Extent of routine central lymph node dissection with small papillary thyroid carcinoma

Area of Science:

• Endocrinology
• Surgical Oncology
• Head and Neck Surgery

Background:

• The optimal extent of central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) remains debated.
• Small PTC (<2 cm) management requires careful consideration of therapeutic benefits versus risks.

Purpose of the Study:

• To compare the therapeutic effects and risks of bilateral versus ipsilateral CLND in patients with small PTC.
• To determine if extensive CLND impacts treatment outcomes or complication rates.

Main Methods:

• Retrospective analysis of 103 patients with small PTC undergoing total thyroidectomy and CLND.
• Patients were divided into bilateral CLND (Group I) and ipsilateral CLND (Group II).
• Therapeutic efficacy assessed by lymph node metastasis and post-thyroidectomy thyroglobulin levels; risks evaluated by hypocalcemia incidence.

Main Results:

• No significant difference in post-thyroidectomy thyroglobulin levels between bilateral and ipsilateral CLND groups.
• Incidence of symptomatic hypocalcemia was significantly higher in the bilateral CLND group (48.0%) compared to the ipsilateral CLND group (20.5%).
• The extent of CLND did not affect therapeutic outcomes for small PTC.

Conclusions:

• Routine bilateral CLND is not superior to ipsilateral CLND for small PTC in terms of therapeutic efficacy.
• A more conservative, ipsilateral CLND approach is associated with a lower risk of transient hypoparathyroidism.
• Findings support a less extensive routine CLND for small papillary thyroid carcinoma to minimize complications.