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Updated: Nov 11, 2025
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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
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A Randomized Controlled Clinical Trial: No Clear Benefit to Prophylactic Central Neck Dissection in Patients With
Rebecca S Sippel1, Sarah E Robbins1,2, Jennifer L Poehls3
1Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Annals of Surgery
|March 24, 2021
Summary
Prophylactic central neck dissection (pCND) in clinically node-negative (cN0) papillary thyroid cancer (PTC) patients does not increase complications or improve oncologic outcomes compared to total thyroidectomy alone. Microscopic lymph node involvement is common but does not affect 1-year results.
Area of Science:
- Oncology
- Surgical Oncology
- Endocrinology
Background:
- Papillary thyroid cancer (PTC) frequently presents with microscopic lymph node involvement, even in clinically node-negative (cN0) patients.
- The optimal surgical management for cN0 PTC regarding prophylactic central neck dissection (pCND) remains debated due to unclear risks and benefits.
Purpose of the Study:
- To evaluate the risks and benefits of pCND in patients with cN0 papillary thyroid cancer (PTC).
- To compare oncologic outcomes and complication rates between total thyroidectomy (TT) alone and TT with pCND.
Main Methods:
- A prospective randomized-controlled trial involving sixty cN0 PTC patients.
- Patients were randomized to either total thyroidectomy (TT) or TT plus prophylactic central neck dissection (pCND).
- Postoperative assessments included laryngoscopies, radioiodine treatment, thyroglobulin (Tg) levels, and neck ultrasounds at specified intervals.
Main Results:
- Tumor size averaged 2.2 cm, with 11.9% exhibiting extra-thyroidal extension.
- 27.6% of patients undergoing pCND had positive lymph nodes, all measuring ≤6 mm.
- No significant differences were observed in postoperative parathyroid hormone (PTH) levels or transient nerve dysfunction between the TT and TT+pCND groups.
- Thyroglobulin (Tg) levels and neck ultrasound results at 6 weeks, 6 months, and 1 year showed comparable oncologic outcomes between the two treatment arms.
Conclusions:
- Total thyroidectomy (TT) with or without prophylactic central neck dissection (pCND) yields similar complication rates in cN0 papillary thyroid cancer (PTC) patients.
- Despite the identification of microscopic lymph node metastases in a subset of pCND patients, oncologic outcomes at one year were comparable between the groups.
