Endocrine

, Volume 44, Issue 2, pp 419–425

Total thyroidectomy, without prophylactic central lymph node dissection, in the treatment of differentiated thyroid cancer. Clinical retrospective study on 221 cases

  • Giovanni Conzo
  • Daniela Pasquali
  • Giuseppe Bellastella
  • Katherine Esposito
  • Carlo Carella
  • Annamaria De Bellis
  • Giovanni Docimo
  • Michele Klain
  • Sergio Iorio
  • Salvatore Napolitano
  • Antonietta Palazzo
  • Alessandra Pizza
  • Antonio Agostino Sinisi
  • Emilia Zampella
  • Antonio Bellastella
  • Luigi Santini
Original Article

DOI: 10.1007/s12020-013-9877-2

Cite this article as:
Conzo, G., Pasquali, D., Bellastella, G. et al. Endocrine (2013) 44: 419. doi:10.1007/s12020-013-9877-2

Abstract

Total thyroidectomy (TT) is the standard of care for differentiated thyroid cancer (DTC), but still there is no consensus about the role of routine use of prophylactic central lymph node dissection. The aim of this study was to analyze our results of TT without prophylactic central lymphadenectomy in the treatment of DTC. Clinical records, between January 1998 and December 2005, of 221 patients undergoing TT, without prophylactic central lymph node dissection, were retrospectively evaluated. Two hundred and eleven patients (95.47 %) also underwent radioiodine (RAI) ablation followed by thyroid stimulating hormone (TSH) suppression therapy. In patients with loco-regional lymph nodal recurrence, lateral and central lymph node dissection was performed. The incidence of permanent hypoparathyroidism (iPTH <10 pg/ml) and permanent vocal fold paralysis were, respectively, 0.91 and 0.91 %. After a 9.6 ± 3.5 years mean follow-up, the rate of loco-regional recurrence, with positive cervical lymph nodes, was 3.16 % (7/221 patients). In these cases a lateral and central lymphadenectomy was carried out without significant complications. Our results showed that TT without prophylactic central lymph node dissection, followed by RAI ablation, was associated with low morbidity and low loco-regional recurrence rate, even if the lack of a control group treated with TT plus prophylactic central lymphadenectomy suggests caution against generalization of our assumption. Such last combined procedure could be indicated in high-risk patients, in whom loco-regional recurrence is more frequent. However, given the trend in the literature toward prophylactic lymphadenectomy and the avoidance of RAI treatment, prospective randomized trials should be conducted to better clarify this issue.

Keywords

Differentiated thyroid cancer Total thyroidectomy Routine central neck dissection Local relapse 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Giovanni Conzo
    • 1
  • Daniela Pasquali
    • 2
  • Giuseppe Bellastella
    • 2
  • Katherine Esposito
    • 2
  • Carlo Carella
    • 2
  • Annamaria De Bellis
    • 2
  • Giovanni Docimo
    • 1
  • Michele Klain
    • 3
  • Sergio Iorio
    • 2
  • Salvatore Napolitano
    • 1
  • Antonietta Palazzo
    • 1
  • Alessandra Pizza
    • 1
  • Antonio Agostino Sinisi
    • 2
  • Emilia Zampella
    • 3
  • Antonio Bellastella
    • 2
  • Luigi Santini
    • 1
  1. 1.Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General and Endocrine SurgerySecond University of NaplesNaplesItaly
  2. 2.Department of Cardio-Thoracic and Respiratory Sciences, Endocrinology Unit SecondUniversity of NaplesNaplesItaly
  3. 3.Department of Biomorphological and Functional ScienceUniversity of NaplesNaplesItaly

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