Skip to main content

Advertisement

SpringerLink
Log in

The role of prophylactic central compartment neck dissection in papillary thyroid cancer

  • Review Article
  • Published:
Hellenic Journal of Surgery

Abstract

Surgical therapy is the cornerstone of treatment in patients with papillary thyroid cancer (PTC). Surgical therapy in PTC includes half-total or total thyroidectomy (TT) and, in cases of lymph node metastases, cervical lymph node dissection (CLND). The inclusion of prophylactic central compartment neck dissection (pCCND) as a new approach in the management of patients with PTC raised controversies among the community of endocrine surgeons and triggered a plethora of studies comparing TT with or without pCCND, focusing mainly on the rate of complications and the risk of recurrence of the disease. The confliction in the results of meta-analyses and systematic reviews highlights a number of issues regarding the necessity, morbidity and utility of pCCND for patients with PTC undergoing surgery, which need to be studied further. The controversies surrounding pCCND are reflected in the heterogeneity of recommendations for pCCND as reported in the guidelines for the treatment of patients with PTC worldwide. It can be concluded that in order to determine specific recommendations on the indication of pCCND for the treatment of patients with PTC, there are issues that still need to be further investigated. Until then, a more selective choice of patients undergoing pCCND is indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 2009;19:1153–8.

    Article  Google Scholar 

  2. Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 1994;18:559–67; discussion 567-8.

    Article  CAS  PubMed  Google Scholar 

  3. Tisell LE, Nilsson B, Molne J, et al. Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg 1996;20:854–9.

    Article  CAS  PubMed  Google Scholar 

  4. Evans DB. Papillary carcinoma of the thyroid: balancing principles of oncology with emerging technology. Surgery 2011;150:1015–22.

    Article  PubMed  Google Scholar 

  5. Henry JF, Gramatica L, Denizot A, Kvachenyuk A, Puccini M, Defechereux T. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg/Deutsche Gesellschaft fur Chirurgie 1998;383:167–9.

    Article  CAS  Google Scholar 

  6. Steinmüller T, Klupp J, Wenking S, Neuhaus P. Complications associated with different surgical approaches to differentiated thyroid carcinoma. Langenbecks Arch Surg 1999;384:50–3.

    Article  PubMed  Google Scholar 

  7. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 2003;237:399–407.

    PubMed Central  PubMed  Google Scholar 

  8. Gemsenjäger E, Perren A, Seifert B, Schuler G, Schweizer I, Heitz PU. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg 2003;197:182–90.

    Article  PubMed  Google Scholar 

  9. Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 2006;140:1000–5. doi:10.1016/j.surg.2006.08.001.

    Article  PubMed  Google Scholar 

  10. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 2007;245:604–10.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Palestini N, Borasi A, Cestino L, Freddi M, Odasso C, Robecchi A. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg 2008;393:693–8.

    Article  CAS  PubMed  Google Scholar 

  12. Bardet S, Malville E, Rame JP, et al. Macroscopic lymphnode involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol 2008;158:551–60.

    Article  CAS  PubMed  Google Scholar 

  13. Choi SJ, Kim TY, Lee JC, et al. Is routine central neck dissection necessary for the treatment of papillary thyroid microcarcinoma? Clin Exp Otorhinolaryngol 2008;1:41–5.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Davidson HC, Park BJ, Johnson JT. Papillary thyroid cancer: controversies in the management of neck metastasis. Laryngoscope 2008;118:2161–5.

    Article  PubMed  Google Scholar 

  15. Son YI, Jeong HS, Baek CH, et al. Extent of prophylactic lymph node dissection in the central neck area of the patients with papillary thyroid carcinoma: comparison of limited versus comprehensive lymph node dissection in a 2-year safety study. Ann Surg Oncol 2008;15:2020–6.

    Article  PubMed  Google Scholar 

  16. Koo BS, Choi EC, Yoon YH, Kim DH, Kim EH, Lim YC. Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg 2009;249:840–4. doi:10.1097/SLA.0b013e3181a40919.

    Article  PubMed  Google Scholar 

  17. Sadowski BM, Snyder SK, Lairmore TC. Routine bilateral central lymph node clearance for papillary thyroid cancer. Surgery 2009;146:696–703. doi:10.1016/j.surg.2009.06.046.

    Article  PubMed  Google Scholar 

  18. Roh JL, Park JY, Kim JM, Song CJ. Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J Surg Oncol 2009;99:28–31. doi:10.1002/jso.21164.

    Article  PubMed  Google Scholar 

  19. Rosenbaum MA, McHenry CR. Central neck dissection for papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 2009;135:1092–7. doi:135/11/1092 [pii] 10.1001/archoto.2009.158.

    Article  PubMed  Google Scholar 

  20. Besic N, Zgajnar J, Hocevar M, Petric R. Extent of thyroidectomy and lymphadenectomy in 254 patients with papillary thyroid microcarcinoma: a single-21 institution experience. Ann Surg Oncol 2009;16:920–8.

    Article  PubMed  Google Scholar 

  21. Zuñiga S, Sanabria A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 2009;135:1087–91. doi:10.1001/archoto.2009.163.

    Article  PubMed  Google Scholar 

  22. Costa S, Giugliano G, Santoro L, et al. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta otorhinolaryngologica Italica: organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale 2009;29:61–9.

    CAS  Google Scholar 

  23. Perrino M, Vannucchi G, Vicentini L, et al. Outcome predictors and impact of central node dissection and radiometabolic treatments in papillary thyroid cancers < or =2 cm. Endocr Relat Cancer 2009;16:201–10. doi:10.1677/ERC-08-0119

    Article  PubMed  Google Scholar 

  24. Shen WT, Ogawa L, Ruan D, Suh I, Duh QY, Clark OH. Central neck lymph node dissection for papillary thyroid cancer: the reliability of surgeon judgment in predicting which patients will benefit. Surgery 2010;148:398–403. doi:10.1016/j.surg.2010.03.021

    Article  PubMed  Google Scholar 

  25. Moo TA, McGill J, Allendorf J, Lee J, Fahey T, 3rd, Zarnegar R. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg 2010;34:1187–91. doi:10.1007/s00268-010-0418-

    Article  PubMed  Google Scholar 

  26. Hughes DT, White ML, Miller BS, et al. Influence of prophylactic central lymph node dissection on postoperativethyoglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery 2010;148:1100–6; discussion 1006-7.

    Article  PubMed  Google Scholar 

  27. Popadich A, Levin O, Lee JC, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery 2011;150:1048–57.

    Article  PubMed  Google Scholar 

  28. So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery 2012;151:192–8. doi:10.1016/j.surg.2011.02.004

    Article  PubMed  Google Scholar 

  29. Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW. Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol 2012;19:4217–22. doi:10.1245/s10434-012-2594-x.

    Article  PubMed  Google Scholar 

  30. Lang BH, Wong KP, Wan KY, Lo CY. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol 2012;19:60–7. doi:10.1245/s10434-011-1833-x.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Laird AM, Gauger PG, Miller BS, Doherty GM. Evaluation of postoperative radioactive iodine scans in patients who underwent prophylactic central lymph node dissection. World J Surg 2012;36:1268–1273. doi:10.1007/s00268-012-1431-5.

    Article  PubMed  Google Scholar 

  32. Lang BH, Yih PC, Shek TW, Wan KY, Wong KP, Lo CY. Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma. J Surg Oncol 2012;106:966–71. doi:10.1002/jso.23201.

    Article  PubMed  Google Scholar 

  33. Raffaelli M, De Crea C, Sessa L, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery 2012;152:957–64. doi:10.1016/j.surg.2012.08.053

    Article  PubMed  Google Scholar 

  34. Barczynski M, Konturek A, Stopa M, Nowak W. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg 2013;100:410–8. doi:10.1002/bjs.8985

    Article  CAS  PubMed  Google Scholar 

  35. Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope 2009;119:1135–9. doi:10.1002/lary.20236.

    Article  PubMed  Google Scholar 

  36. Zetoune T, Keutgen X, Buitrago D, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol 2010;17:3287–93. doi:10.1245/s10434-010-1137-6.

    Article  PubMed  Google Scholar 

  37. Shan C-X, Zhang W, Jiang D-Z, Zheng X-M, Liu S, Qiu M. Routine central neck dissection in differentiated thyroid carcinoma: A systematic review and meta-analysis. Laryngoscope 2012;122:797–804. doi:10.1002/lary.22162.

    Article  PubMed  Google Scholar 

  38. Lang BH, Ng SH, Lau L, Cowling B, Wong KP, Wan KY. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid 2013. doi:10.1089/thy.2012.0608

    Google Scholar 

  39. Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA. A Meta-analysis of the Effect of Prophylactic Central Compartment Neck Dissection on Locoregional Recurrence Rates in Patients with Papillary Thyroid Cancer. Ann Surg Oncol 2013. doi:10.1245/s10434-013-3125-0

    Google Scholar 

  40. Pereira JA, Jimeno J, Miquel J, Iglesias M, Munne A, Sancho JJ, Sitges-Serra A. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 2005;138:1095–100. doi:10.1016/j.surg.2005.09.013.

    Article  PubMed  Google Scholar 

  41. Jeon MJ, Yoon JH, Han JM, et al. The prognostic value of the metastatic lymph node ratio and maximal metastatic tumor size in pathological N1a papillary thyroid carcinoma. Eur J Endocrinol 2013;168:219–25.

    Article  CAS  PubMed  Google Scholar 

  42. Randolph GW, Duh QY, Heller KS, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 2012;22:1144–52.

    Article  PubMed  Google Scholar 

  43. Dralle H, Lorenz K, Machens A. Chirurgie der Schilddrüsenkarzinome. Chirurg (German) 2009;80:1069–83.

    Article  CAS  Google Scholar 

  44. Mulla M, Schulte KM. Central cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the central compartment. Clin Endocrinol (Oxf) 2012;76:131–6.

    Article  Google Scholar 

  45. Lian-Ming Wu, Hai-Yan Gua, Xin-Hua Qub, et al. The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: A meta-analysis. Eur J Radiol. 2012;81(8):1798–805.

    Article  Google Scholar 

  46. Cunningham DK, Yao KA, Turner RR, et al. Sentinel lymph node biopsy for papillary thyroid cancer: 12 years of experience at a single institution. Ann Surg Oncol 2010;17:2970–5.

    Article  PubMed  Google Scholar 

  47. Mazzaferri EL, Young RL. Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 1981;70:511–8.

    Article  CAS  PubMed  Google Scholar 

  48. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10–29.

    Article  PubMed  Google Scholar 

  49. Shindo M, Wu JC, Park EE, et al. The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 2006;132:650–4.

    Article  PubMed  Google Scholar 

  50. Lang BH, Tang AH, Wong KP, et al. Significance of size of lymph node metastasis on postsurgical stimulated thyroglobulin levels after prophylactic unilateral central neck dissection in papillary thyroid carcinoma. Ann Surg Oncol 2012;19:3472–8.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Lang BH, Tang AH, Wong KP, et al. Significance of size of lymph node metastasis on postsurgical stimulated thyroglobulin levels after prophylactic unilateral central neck dissection in papillary thyroid carcinoma. Ann Surg Oncol 2012;19:3472–8.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Gyorki DE, Untch B, Tuttle RM, et al. Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence. Ann Surg Oncol 2013;20:2285–9.

    Article  PubMed  Google Scholar 

  53. Cooper DS, Doherty GM, et al; American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214.

    Article  PubMed  Google Scholar 

  54. Yoo D, Ajmal S, Gowda S, Machan J, Monchik J, Mazzaglia P. Level VI lymph node dissection does not decrease radioiodine uptake in patients undergoing radioiodine ablation for differentiated thyroid cancer. World J Surg 2012:36:1255–61. doi:10.1007/s00268-012-1507-2.

    Article  PubMed  Google Scholar 

  55. So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery 2012:151:192–8. doi:10.1016/j.surg.2011.02.004.

    Article  PubMed  Google Scholar 

  56. Roh JL, Kim JM, Park CI. Central compartment reoperation for recurrent/persistent differentiated thyroid cancer: patterns of recurrence, morbidity, and prediction of postoperative hypocalcemia. Ann Surg Oncol 2011;18:1312–8.

    Article  PubMed  Google Scholar 

  57. Clayman GL, Agarwal G, Edeiken BS, et al. Long-term outcome of comprehensive central compartment dissection in patients with recurrent/persistent papillary thyroid carcinoma. Thyroid 2011;21:1309–16.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Steward DL. Update in utility of secondary node dissection for papillary thyroid cancer. J Clin Endocrinol Metab 2012;97:3393–8.

    Article  PubMed  Google Scholar 

  59. Schuff KG, Weber SM, Givi B, et al. Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer. Laryngoscope 2008;118:768–75.

    Article  PubMed  Google Scholar 

  60. Alvarado R, Sywak MS, Delbridge L, et al. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: Is there added morbidity? Surgery 2009;145:514–8.

    Article  PubMed  Google Scholar 

  61. Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg 2010;145:272–5.

    Article  PubMed  Google Scholar 

  62. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 2012;22:911–7.

    Article  PubMed  Google Scholar 

  63. Tuttle RM, Ball DW, Byrd D, et al. Thyroid carcinoma. National Comprehensive Cancer Network, 2012.

    Google Scholar 

  64. Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with diff erentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006;154:787–803.

    Article  CAS  PubMed  Google Scholar 

  65. Pacini F, Castagna MG, Brilli L, et al. Differentiated thyroid cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009;20(Suppl 4):143–6.

    PubMed  Google Scholar 

  66. Perros P, ed. British Thyroid Association, Royal College of Physicians. Guidelines for the management of thyroid cancer, 2nd edn. London: Royal College of Physicians, 2007.

    Google Scholar 

  67. Dralle H, Musholt JT, Schabram J et al; for the German Societies of General and Visceral Surgery; Endocrinology; Nuclear Medicine; Pathology; Radiooncology; Oncological Hematology; and the German Thyroid Cancer Patient Support Organization Ohne Schilddrüse leben e.V. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors Langenbecks Arch Surg 2013;398:347–75. DOI 10.1007/s00423-013-1057-6.

    Article  PubMed  Google Scholar 

  68. Guerrier B, Berthet JP, Cartier C et al. French ENT Society (SFORL) practice guidelines for lymph-node management in adult differentiated thyroid carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Aug;129(4):197–206.

    Article  CAS  PubMed  Google Scholar 

  69. Takami H, Ito Y, Okamoto T, Yoshida A. Therapeutic strategy for diff erentiated thyroid carcinoma in Japan based on a newly established guideline managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons. World J Surg 2011;35:111–21.

    Article  PubMed  Google Scholar 

  70. Pitoia F, Ward L, Wohllk N, et al. Recommendations of the Latin American Thyroid Society on diagnosis and management of diff erentiated thyroid cancer. Arq Bras Endocrinol Metabol 2009;53:884–97.

    Article  PubMed  Google Scholar 

  71. Shaha AR. Central compartment dissection for papillary thyroid cancer. Br J Surg 2013:100:438–9. doi:10.1002/bjs.9055.

    Article  CAS  PubMed  Google Scholar 

  72. Carling T, Carty SE, Ciarleglio MM, et al; American Thyroid Association Surgical Affairs C; American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid 2012;22:237–44. doi:10.1089/thy.2011.0317.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2nd Department of Surgery, Medical School, Aristoteleio University of Thessaloniki, Thessaloniki, Greece

    I. Koutelidakis, A. Doundis, G. Chatzimavroudis & J. Makris

Authors
  1. I. Koutelidakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Doundis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Chatzimavroudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Makris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Koutelidakis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koutelidakis, I., Doundis, A., Chatzimavroudis, G. et al. The role of prophylactic central compartment neck dissection in papillary thyroid cancer. Hellenic J Surg 87, 41–48 (2015). https://doi.org/10.1007/s13126-015-0178-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13126-015-0178-5

Key words

Search

Navigation