Elsevier

Surgery

Volume 138, Issue 6, December 2005, Pages 1095-1101
Surgery

American Association of Endocrine Surgeon
Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma

https://doi.org/10.1016/j.surg.2005.09.013Get rights and content

Background

The role of central neck dissection (CND) in differentiated thyroid cancer remains controversial. This study aims at elucidating the potential benefits and drawbacks of CND associated to total thyroidectomy in papillary cancer.

Methods

Protocols of patients undergoing total thyroidectomy and CND for papillary cancer were reviewed. The following data were recorded: macroscopic appearance of central nodes; nodes obtained at operation; number of metastatic nodes and parathyroid glands incidentally resected; metastases, age, completeness, invasiveness, size score; postoperative s-Ca; complications; and recurrences. Differences between therapeutic (gross nodal involvement) and prophylactic (no apparent node involvement) CNDs were studied.

Results

Forty-three patients (mean age, 52 ± 17 years) were studied. A mean of 8.4 ± 6.6 nodes were resected per patient. A 60% prevalence (26/43) of presence of nodal involvement (N+) was found with no difference between low- and high-risk patients. Twenty-five (60%) patients developed transient hypocalcemia, which was associated with incidental parathyroidectomy, number of nodes resected, and thymectomy. Two patients (4.6%) developed permanent hypoparathyroidism and 3 (7%), transient vocal cord paralysis. Parathyroid glands were found in 19% of the specimens. At follow-up, there were no central neck recurrences, but 5 patients developed lateral recurrences despite treatment with I131. All 5 patients had had therapeutic CND with 6 or more metastatic nodes obtained in the CND specimen. No lateral neck recurrences were observed after prophylactic CND or in patients with < 6 nodes involved.

Conclusions

CND prevents central neck recurrences. Morbidity of bilateral CND is significant, and its systematic implementation in the absence on gross nodal involvement requires reassessment

Section snippets

Patients and methods

The surgical and pathology prospective protocols of a series of patients undergoing total thyroidectomy and CND for papillary thyroid cancer between 1995 and 2003 were reviewed. Patients were excluded from the study if (1) papillary cancer was diagnosed after operation (microcarcinoma or missed initial diagnosis), (2) they were undergoing completion thyroidectomy, (3) they had recurrent cancer (local or nodal metastasis), or (4) they were referred for neck dissection after thyroidectomy.

Results

Demographic and tumor characteristics of the series are shown in Table I. The surgical procedures performed and the intraoperative findings are shown in Table II. In 4 patients, section of the inferior laryngeal nerve was carried out to assure the complete resection of tumors and/or nodal metastasis invading the nerve. In 2 of these 4 patients, a tracheal sleeve resection also was performed. In addition, 1 patient required resection of the internal jugular vein, which was invaded in continuity

Discussion

The rationale for introducing CND in papillary cancer was similar to that emphasized for treating medullary carcinoma: preventing local recurrences in the central compartment where reoperation is difficult and, eventually, reducing the mortality rate, particularly in the high-risk patients. In addition, all studies on lymph node metastasis of papillary cancer agree in that the central neck compartment, particularly the region ipsilateral to the tumor, is involved most frequently. In our study,

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