Comparison of outcomes between hemithyroidectomy alone and hemithyroidectomy with elective unilateral central neck dissection in patients with papillary thyroid microcarcinoma

Abstract

Background There have been arguments over the efficacy of elective unilateral central neck dissection (CND) in patients with papillary thyroid carcinoma (PTC) <1 cm who underwent hemithyroidectomy. This study was designed to investigate locoregional recurrence and postoperative complications related to elective unilateral CND for papillary thyroid microcarcinoma (PTMC). Methods Five hundred thirty‐seven patients who underwent hemithyroidectomy, with or without CND for PTMC, were included. We compared locoregional recurrence and postoperative complication rates between 138 patients who underwent hemithyroidectomy only (CND group) and 399 patients who underwent hemithyroidectomy with elective unilateral CND (CND+ group). Results Recurrence was observed in 32 patients. Twenty‐two patients with recurrence were in the CND+ group and 10 were in the CND‐ group. Recurrence rate was not significantly different between the 2 groups (P = .434). Conclusion Concomitant unilateral elective CND did not enhance outcomes of hemithyroidectomy for the treatment of PTMC.

Recurrence following hemithyroidectomy in patients with low- and intermediate-risk papillary thyroid carcinoma

“…In the present study, the incidence of multifocality (10·2 per cent) was comparable to previously reported rates ranging from 6·7 to 14·6 per cent, and this factor was identified as the sole predictor of recurrence. This result, together with the recurrence pattern, indicates that a degree of occult contralateral PTC led to frequent recurrence in the contralateral thyroid lobe.…”

“…The recurrence rate of 4·5 per cent in the present study was comparable to, or lower than, that in recent studies of PTC operated with hemithyroidectomy alone (3·1–13·0 per cent). Recurrence patterns in the present study were consistent with those of a recent study of 724 patients with PTC undergoing lobectomy only.…”

“…These findings suggest that central neck metastases were not common and had little clinical impact on prognosis in patients with low‐ and intermediate‐risk PTC for whom hemithyroidectomy was indicated. These findings highlight the results of previous studies, and latest international guidelines for the management of thyroid cancer stating that routine CND is not mandatory in patients who are candidates for hemithyroidectomy.…”

“…Interestingly, although CND was not done routinely in the present study and performed in only 11·6 per cent of patients, the recurrence rate was comparable to those in studies involving routine CND in patients with similar clinicopathological characteristics (4·0–5·5 per cent). Among the 65 patients who underwent CND, the rate of central neck metastasis was only 14 per cent (9 of 65), and it was not associated with recurrence.…”

“…Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid carcinoma. It has an excellent prognosis, with a 10‐year survival rate of more than 95 per cent, although outcome is poorer for aggressive subtypes. In contrast to the excellent survival outcomes, recurrence after initial surgery is relatively common, with a reported incidence of 30 per cent.…”