Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node–negative papillary thyroid carcinoma

The total number of prelaryngeal and pretracheal lymph node metastases: is it a reliable predictor of contralateral central lymph node metastasis in papillary thyroid carcinoma?

“…Although it is traditionally accepted that nodal metastasis does not affect survival rate directly, regional nodal metastasis is an important prognostic factor that is closely related to tumor recurrence [17][18]. Therefore, some authors recommend that routine CLND for PTC patients has potential benefits that can prevent future recurrence, improve the accuracy of staging, decrease postoperative serum Tg levels, and facilitate the selection of patients for RAI [19][20][21]. The major argument against prophylactic CLND, however, is the greater risk of postoperative complications, even though a study has demonstrated that it can be performed safely and without added morbidity or complications by the hands of experienced surgeons [20].…”

Incidental parathyroidectomy during thyroid surgery: risk factors, incidence, and outcomes

“…Due to the variable number of parathyroid glands and the anatomical variations in each patient, injury and/ or incidental resection of the parathyroids is possible (10). Compliance with anatomical principles and surgical guidelines during the operation will decrease the number of these surgical complications (11,12). During the operation, attempting to visualize each parathyroid gland is dangerous and will cause more injuries due to the anatomical variations and the variable number of parathyroid glands (6).…”

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

“…• Regional neck nodes dissection -Differentiated carcinoma Regional lymph node metastases at diagnosis are reported in 30-60 % of patients [54,55]. The prognostic significance of lymph node involvement and, consequently, indications for and the extent of lymphadenectomy are still subject to debate [1,54,55].…”

“…The prognostic significance of lymph node involvement and, consequently, indications for and the extent of lymphadenectomy are still subject to debate [1,54,55]. Lymph node metastases are associated with increased risk of disease recurrence and reduced survival [55].…”

“…In conclusion, there are no preoperative parameters (age, gender, tumor size) to reliable identify an "at-risk" population who could benefit from a prophylactic central neck dissection [57]. Prophylactic ipsilateral central neck dissection with or without intraoperative pathology consultation on the nodes removed has been proposed for clinically unifocal and cN0 tumors, to reduce the risk of complications associated with prophylactic central neck dissection [54,[58][59][60]. Prophylactic lateral neck dissection in patients with differentiated thyroid carcinoma is not indicated.…”