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Updated: Jun 11, 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
Lymph node management in clinically node-negative patients with papillary thyroid carcinoma
S Vergez1, J Sarini, J Percodani
1Department of Head and Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France. vergez.s@chu-toulouse.fr
Summary
Systematic central neck dissection (CND) is recommended for papillary thyroid carcinoma (PTC) patients, as lateral neck dissection is only advised for those with suspected lymph node metastases (LNM). This approach aids in detecting small LNM in the central neck.
Area of Science:
- Oncology
- Surgical Pathology
- Head and Neck Surgery
Background:
- The role of systematic lymph node dissection in papillary thyroid carcinoma (PTC) management is debated.
- Accurate preoperative assessment of lymph node metastasis (LNM) in clinically node-negative PTC patients is challenging due to small LNM size.
Purpose of the Study:
- To investigate the lymph node spread patterns in clinically node-negative PTC patients.
- To propose an evidence-based lymph node management strategy for PTC.
Main Methods:
- Retrospective review of 90 PTC patients undergoing total thyroidectomy with central neck dissection (CND) and lateral neck dissection.
- Inclusion criteria: clinically node-negative status based on preoperative palpation and ultrasonography.
Main Results:
- Lymph node metastasis (LNM) was detected in 45.5% of patients.
- Central and lateral compartment involvement occurred in 31% of cases.
- Patients without central compartment LNM were also negative in the lateral compartment; LNM in the central compartment were often small (≤5mm), impacting preoperative detection accuracy.
Conclusions:
- Central neck dissection (CND) is valuable for preoperative or intraoperative PTC staging.
- Lateral neck dissection should be reserved for cases with suspected or confirmed LNM.
- Systematic CND provides objective lymph node status evaluation, crucial for managing small, difficult-to-detect LNM in PTC.
