Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence...

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Cancer Research

Background:

• Papillary thyroid microcarcinoma (PTMC) with lymph node metastasis (LNM) correlates with higher locoregional recurrence.
• Prophylactic central lymph node dissection (CLND) for subclinical LNM in PTMC is debated due to the cancer's generally excellent prognosis.

Purpose of the Study:

• To evaluate the benefits and risks of prophylactic CLND in patients with clinically node-negative PTMC.

Main Methods:

• A comparative study of 232 patients with clinically node-negative PTMC from 1999-2006.
• Group 1: 113 patients underwent total thyroidectomy (TT) only.
• Group 2: 119 patients underwent TT with prophylactic bilateral CLND (TT with CLND).
• Comparison of serum thyroglobulin (Tg) levels, recurrence rates, and complications.

Main Results:

• Postoperative stimulated serum Tg levels were significantly lower in the TT with CLND group (1.07 ng/mL) versus TT only group (2.24 ng/mL; P=.022).
• Stimulated Tg levels normalized between groups after radioactive iodine treatment (0.44 ng/mL vs. 0.69 ng/mL; P=0.341).
• No significant difference in 3-year locoregional control rates (98.3% vs. 96.5%; P=.368).
• Permanent hypocalcemia occurred more frequently in the TT with CLND group (5.6%) than TT only group (1.8%), but this was not statistically significant.

Conclusions:

• Prophylactic CLND significantly reduces postoperative thyroglobulin levels in PTMC patients.
• Prophylactic CLND does not improve short-term locoregional recurrence rates in clinically node-negative PTMC.
• The risk of permanent hypocalcemia may be elevated following prophylactic CLND.