World Journal of Surgery

, Volume 31, Issue 5, pp 895–904 | Cite as

Central Lymph Node Dissection in Differentiated Thyroid Cancer

  • Matthew L. White
  • Paul G. Gauger
  • Gerard M. DohertyEmail author



There has been renewed interest in extensive lymph node dissection for papillary thyroid cancer (PTC), and a number of reports have been published concerning compartment-oriented dissection of regional lymph nodes in PTC. A comprehensive review of this body of literature using evidence-based methodology is pending.


Systematic review of the literature using evidence-based criteria.


Issue 1: Systematic compartment-oriented central lymph node dissection (CLND) may decrease recurrence of PTC (Levels IV and V data, no recommendation) and likely improves disease-specific survival (grade C recommendation). Limited level III data suggest survival benefit with the addition of prophylactic dissection to thyroidectomy (grade C recommendation). The addition of CLND to total thyroidectomy can significantly reduce levels of serum thyroglobulin and increase rates of athyroglobulinemia (level IV data, no recommendation). Issue 2: There may be a higher rate of permanent hypoparathyroidism and unintentional permanent nerve injury when CLND is performed with total thyroidectomy than for total thyroidectomy alone (grade C recommendation). Issue 3: Reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury when compared with total thyroidectomy with or without CLND (grade C recommendation), supporting a more aggressive initial operation.


Evidence-based recommendations support CLND for PTC in patients under the care of experienced endocrine surgeons.


Thyroid Cancer Papillary Thyroid Carcinoma Neck Dissection Total Thyroidectomy Papillary Thyroid Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sherman SI. Thyroid carcinoma. Lancet 2003;361:501–511.CrossRefPubMedGoogle Scholar
  2. 2.
    Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109–142.CrossRefPubMedGoogle Scholar
  3. 3.
    Arturi F, Russo D, Giuffrida D, et al. Early diagnosis by genetic analysis of differentiated thyroid cancer metastases in small lymph nodes. J Clin Endocrinol Metab 1997;82:1638–1641.CrossRefPubMedGoogle Scholar
  4. 4.
    Machens A, Hinze R, Thomusch O, et al. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 2002;26:22–28.CrossRefPubMedGoogle Scholar
  5. 5.
    Hamming JF, Roukema JA. Management of regional lymph nodes in papillary, follicular, and medullary thyroid cancer. In: Clark OH, Duh Q-Y, Kebebew E, editors. Textbook of endocrine surgery, 2nd ed. Philadelphia, Saunders, 2005, pp 195–206Google Scholar
  6. 6.
    Qubain SW, Nakano S, Baba M, et al. Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery 2002;131:249–256.CrossRefPubMedGoogle Scholar
  7. 7.
    Gimm O, Rath FW, Dralle H. Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg 1998;85:252–254.CrossRefPubMedGoogle Scholar
  8. 8.
    Machens A, Holzhausen HJ, Dralle H. Skip metastases in thyroid cancer leaping the central lymph node compartment. Arch Surg 2004;139:43–45.CrossRefPubMedGoogle Scholar
  9. 9.
    Gauger PG. Thyroid gland. In: Mulholland MW, Lillemoe KD, Doherty GM, editors. Greenfield’s Surgery: Scientific Principles and Practice, 4th ed. Philadelphia, Lippincott Williams & Wilkins, 2006, pp. 1289–1309Google Scholar
  10. 10.
    Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg 1998;383:167–169.PubMedGoogle Scholar
  11. 11.
    Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 2005;138:1095–1100; discussion 1100–1101.CrossRefPubMedGoogle Scholar
  12. 12.
    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;132:650–654.CrossRefPubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    Scheumann GF, Gimm O, Wegener G, et al. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 1994;18:559–567; discussion 567–558.CrossRefPubMedGoogle Scholar
  15. 15.
    Robbins KT, Medina JE, Wolfe GT, et al. Standardizing neck dissection terminology. Official report of the Academy’s Committee for Head and Neck Surgery and Oncology. Arch Otolaryngol Head Neck Surg 1991;117:601–605.PubMedGoogle Scholar
  16. 16.
    Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 2002;128:751–758.PubMedGoogle Scholar
  17. 17.
    Tisell LE, Hansson G, Jansson S, et al. Reoperation in the treatment of asymptomatic metastasizing medullary thyroid carcinoma. Surgery 1986;99:60–66.PubMedGoogle Scholar
  18. 18.
    Moley JF, Wells SA. Compartment-mediated dissection for papillary thyroid cancer. Langenbecks Arch Surg 1999;384:9–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 1989;95:2S–4S.PubMedGoogle Scholar
  20. 20.
    Rossi RL, Cady B, Silverman ML, et al. Current results of conservative surgery for differentiated thyroid carcinoma. World J Surg 1986;10:612–622.CrossRefPubMedGoogle Scholar
  21. 21.
    Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994;97:418–428.CrossRefPubMedGoogle Scholar
  22. 22.
    Hughes CJ, Shaha AR, Shah JP, et al. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck 1996;18:127–132.CrossRefPubMedGoogle Scholar
  23. 23.
    Cady B, Sedgwick CE, Meissner WA, et al. Risk factor analysis in differentiated thyroid cancer. Cancer 1979;43:810–820.CrossRefPubMedGoogle Scholar
  24. 24.
    Hay ID, Grant CS, Taylor WF, et al. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 1987;102:1088–1095.PubMedGoogle Scholar
  25. 25.
    Hay ID, Bergstralh EJ, Goellner JR, et al. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993;114:1050–1057; discussion 1057–1058.PubMedGoogle Scholar
  26. 26.
    Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer 2006;106:524–531.CrossRefPubMedGoogle Scholar
  27. 27.
    Heinrich S, Schafer M, Rousson V, et al. Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg 2006;243:154–168.CrossRefPubMedGoogle Scholar
  28. 28.
    Tisell LE, Nilsson B, Molne J, et al. Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg 1996;20:854–859.CrossRefPubMedGoogle Scholar
  29. 29.
    Shah MD, Hall FT, Eski SJ, et al. Clinical course of thyroid carcinoma after neck dissection. Laryngoscope 2003;113:2102–2107.CrossRefPubMedGoogle Scholar
  30. 30.
    Steinmuller T, Klupp J, Rayes N, et al. Prognostic factors in patients with differentiated thyroid carcinoma. Eur J Surg 2000;166:29–33.CrossRefPubMedGoogle Scholar
  31. 31.
    Noguchi S, Murakami N, Yamashita H, et al. Papillary thyroid carcinoma: modified radical neck dissection improves prognosis. Arch Surg 1998;133:276–280.CrossRefPubMedGoogle Scholar
  32. 32.
    Simon D, Goretzki PE, Witte J, et al. Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 1996;20:860–866; discussion 866.CrossRefPubMedGoogle Scholar
  33. 33.
    Leboulleux S, Rubino C, Baudin E, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab 2005;90:5723–5729.CrossRefPubMedGoogle Scholar
  34. 34.
    Baudin E, Travagli JP, Ropers J, et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer 1998;83:553–559.CrossRefPubMedGoogle Scholar
  35. 35.
    Sato N, Oyamatsu M, Koyama Y, et al. Do the level of nodal disease according to the TNM classification and the number of involved cervical nodes reflect prognosis in patients with differentiated carcinoma of the thyroid gland? J Surg Oncol 1998;69:151–155.CrossRefPubMedGoogle Scholar
  36. 36.
    Ito Y, Jikuzono T, Higashiyama T, et al. Clinical significance of lymph node metastasis of thyroid papillary carcinoma located in one lobe. World J Surg 2006;30:1821–1828.CrossRefPubMedGoogle Scholar
  37. 37.
    Sywak M, Cornford L, Roach P, et al. Routine level six lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 2006;140:1000–1005; discussion 1005–1007.CrossRefPubMedGoogle Scholar
  38. 38.
    Clark OH, Levin K, Zeng QH, et al. Thyroid cancer: the case for total thyroidectomy. Eur J Cancer Clin Oncol 1988;24:305–313.CrossRefPubMedGoogle Scholar
  39. 39.
    Ley PB, Roberts JW, Symmonds RE Jr, et al. Safety and efficacy of total thyroidectomy for differentiated thyroid carcinoma: a 20-year review. Am Surg 1993;59:110–114.PubMedGoogle Scholar
  40. 40.
    Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004;28:271–276.CrossRefPubMedGoogle Scholar
  41. 41.
    Gemsenjager E, Perren A, Seifert B, et al. Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg 2003;197:182–190.CrossRefPubMedGoogle Scholar
  42. 42.
    Steinmuller T, Klupp J, Wenking S, et al. Complications associated with different surgical approaches to differentiated thyroid carcinoma. Langenbecks Arch Surg 1999;384:50–53.CrossRefPubMedGoogle Scholar
  43. 43.
    Goropoulos A, Karamoshos K, Christodoulou A, et al. Value of the cervical compartments in the surgical treatment of papillary thyroid carcinoma. World J Surg 2004;28:1275–1281.CrossRefPubMedGoogle Scholar
  44. 44.
    Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg 2006;30:91–99.CrossRefPubMedGoogle Scholar
  45. 45.
    Segal K, Friedental R, Lubin E, et al. Papillary carcinoma of the thyroid. Otolaryngol Head Neck Surg 1995;113:356–363.CrossRefPubMedGoogle Scholar
  46. 46.
    Moley JF, Lairmore TC, Doherty GM, et al. Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations. Surgery 1999;126:673–677; discussion 677–679.PubMedGoogle Scholar
  47. 47.
    Kim MK, Mandel SH, Baloch Z, et al. Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg 2004;130:1214–1216.CrossRefPubMedGoogle Scholar
  48. 48.
    Uruno T, Miyauchi A, Shimizu K, et al. Prognosis after reoperation for local recurrence of papillary thyroid carcinoma. Surg Today 2004;34:891–895.CrossRefPubMedGoogle Scholar
  49. 49.
    Kouvaraki MA, Lee JE, Shapiro SE, et al. Preventable reoperations for persistent and recurrent papillary thyroid carcinoma. Surgery 2004;136:1183–1191.CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Matthew L. White
    • 1
    • 2
  • Paul G. Gauger
    • 1
  • Gerard M. Doherty
    • 1
    Email author
  1. 1.Department of SurgeryUniversity of MichiganAnn ArborUSA
  2. 2.Department of SurgerySt. Joseph Mercy HospitalAnn ArborUSA

Personalised recommendations