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Prophylactic Central Neck Dissection in Papillary Thyroid Carcinoma: All Risks, No Reward
Jonathan Dismukes1, Jessica Fazendin1, Ruth Obiarinze1
1Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.
The Journal of Surgical Research
|April 10, 2021
Summary
Central neck dissection for clinically node-negative papillary thyroid cancer (PTC) patients does not improve recurrence rates but increases surgical risks. Routine central neck dissection is not recommended for these patients.
Area of Science:
- Oncology
- Surgical Pathology
- Endocrine Surgery
Background:
- Central neck dissection (CND) for papillary thyroid carcinoma (PTC) with clinically node-negative (cN0) disease is debated.
- Concerns exist regarding the balance between potential benefits and surgical complication risks.
Purpose of the Study:
- To evaluate the efficacy and safety of CND in cN0 PTC patients.
- To assess the oncologic impact of CND in this patient group.
Main Methods:
- Retrospective review of 695 PTC patients (1998-2018), stratified by CND status.
- Analysis included patient demographics, pathological results, and surgical/oncologic outcomes.
- Statistical analyses utilized ANOVA, t-tests, and chi-squared tests.
Main Results:
- Of 492 cN0 PTC patients, 61 underwent CND.
- CND did not significantly reduce disease recurrence, distant metastasis, or persistence.
- CND(+) patients had higher rates of transient hypocalcemia and recurrent laryngeal nerve (RLN) injury, including permanent RLN injury.
Conclusions:
- CND in cN0 PTC patients was not associated with improved short-term oncologic outcomes.
- CND was linked to increased postoperative morbidity.
- Routine CND is not advised for cN0 PTC patients.
