The effectiveness of prophylactic ipsilateral central neck dissection in selected patients who underwent total thyroidectomy for clinically node-negative unilateral papillary thyroid carcinoma

Abstract

Background: Prophylactic central neck dissection (CND) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial. The purpose of this study was to evaluate the benefits of prophylactic ipsilateral CND compared with bilateral CND in total thyroidectomy for cN0 unilateral PTC. Methods: We retrospectively enrolled 174 patients who underwent total thyroidectomies with prophylactic CND for cN0 unilateral PTC between January 2009 and May 2010. The prophylactic CND patients were divided into group 1, the ipsilateral CND group (n=74), and group 2, the bilateral CND group (n=100). The incidence of central lymph node metastasis (CLNM) and postoperative complications, such as hypoparathyroidism, recurrent laryngeal nerve injury, and recurrence were assessed. Results: CLNM was found in 22 (29.8%) in group 1 and 69 (69%) in group 2. The incidence of postoperative severe hypocalcemia less than 7.0 was also significantly different (six patients [8.1%] in group 1 and 23 [23%] in group 2; p=0.009). Permanent hypoparathyroidism was significantly more frequent in group 2 (4.1% vs. 19%; p=0.005). However, the incidence of transient hypoparathyroidism, recurrence, and recurrent laryngeal nerve injury was not significantly different. Conclusion: Prophylactic ipsilateral CND has advantage not only to reduce incidence of some complications but also to have similar recurrence rate compared with bilateral CND. We suggest that prophylactic ipsilateral CND may be safe and effective for selected patients undergoing total thyroidectomy for cN0 unilateral PTC.

Comparison of prophylactic ipsilateral and bilateral central lymph node dissection in papillary thyroid carcinoma: a meta-analysis

“…36 full-text research studies were evaluated for eligibility by excluding duplicates, irrelevant topics, non-original studies and studies without control groups. Finally, 6 studies 6 , 7 , 8 , 9 , 10 , 11 comparing ipsilateral CND with bilateral CND were eligible and included in our meta-analysis.

Figure 1 Flowchart of literature search results.

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“… Author, year Country No. of patients Sex (male/female) Mean age (year) Mean tumor size (mm) Multifocality Extrathyroidal extension Time to recurrence (months) Follow-up time (months) Quality of score Study design Calò 2017 9 Italy 258 56/202 44.4 ± 11.8 Ipsi-CND 16.7 ± 10.7 Ipsi-CND 18/30 ‒ ‒ Ipsi-CND 74.9 ± 19.2 7/9 Retrospective Bil-CND 13.8 ± 7.5 Bil-CND 21/30 Bil-CND 67.8 ± 22.8 Giordano 2017 6 Italy 610 135/475 49 ± 14 ‒ ‒ ‒ ‒ 113 ± 53 7/9 Retrospective Kang 2020 11 Korea 174 0/174 Ipsi-CND 47.8 ± 11.2 Ipsi-CND 8 ± 5 Ipsi-CND 14/74 Ipsi-CND 43/74 ‒ Ipsi-CND 118.2 ± 4.6 8/9 Retrospective Bil-CND 45.1 ± 10.2 Bil-CND 9 ± 6 Bil-CND 16/100 Bil-CND 66/100 Bil-CND 115.5 ± 4.1 ...…”

“…Permanent RLN injury was considered as persistent hoarseness and vocal cord palsy identified by laryngeal examination more than 6 months postoperatively. 8 , 11 , 13 Hypoparathyroidism was described as PTH levels < 10 pg/mL. Permanent hypoparathyroidism was determined as PTH < 10 pg/mL with constant low PTH levels throughout the follow-up period.…”

Fine-Needle Pricking Test of the Parathyroid Gland during Thyroid Surgery in Predicting Parathyroid Function

“…However, observation of the parathyroid color change is not reliable [29]. High rates (4.1-16.2%) of permanent hypoparathyroidism have been reported after total thyroidectomy and CND in some thyroid centers [4][5][6]30].…”