Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma

Area of Science:

• Oncology
• Head and Neck Surgery
• Thyroid Cancer Research

Background:

• Papillary thyroid carcinoma (PTC) staging is crucial for treatment decisions.
• The role of prophylactic central neck dissection (CND) in clinically node-negative (N0) PTC remains debated.
• Accurate assessment of disease-free survival (DFS) is essential for evaluating surgical interventions.

Purpose of the Study:

• To evaluate the disease-free survival (DFS) outcomes of prophylactic central neck dissection (CND) in patients with papillary thyroid cancer (PTC) clinically staged as N0.
• To determine if CND impacts the rate of neck recurrence in this patient population.
• To identify factors associated with the decision to perform CND.

Main Methods:

• An inception cohort of 266 patients with histologically confirmed stage N0 PTC was analyzed.
• Patients had no prior oncologic treatment, recurrent tumor, or distant metastasis.
• Central neck dissection (CND) was performed in 51.3% of patients, with 82.3% of these having metastatic lymph nodes detected.

Main Results:

• The 5-year neck disease-free survival was 86.8%, with no significant difference between the CND group (88.2%) and the no-CND group (85.6%) (P = .72).
• Neck recurrence occurred in 16.9% of patients.
• Macroscopic extrathyroidal extension and multifocality were factors associated with the decision for CND.

Conclusions:

• Prophylactic central neck dissection (CND) does not offer a significant advantage in reducing neck recurrence rates for papillary thyroid cancer (PTC) patients staged as clinically N0.
• The study suggests that CND may not be beneficial in improving disease-free survival for this specific patient group.
• Further research may be warranted to refine indications for CND in early-stage PTC.