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Spontaneous Murine Model of Anaplastic Thyroid Cancer
Published on: February 3, 2023
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Decision making for the central compartment in differentiated thyroid cancer
João Gonçalves Filho1, Mark E Zafereo2, Faisal I Ahmad2
1Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil.
Summary
Elective central compartment neck dissection for differentiated thyroid carcinoma (DTC) is controversial. An individualized approach is needed, considering patient factors and surgeon experience to balance recurrence risk against complications like nerve injury.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Nodal spread to the central compartment is common in differentiated thyroid carcinoma (DTC).
- Many DTC patients present with clinically node-negative (cN0) disease, making the role of prophylactic central compartment neck dissection (CND) debated.
Purpose of the Study:
- To systematically review the literature and international guidelines on the role of elective central compartment neck dissection (CND) in differentiated thyroid carcinoma (DTC).
- To discuss the anatomical, technical, and risk-benefit aspects of performing elective CND.
Main Methods:
- Systematic literature review.
- Analysis of international guidelines.
- Discussion of anatomical and technical considerations.
- Evaluation of risks and benefits.
Main Results:
- Current literature does not provide uniform support for or against elective CND in DTC patients.
- Patients with large tumors (>4 cm) and extrathyroidal extension, particularly older males, may benefit more from elective CND.
- Elective CND increases risks of hypoparathyroidism and recurrent laryngeal nerve injury, especially with low-volume surgeons.
Conclusions:
- An individualized approach to elective CND in DTC is warranted.
- Surgeon experience and patient-specific factors (tumor size, extrathyroidal extension) should guide the decision.
- Surgeons must weigh the number needed to treat against the number needed to harm for recurrence prevention versus complications.
Keywords:
Central compartmentLevel VILymph node metastasesNeck dissectionSurgeryThyroid cancerThyroidectomyMore Related Videos
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