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Updated: Apr 18, 2026
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived
D Viola1, G Materazzi, L Valerio
1Endocrine Section, Department of Clinical and Experimental Medicine, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders (D.V., L.V., E.M., L.A., C.R., P.P., P.V., R.E.), Surgery Section (G.M, P.M.), Pathology Section (P.F., E.S., L.T., F.B.), and Otorhinolaryngology Section (V.S., S.S.-F.), Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56124 Pisa, Italy.
Prophylactic central compartment lymph node dissection (pCCND) in papillary thyroid cancer (PTC) offers no survival benefit over total thyroidectomy alone. However, pCCND reduces the need for radioactive iodine treatment but increases the risk of permanent hypoparathyroidism.
Area of Science:
- Endocrinology
- Surgical Oncology
- Thyroid Cancer Research
Background:
- Prophylactic central compartment lymph node dissection (pCCND) benefits in papillary thyroid cancer (PTC) remain debated.
- While pCCND may reduce recurrence, it carries increased surgical complication risks.
- Lack of prospective randomized trials hinders definitive recommendations for pCCND in PTC.
Purpose of the Study:
- To evaluate the clinical advantages and disadvantages of pCCND in cN0 PTC patients.
- To compare outcomes between total thyroidectomy (TTx) and TTx + pCCND.
- To assess the impact of pCCND on recurrence, (131)I treatment, and surgical complications.
Main Methods:
- A prospective randomized controlled study involving 181 cN0 PTC patients.
- Patients were assigned to either TTx (Group A, n=88) or TTx + pCCND (Group B, n=93).
- Follow-up duration was 5 years to assess clinical outcomes.
Main Results:
- No significant difference in overall outcome between TTx and TTx + pCCND groups after 5 years.
- Group A (TTx) required more (131)I courses (P=.002).
- Group B (TTx + pCCND) had a higher prevalence of permanent hypoparathyroidism (P=.02).
Conclusions:
- TTx and TTx + pCCND yield similar outcomes for cN0 PTC patients.
- pCCND reduces (131)I retreatment necessity but increases permanent hypoparathyroidism risk.
- Preoperative factors, including BRAF mutation, do not reliably predict micrometastatic lymph nodes, which did not impact outcomes.
