Abstract
Purpose
The objective of this study was to investigate whether prophylactic central lymph node dissection (pCLND) facilitates postoperative thyroglobulin (Tg) follow-up in the patients with papillary thyroid carcinoma (PTC). We also questioned whether radioactive iodine (RAI) remnant ablation provides any further advantage in this regard.
Methods
The records of patients with low-intermediate risk PTC who underwent either only total thyroidectomy (TT) or TT in conjunction with pCLND were reviewed.
Adjuvant RAI ablation was performed depending on tumor diameter, multifocality, the presence of positive lymph nodes and adverse histopathologic features. Pre-ablative and post-ablative Tg levels, post-operative complications and clinico-pathological characteristics were compared between the two groups (TT alone and TT with pCLND).
Results
Among the 302 patients, TT was performed in 140 (46.4%) and TT with pCLND in 162 (53.6%).
More than half of all patients in both groups had papillary microcarcinoma (58.0% and 53,1%, respectively). Postoperatively, the median preablative Tg level was higher in the TT only group than that of the TT with pCLND group (0.96 vs 0.27 ng/ml, respectively). The post-ablative Tg levels were undetectable in both groups at the last follow-up visit. Also, a subgroup of patients (19.5%) who did not receive RAI ablation all became athyroglobulinemic at one year after surgery.
Conclusions
Although performing pCLND with TT seems to have an advantage over TT alone as to achieve lower Tg levels in the early post-operative period, Tg levels become comparable following RAI ablation. On the other hand, the patients who have not been treated with adjuvant RAI ablation, also became athyroglobulinemic regardless of the surgical method.
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No funding source had any role in the design of this study.
Author Hakan Korkmaz declares that he has no conflict of interest. Author Bülent Öcal declares that he has no conflict of interest. Author Güleser Saylam declares that she has no conflict of interest. Author Erman Çakal declares that he has no conflict of interest. Author Ömer Bayır, declares that he has no conflict of interest. Author Esra Tutal declares that she has no conflict of interest. Author Emel Çadallı Tatar declares that she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Korkmaz, M., Öcal, B., Saylam, G. et al. The need of prophylactic central lymph node dissection is controversial in terms of postoperative thyroglobulin follow-up of patients with cN0 papillary thyroid cancer. Langenbecks Arch Surg 402, 235–242 (2017). https://doi.org/10.1007/s00423-017-1556-y
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DOI: https://doi.org/10.1007/s00423-017-1556-y