Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma

Giordano, Davide; Frasoldati, Andrea; Gabrielli, Enrico; Pernice, Carmine; Zini, Michele; Castellucci, Andrea; Piana, Simonetta; Ciarrocchi, Alessia; Cavuto, Silvio; Barbieri, Verter

doi:10.1016/j.amjoto.2017.06.004

Cited by 22 publications

(26 citation statements)

References 31 publications

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“…4 The commonly reported complications included vocal cord paralysis or recurrent laryngeal nerve injury and hypothyroidism, with a noted higher risk of permanent hypoparathyroidism if bilateral neck dissection was done. [11][12][13] Interestingly, the overall recurrence rate and survival rate did not significantly differ between the two groups in these studies. [11][12][13][14] From the results of these studies, it seems evident that the incidence of morbidity is clearly and consistently proportional to the extent of surgery.…”

mentioning

confidence: 69%

“…[11][12][13] Interestingly, the overall recurrence rate and survival rate did not significantly differ between the two groups in these studies. [11][12][13][14] From the results of these studies, it seems evident that the incidence of morbidity is clearly and consistently proportional to the extent of surgery. This result is not unexpected however, since more extensive dissection in the central neck during surgery may interfere with the blood supply to the parathyroid glands, particularly the inferior parathyroid glands.…”

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confidence: 69%

“…16 The retrospective study results of Giordano et al on 610 patients show a similar rate of neck recurrence in all groups regardless of whether they underwent total thyroidectomy alone or total thyroidectomy with either ipsilateral or bilateral central neck dissection. 12 This finding suggests that lymph node micrometastasis seems not to affect the clinical outcome of patients with PTC. 12 Moreover, patients with PTC developing locoregional recurrence or distant metastasis can be treated effectively in most cases.…”

Section: Discussionmentioning

confidence: 89%

“…12 This finding suggests that lymph node micrometastasis seems not to affect the clinical outcome of patients with PTC. 12 Moreover, patients with PTC developing locoregional recurrence or distant metastasis can be treated effectively in most cases. This is similar to the results of Kim et al, the largest study on pCND to date, that found that pCND did not significantly decrease the risk of locoregional recurrence in cN0 PTC patients, even though META-ANALYSIS Figure 4B.…”

Section: Discussionmentioning

confidence: 89%

“…Similar to the previous metaanalysis, most of these studies revealed no significant differences in the rates of temporary or permanent nerve injury in patients undergoing prophylactic CND compared to patients undergoing total thyroidectomy alone. 6,8,12,[14][15][16][17][25][26][27] Giordano et al also found no significant differences in recurrent laryngeal nerve injury for TT alone patients compared to those with combined ipsilateral or bilateral pCND. 25 The study by Kim et al was the only other study that showed a significantly increased rate of temporary vocal cord palsy in pCND patients however these results may be skewed since the pre-operative and post-operative laryngoscopic examination was not performed in all patients.…”

Section: Discussionmentioning

confidence: 93%

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Morbidity Outcomes of Prophylactic Central Neck Dissection with Total Thyroidectomy versus Total Thyroidectomy Alone in Patients with Node Negative Papillary Thyroid Cancer: A Meta-Analysis of Observational Studies

Sison¹,

Fernando²,

Gutierrez³

2019

Philipp J Otolaryngol Head Neck Surg

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Objective: The primary objective of this meta-analysis is to compare locoregional recurrence, vocal cord paralysis, and permanent hypoparathyroidism in patients with thyroid papillary carcinoma without neck node metastases, after total thyroidectomy with and without prophylactic central neck dissection. Methods: Two independent reviewers performed a detailed literature search of MEDLINE (PubMed), HERDIN and Cochrane Library electronic databases to assess research studies until 2018 for inclusion. The primary endpoints of locoregional recurrence, permanent hypoparathyroidism, and vocal cord paralysis were included in the assessment. Design: Meta-Analysis of Retrospective Cohort Studies Setting: University Hospitals and Tertiary Referral Centers Participants: Patients with node-negative papillary thyroid cancer who underwent either total thyroidectomy alone or total thyroidectomy with prophylactic central neck dissection (either unilateral or bilateral). Results: This meta-analysis showed that there is a significantly increased risk for locoregional recurrence in the total thyroidectomy alone group (1.96% TT with pCND VS 2.60% TT, RR=0.62, 95% Cl=0.40-0.95, p=.03), permanent hypoparathyroidism in the total thyroidectomy with prophylactic central neck dissection group (5.72% TT with pCND vs 3.34% TT, RR=2.19, 95% Cl=1.62-2.98, p=.00001) and no significant difference for vocal cord paralysis between the 2 groups (RR=1.56, 95% Cl=0.86-2.84, p=.14). Conclusion: This meta-analysis revealed that performing pCND in patients with node-negative PTC increases the risk of morbidity for hypoparathyroidism but not for vocal cord paralysis. More importantly, the incidence of recurrence is decreased in the pCND group, which may have implications on the overall survival of patients. The benefit of performing pCND may outweigh the risk but the role of prophylactic CND in the treatment of patients with PTC with clinically negative lymph nodes is still debatable in terms of overall survival. Keywords: thyroidectomy, complications; neck dissection; papillary thyroid carcinoma; lymph node dissection; recurrence; vocal cord paralysis; hypoparathyroidism

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confidence: 69%

mentioning

confidence: 69%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 93%

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Morbidity Outcomes of Prophylactic Central Neck Dissection with Total Thyroidectomy versus Total Thyroidectomy Alone in Patients with Node Negative Papillary Thyroid Cancer: A Meta-Analysis of Observational Studies

Sison¹,

Fernando²,

Gutierrez³

2019

Philipp J Otolaryngol Head Neck Surg

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Postoperative Calcium Management

Slonimsky

Goldenberg

2021

Innovations in Modern Endocrine Surgery

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Positive Lymph Node Counts in American Thyroid Association Low‐Risk Papillary Thyroid Carcinoma Patients

et al. 2020

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Background Current American Thyroid Association (ATA) guidelines state that patients with intermediate‐risk papillary thyroid cancer (PTC) may benefit from remnant ablation. One criterion for intermediate‐risk classification is >5 positive lymph nodes (LNs). We investigate whether performing step‐sectioning of LNs increases the metastatic detection rate, thereby influencing ATA risk of recurrence (ROR) classification. Methods A retrospective review was conducted of cases in which ≥ 5 LNs were removed during thyroidectomy and ≤5 LNs were found positive for PTC. Step‐sectioning was performed on the original tissue blocks. All slides were re‐reviewed by a senior pathologist. Results Twenty patients met study criteria. Step‐sectioning significantly increased LN yield compared to standard sectioning. In total, we found 12 new positive lymph nodes; seven (58%) were in totally new lymph nodes, while five (42%) were in lymph nodes previously read as negative. All newly discovered metastases were classified as micrometastases (≤2 mm). Of the 15 patients originally classified as low‐risk, the step‐sectioning protocol impacted two patients (13%), increasing ROR stratification. Conclusion Intensive step‐sectioning reveals additional micrometastases. More detailed analysis did not identify clinically significant nodal disease likely to impact the clinical course of patients in this study. Our study supports current standards of pathology specimen handling related to LN assessment and the impact on ATA ROR classification. Nonetheless, it is important for clinicians to understand their institution's sectioning protocol utilized to report positive and total LN counts, which could impact ATA risk stratification and denote the comprehensive nature of the LN dissection that was performed.

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Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma

Cited by 22 publications

References 31 publications

Morbidity Outcomes of Prophylactic Central Neck Dissection with Total Thyroidectomy versus Total Thyroidectomy Alone in Patients with Node Negative Papillary Thyroid Cancer: A Meta-Analysis of Observational Studies

Morbidity Outcomes of Prophylactic Central Neck Dissection with Total Thyroidectomy versus Total Thyroidectomy Alone in Patients with Node Negative Papillary Thyroid Cancer: A Meta-Analysis of Observational Studies

Postoperative Calcium Management

Positive Lymph Node Counts in American Thyroid Association Low‐Risk Papillary Thyroid Carcinoma Patients

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