Selective prophylactic lateral node dissection improves the ipsilateral lateral node recurrence-free survival: A...

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Prophylactic lateral neck dissection (pLND) is debated for papillary thyroid carcinoma (PTC) and not widely recommended in Western guidelines.
• Clinical decisions for pLND in PTC at our institution are individualized based on risk factors.
• This study evaluates the significance and indications for pLND in PTC patients.

Purpose of the Study:

• To investigate the significance and indications of prophylactic lateral neck dissection (pLND) in patients with papillary thyroid carcinoma (PTC).
• To compare lateral compartment recurrence-free survival (RFS) and distant RFS between patients who underwent pLND and those who did not.

Main Methods:

• Retrospective analysis of PTC patients at stage N0 or N1a and M0 who underwent surgery between 2007 and 2017.
• Comparison of lateral compartment recurrence-free survival (RFS) and distant RFS between pLND and non-pLND groups.
• Multivariate analysis to identify independent predictors for lateral compartment recurrence.

Main Results:

• No significant difference in overall lateral compartment RFS between pLND and non-pLND groups.
• Tumor size ≥3 cm and positive extrathyroidal extension were independent predictors for lateral compartment recurrence.
• In a subset of patients with tumors ≥3 cm and positive extrathyroidal extension, pLND significantly improved lateral compartment RFS (p < 0.01), reducing recurrence by 20.7% over 5 years.
• pLND did not improve distant RFS.

Conclusions:

• Prophylactic lateral neck dissection (pLND) significantly enhances lateral node recurrence-free survival in papillary thyroid carcinoma (PTC) patients with tumors ≥3 cm and significant extrathyroidal extension.
• Consideration of pLND during initial surgery for these specific PTC patients may help avoid a second surgery.