Central lymph node dissection as a secondary procedure for papillary thyroid cancer: Is there added morbidity?

Alvarado, Raúl; Sywak, Mark; Delbridge, Leigh; Sidhu, Stan

doi:10.1016/j.surg.2009.01.013

Cited by 108 publications

(88 citation statements)

References 19 publications

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“…Even if some authors reported that reoperation in the same field was performed without additional morbidity, numerous studies have concluded that reoperation due to recurrence in Level VI is associated with an increase in postoperative complications, such as reccurent laryngeal nerve injury and hypoparathyroidism [26,27]. Furthermore, secondary operation is associated with a requirement for general anesthesia, patient stress, and higher cost of care.…”

Section: Discussionmentioning

confidence: 99%

Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma

et al. 2012

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“…Prophylactic CLND could potentially avoid a reoperation for metastasis in the central neck that possibly could be associated with increased morbidity (specifically RLN injury and inadvertent parathyroid gland resection). Alvarado et al [21] compared 170 patients (group A) who had a CLND as part of their primary surgical procedure whereas 23 patients underwent CLND as a secondary procedure. The incidence of temporary hypocalcemia (12% versus 9%), permanent hypoparathyroidism (1.8% versus 0%), temporary RLN paresis (3% versus 4%), permanent RLN paresis (0.6% versus 0%) and wound infection (0.6% vs. 4.3%) was comparable in groups A and B, suggesting that there is no additional morbidity when CLND is performed as a secondary procedure for patients with PTC.…”

Section: For Againstmentioning

confidence: 99%

Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer

Carling

Long

Udelsman

2010

Current Opinion in Oncology

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“…Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, comprising approximately 90% of new cases of thyroid cancer in iodine-sufficient areas of the world [1-6]. Patients with PTC have an excellent prognosis, with 10-year survival rates exceeding 90% [1,2,4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment?

et al. 2014

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BackgroundCervical lymph node metastases in papillary thyroid cancer are common. Although central neck dissection is indicated in clinically nodal-positive disease, it remains controversial in patients with no clinical evidence of nodal metastasis. The aim of this retrospective study was to determine the outcomes of clinically lymph node-negative patients with papillary thyroid cancer who underwent total thyroidectomy without a central neck dissection, in order to determine the rates of recurrence and reoperation in these patients compared with a group of patients submitted to total thyroidectomy with central neck dissection.MethodsTwo-hundred and eighty-five patients undergoing total thyroidectomy with preoperative diagnosis of papillary thyroid cancer, in the absence of suspicious nodes, were divided in two groups: those who underwent a thyroidectomy only (group A; n = 220) and those who also received a central neck dissection (group B; n = 65).ResultsSix cases (2.1%) of nodal recurrence were observed: 4 in group A and 2 in group B. Tumor histology was associated with risk of recurrence: Hürthle cell-variant and tall cell-variant carcinomas were associated with a high risk of recurrence. Multifocality and extrathyroidal invasion also presented a higher risk, while smaller tumors were at lower risk.ConclusionsThe role of prophylactic central lymph node dissection in the management of papillary thyroid cancer remains controversial. Total thyroidectomy appears to be an adequate treatment for clinically node-negative papillary thyroid cancer. Prophylactic central neck dissection could be considered for the more appropriate selection of patients for radioiodine treatment and should be reserved for high-risk patients only. No clinical or pathological factors are able to predict with any certainty the presence of nodal metastasis. In our experience, tumor size, some histological types, multifocality, and locoregional infiltration are related to an increased risk of recurrence. The potential use of molecular markers will hopefully offer a further strategy to stratify the risk of recurrence in patients with papillary thyroid cancer and allow a more tailored approach to offer prophylactic central neck dissection to patients with the greatest benefit. Multi-institutional larger studies with longer follow-up periods are necessary to draw definitive conclusions.

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Central lymph node dissection as a secondary procedure for papillary thyroid cancer: Is there added morbidity?

Cited by 108 publications

References 19 publications

Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma

Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma

Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer

Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment?

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