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Prophylactic lymph node dissection in papillary thyroid carcinoma: is there a place for lateral neck dissection?
Romain Ducoudray1, Christophe Trésallet, Gaelle Godiris-Petit
1Department of General and Endocrine Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie (Paris VI), Paris, France. romainducoudray@free.fr
World Journal of Surgery
|April 9, 2013
Summary
Prophylactic lymph node dissection in papillary thyroid carcinoma (PTC) patients with no preoperative lymph node metastasis (N0) is recommended. This approach identifies high-risk individuals and impacts recurrence rates.
Area of Science:
- Oncology
- Surgical Oncology
- Endocrine Surgery
Background:
- Cervical lymph node (LN) metastases are frequent in papillary thyroid carcinoma (PTC) and negatively impact recurrence.
- Management of preoperatively node-negative (N0) PTC remains controversial.
- This study evaluates prophylactic bilateral lymph node dissection (LND) in N0 PTC patients.
Purpose of the Study:
- To describe the outcomes of prophylactic bilateral LND in N0 PTC.
- To investigate the impact of prophylactic LND on recurrence in N0 PTC patients.
Main Methods:
- Analysis of 603 consecutive N0 PTC patients from 2003-2011.
- Review of patient demographics, tumor characteristics, LN metastasis patterns, and outcomes.
- Multivariate analysis to identify risk factors for LN metastasis and recurrence.
Main Results:
- 23% of N0 PTC patients had LN metastases (19% central, 8% lateral).
- Hyperthyroidism and extrathyroidal invasion were associated with LN metastasis.
- Recurrence rates were 2% (N0), 5% (N1a), and 22% (N1b), with prophylactic LND identifying high-risk patients.
Conclusions:
- LN metastases are common in central and ipsilateral lateral compartments in preoperatively N0 PTC.
- Prophylactic LND in central and ipsilateral lateral compartments is recommended for PTC.
- This strategy helps identify high-risk patients and manage recurrence effectively.
