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

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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.

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Authors and Affiliations

  1. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General and Endocrine Surgery, Second University of Naples, Via Pansini 5, Build 17, 80131, Naples, Italy

    Giovanni Conzo, Giovanni Docimo, Salvatore Napolitano, Antonietta Palazzo, Alessandra Pizza & Luigi Santini

  2. Department of Cardio-Thoracic and Respiratory Sciences, Endocrinology Unit Second, University of Naples, Via Pansini 5, Build 16, 80131, Naples, Italy

    Daniela Pasquali, Giuseppe Bellastella, Katherine Esposito, Carlo Carella, Annamaria De Bellis, Sergio Iorio, Antonio Agostino Sinisi & Antonio Bellastella

  3. Department of Biomorphological and Functional Science, University of Naples, “Federico II”, Via Pansini 5, Build 1, 80131, Naples, Italy

    Michele Klain & Emilia Zampella

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  1. Giovanni Conzo
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Conzo, G., Pasquali, D., Bellastella, G. et al. Total thyroidectomy, without prophylactic central lymph node dissection, in the treatment of differentiated thyroid cancer. Clinical retrospective study on 221 cases. Endocrine 44, 419–425 (2013). https://doi.org/10.1007/s12020-013-9877-2

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