[Differentiated thyroid gland carcinoma p-T2/T3--extent of lymphadenectomy]

Systematic lymphadenectomy, which is compartment-orientated, from central node dissection to (modified) radical neck dissection, is not controversial in cases with intra-operative macroscopic node involvement. General "prophylactic" dissection, at least of the ipsilateral central compartment, is advocated due to a high incidence of "occult", microscopic positive nodes, and the elevated risk regarding recurrency and survival which is connected to node-positivity, and lowered recurrence rates with systematic lymphadenectomy. Nevertheless, the biological impact of occult positive nodes, as an independent risk-factor, is not yet clear, with important differences between papillary and follicular carcinoma ("marker" or "governor" of the disease?). Enhanced operative morbidity by extensive lymphadenectomy, especially hypoparathyroidism, must be taken into account.