Prophylactic Central Compartment Neck Dissection in Papillary Thyroid Cancer and Effect on Locoregional Recurrence. Ann Surg Oncol 2018 Sep;25(9):2526-2534
Date
05/23/2018Pubmed ID
29786126DOI
10.1245/s10434-018-6528-0Scopus ID
2-s2.0-85047201138 (requires institutional sign-in at Scopus site) 64 CitationsAbstract
BACKGROUND: Prophylactic central compartment neck dissection (pCCND) in addition to total thyroidectomy (TT) includes removal of central compartment lymph nodes in the absence of clinical involvement on preoperative and intraoperative evaluation. The data regarding the influence of pCCND on oncologic outcomes and surgical complication rates is mixed and, therefore, is the focus of this analysis.
METHODS: A systematic review of the literature on total thyroidectomy with prophylactic central compartment neck dissection (TT + pCCND) from January 1990 to October 2017 identified 221 abstracts of which 17 met inclusion criteria and were reviewed (1 randomized-control trial, 13 retrospective cohort studies, and 3 meta-analyses).
RESULTS: TT + pCCND was found to detect occult lymph node metastasis in approximately 50% of patients who had no clinical evidence of lymph node metastasis on preoperative imaging. Permanent hypoparathyroidism occurs more frequently following TT + pCCND (TT = 1.55% vs. TT + pCCND = 3.45%), but the rates of permanent recurrent laryngeal nerve dysfunction are similar (TT = 0.89% vs. TT + pCCND = 0.96%). The locoregional recurrence rates across all 14 studies included in this analysis was 6.75% for TT alone and 4.55% for TT + pCCND. The rate of locoregional recurrence was significantly lower in patients who underwent pCCND in a few studies and one meta-analysis, but were not significantly different in the majority of studies.
CONCLUSIONS: TT + pCCND in clinically node-negative papillary thyroid cancer will detect occult lymph node metastasis in approximately half of patients. This may change their postoperative management with regard to adjuvant radioiodine therapy. There is a higher risk of hypoparathyroidism with pCCND, and the effect on rates of locoregional recurrence remains uncertain.
Author List
Hughes DT, Rosen JE, Evans DB, Grubbs E, Wang TS, Solórzano CCAuthors
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinTracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
HumansLymphatic Metastasis
Neck Dissection
Neoplasm Recurrence, Local
Prophylactic Surgical Procedures
Thyroid Neoplasms
Thyroidectomy