Prophylactic central lymph node dissection for low-risk papillary thyroid cancer-Impact on subsequent therapy.

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Cancer Research

Background:

• American Thyroid Association guidelines suggest prophylactic central lymph node dissection (pCLND) for small papillary thyroid cancers (PTCs) if it impacts management.
• The study investigates the impact of pCLND on de-escalating subsequent therapies for PTCs.

Purpose of the Study:

• To determine if pCLND for small PTCs influences the need for completion thyroidectomy and radioactive iodine (RAI) ablation.
• To assess the safety and efficacy of pCLND in managing low-risk PTCs.

Main Methods:

• A cohort study of adults with T1, T2, and cN0 PTCs was conducted across 42 centers in Australia and New Zealand (2017-2023).
• Patients without clinical nodal involvement or distant metastases were analyzed, comparing those who underwent pCLND with those who did not.
• Subsequent therapies and complication rates were recorded and compared.

Main Results:

• Of 1290 patients, 37% underwent pCLND, revealing occult lymph node metastases in 36% of these cases.
• Absence of lymph node metastasis after pCLND was linked to significantly fewer completion thyroidectomies (aRR=0.65) and reduced RAI ablation (aRR=0.55).
• pCLND was not associated with increased risks of recurrent laryngeal nerve injury, temporary hypocalcemia, or permanent hypoparathyroidism.

Conclusions:

• In specialized Australian and New Zealand centers, pCLND for low-risk cN0 PTCs is associated with decreased rates of completion thyroidectomy and RAI ablation.
• pCLND, when performed by experienced thyroid surgeons, does not lead to higher complication rates.