The Role of Prophylactic Central Neck Dissection in Differentiated Thyroid Carcinoma: Issues and Controversies

Abstract

Prophylactic central neck dissection (pCND) in differentiated thyroid carcinoma (DTC) is one of the most controversial surgical subjects in recent times. To date, there is little evidence to support the practice of pCND in patients with DTC undergoing total thyroidectomy. Although the recently revised American Thyroid Association (ATA) guideline has clarified many inconsistencies regarding pCND and has recommended pCND in “high-risk” patients, many issues and controversies surrounding the subject of pCND in DTC remain. The recent literature has revealed an insignificant trend toward lower recurrence rate in patients with DTC who undergo total thyroidectomy and pCND than those who undergo total thyroidectomy alone. However, this was subjected to biases, and there are concerns whether pCND should be performed by all surgeons who manage DTC because of increased surgical morbodity. Performing a unilateral pCND may be better than a bilateral pCND given its lower surgical morbidity. Further studies in this controversial subject are much needed.

Postablation Stimulated Thyroglobulin Level is an Important Predictor of Biochemical Complete Remission after Reoperative Cervical Neck Dissection in Persistent/Recurrent Papillary Thyroid Carcinoma

“…Because none of the patients underwent concomitant prophylactic central neck dissection at the initial operation, it remains unknown whether this dissection might have affected the BCR rate after RND. Preoperative USG is known to have a low sensitivity in detecting central compartment metastases 12 , 17. Also, because we did not routinely explore the central compartment at the time of RND unless there was suspected disease, it was unknown whether there was still subclinical residual disease in the central compartment and whether clearing this compartment might further improve the BCR rate.…”

Significance of Size of Lymph Node Metastasis on Postsurgical Stimulated Thyroglobulin Levels After Prophylactic Unilateral Central Neck Dissection in Papillary Thyroid Carcinoma

“…In fact, this was the rationale for performing therapeutic selective neck dissection in the lateral compartment and not prophylactic selective neck dissection in patients with PTC 13. However, in comparison to lateral selective neck dissection, pCND is associated with lower surgical morbidity and can be performed within the same incision as the thyroidectomy 23. In addition, it provides more information regarding the nodal status as required by the TNM and may lower LRRs 23.…”

Prophylactic Central Compartment Node Dissection for Papillary Thyroid Carcinoma: Complication and Outcome

“…(28,29) Although this study did not analyze, Kai-Pun Wong et al recommend that if one has decided on performing a prophylactic central compartment lymph node dissection, an unilateral rather than a bilateral prophylactic central compartment lymph node dissection would appear to be the correct choice as it provides a balance between achieving surgical completeness and avoiding significant surgical morbidity. (30) Currently, there are no prospective, randomized studies about the influence of central compartment lymph node dissection on the recurrence and prognosis of papillary thyroid cancer. The limitations of this study is that the number of subjects is relatively small, and the period the operation took place was different for the patient groups with only total thyroidectomy and with additional prophylactic central compartment lymph node dissection.…”