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Published on: September 15, 2023
Prophylactic Central Neck Dissection in Well-differentiated Thyroid Cancer.
Krešimir Gršić1, Boris Bumber1, Renata Curić Radivojević1
11Department of Otorhinolaryngology and head and neck surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 2Department of Anaesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia; 4Department of Dental Medicine, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia.
Prophylactic central neck dissection is not recommended for most well-differentiated thyroid cancers. It is only indicated for advanced papillary thyroid cancers or those with metastatic lymph nodes.
Area of Science:
- Oncology
- Surgical Oncology
- Endocrinology
Background:
- Well-differentiated thyroid carcinomas (papillary and follicular) comprise 90% of thyroid cancers.
- These cancers typically have an indolent course with excellent long-term survival (>90% at 20 years).
- Standard treatment involves total thyroidectomy or lobectomy.
Purpose of the Study:
- To clarify the indications for prophylactic central neck dissection in well-differentiated thyroid carcinoma.
- To evaluate the risks and benefits of this surgical approach.
Main Methods:
- Review of current guidelines and clinical evidence regarding prophylactic central neck dissection.
- Analysis of metastatic patterns for follicular and papillary thyroid carcinomas.
- Assessment of survival benefits versus postoperative complication risks.
Main Results:
- Prophylactic central neck dissection is not indicated for follicular thyroid carcinomas due to their primary hematogenous spread.
- For small papillary thyroid carcinomas (T1-T2), it offers no survival benefit and increases complication risks.
- Indications include advanced papillary thyroid cancers (T3-T4), high-risk tumors, and lateral neck metastases.
Conclusions:
- Prophylactic central neck dissection should be selectively applied in well-differentiated thyroid cancer.
- The decision must balance potential benefits against significant risks of complications.
- Current evidence does not support routine use in early-stage or follicular thyroid cancers.
