Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer

Differentiated thyroid cancer (DTC), with a rapidly increasing incidence is the most common endocrine malignancy, but with generally favorable survival. Total thyroidectomy with 'therapeutic' cervical lymph node dissection for involved lymph nodes is the standard of care. A more controversial topic is whether routine 'prophylactic' central lymph node dissection (CLND) in patients without evidence of lymph node metastasis should be performed in patients with DTC, as suggested by several recent management guidelines.

A number of retrospective studies suggest that regional lymph node metastases are associated with tumor recurrence and adverse survival. CLND is associated with a higher rate of postoperative athyroglobulinemia and may modify the indications for radioactive iodine treatment. Current guidelines from the American Thyroid Association suggest that prophylactic CLND may be performed for papillary thyroid cancer, especially for advanced tumors (T3 and T4).

Recent studies and the arguments for and against prophylactic CLND are reviewed. There is currently a trend toward more aggressive surgical therapy, including prophylactic CLND and avoidance of radioactive iodine treatment for DTC, when appropriate. Randomized prospective controlled trials are lacking at this point to determine the role of prophylactic CLND in the management of DTC.