998-2002).
- Selective lymph node dissection (SLND) became the predominant approach, performed in 84% of LND cases in the later period.
- No significant difference in complication rates was observed between patients who underwent neck dissection and those who did not.
Conclusions:
- The study demonstrates a clear shift from modified radical neck dissection towards SLND for PTC.
- SLND, tailored to disease extent, is effective for staging and local control with low morbidity in specialist centers.
- Lymphadenopathy in adult PTC is increasingly recognized as an adverse prognostic factor, supporting the role of SLND.
