The Benefits and Risks of Prophylactic Central Neck Dissection for Papillary Thyroid Carcinoma: Prospective Cohort Study

Abstract

Objectives. This study evaluated the benefits of performing prophylactic central neck dissection (CND) with total thyroidectomy (TT) in management of papillary thyroid carcinoma (PTC) patients who were clinically node-negative at presentation. Methods. A total of 257 patients with stage T1 or T2 PTC and without preoperative evidence of lymph node involvement (N0) were enrolled in this prospective study. The patients were randomly assigned to two groups: (1) a total thyroidectomy (TT) group (n = 104) or (2) a TT plus CND group (n = 153). The two groups were compared for their perioperative data, complication rates, disease recurrence rates, and clinical outcomes. Results. The two groups of patients were similar in age, sex ratio, follow-up duration, and tumor size (P = 0.227, 0.359, 0.214, and 0.878, resp.). The two groups showed similar rates of disease recurrence (3.9% in the TT group versus 3.3% in the TT plus CND group); however, complications occurred more frequently in the TT plus CND group; especially transient hypocalcemia (P = 0.043). Conclusions. Patients treated with TT plus CND had a higher rate of complications with similar recurrence rate. We believe that CND may not be routinely recommended when treating patients with PTC.

Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

“…Temporary hypoparathyroidism was (Tartaglia et al, 2014), 6% (Wang et al, 2013) and 9.7% (Popadich et al, 2011) but sometimes as high as 60% (Pereira et al, 2005). In this study, the permanent VCD was documented in 3.2% in group A and 6.3% in group B which was within the reported range (0-12%) in other studies (Choi et al, 2011;Hughes and Doherty, 2011;Popadich et al, 2011;Giordano et al, 2012;Wang et al, 2013;Tartaglia et al, 2014;Lee et al, 2015), while temporary VCD was reported to be 12.9% in group A and 9.4% in group B which was slightly higher than the reported range (0.4-9%) in other studies (Pereira et al, 2005;Popadich et al, 2011;Wang et al, 2013;Tartaglia et al, 2014;Lee et al, 2015).…”

“…In this study, the permanent hypoparathyroidism was documented in 6.5% for group A and 9.4% for group B patients which was much less than that reported by Tartaglia et al, 2014 25.4% of patients who underwent TT + CND, within the range reported by White et al, 20070-14.3% while Pereira et al, 2005Choi et al, 2011;Popadich et al,2011;Wang et al, 2013;and Lee et al, 2015 reported only 2%, 3% ,0.8%, 4.6% and 3.3% permanent hypoparathyroidism respectively. Temporary hypoparathyroidism was (Tartaglia et al, 2014), 6% (Wang et al, 2013) and 9.7% (Popadich et al, 2011) but sometimes as high as 60% (Pereira et al, 2005).…”

Incidence of permanent hypocalcaemia after total thyroidectomy with or without central neck dissection for thyroid carcinoma: a nationwide claim study

“…In general, all four parathyroid glands are located in the central neck compartment, and therefore, CND inevitably puts the parathyroid glands in danger. However, it is still unclear whether CND is associated with higher rates of permanent hypocalcaemia; indeed, several studies report that TT with CND does not increase the incidence of permanent hypocalcaemia any more than TT alone . This might be because the incidence of permanent hypocalcaemia was too low to have sufficient statistical power to identify a difference; even a recent meta‐analysis could not identify a difference …”

“…However, it is still unclear whether CND is associated with higher rates of permanent hypocalcaemia; indeed, several studies report that TT with CND does not increase the incidence of permanent hypocalcaemia any more than TT alone. [10][11][12][13] This might be because the incidence of permanent hypocalcaemia was too low to have sufficient statistical power to identify a difference; even a recent meta-analysis could not identify a difference. 14 Here, we examined data held in a nationwide claim database and compared the incidence of permanent hypocalcaemia after TT alone with that after TT plus CND.…”

Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis

“…22 Another prospective, controlled study that included 257 low-risk PTC patients who were followed for approximately 4 years had similar results, with no difference in the recurrence rate between patients treated either via total thyroidectomy or via thyroidectomy and central lymph node dissection (3.9% vs 3.3%), although more perioperative complications were observed in the latter group of patients. 23 In a contrasting finding, a retrospectively controlled (but non-randomized) study of PTC in low-risk patients who underwent total thyroidectomy or also PCCLND, the rate of permanent surgical complications was similar between the two groups. 24 Finally, in a systematic review and meta-analysis including 14 non-randomized studies of which 13 were retrospective, it was found that patients treated with total thyroidectomy and PC-CLND were more likely to have postoperative RAI ablation and temporary hypocalcemia but had a 35% reduction in risk of locoregional recurrence in the short term (<5 years).…”