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Evaluation of the role of prophylactic bilateral central neck lymph node dissection in patients with papillary thyroid carcinoma: a case controlled study

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Abstract

Thyroid cancer is the most common malignancy in the endocrine system. Papillary thyroid carcinoma (PTC) is the most common differentiated thyroid cancer. There are considerable discrepancies regarding the role and extent of prophylactic central lymph node dissection (PCLND) for patients with PTC. Our primary goal was the evaluation of CLN involvement based on the tumor features and staging on the eight version of the American Joint Committee on Cancer and also the TNM method. Our secondary aim was to evaluate the features of the CLNs with tumoral features and also features associated with the development of transient hypoparathyroidism. This prospective case-controlled study was performed among PTC patients. Total thyroidectomy and bilateral dissection of the CLNs of the central compartment of the neck was performed, and samples were sent for pathological evaluation. CLN involvement, tumoral features and transient hypoparathyroidism were cross-evaluated and analyzed with SPSS version 26.0. In this study, out of 61 patients, 11 (18%) were male, the average age was 37.3 ± 13.7 years, based on AJCC staging, 53 (86.9%) were stage I and 8 (13.1%) were stage II, and based on TNM staging, 39 patients (66.1%) were T1, including 13 (22.0%) T1a and 26 (44.1%) T1b, 15 patients (25.4%) were T2, and five patients (8.5%) were T3. Based on permanent pathology evaluation, the majority of patients (n = 48; 78.7%) had CLN involvement. None of the preoperative and tumor features had a significant association with CLN involvement. 75% of stage I and 100% of stage two cases, while 76.9% of T1, 86.7% of T2, and 80.0% of T3 cases had CLN involvement. There was no significant association between the involvement of CLN and the AJCC staging (P = 0.184) or TNM staging (P = 0.875). The involved to dissected CLN ratio was significantly higher in stage II patients compared to stage I (72.5 vs. 34.8%; P = 0.006), and also with higher T staging (0.009). There was a statistically significant association between the larger CLN size and older patients’ age, higher postoperative thyroglobulin levels, and smaller tumor size. Higher postoperative thyroglobulin level was significantly associated with larger tumors size and thyroid capsule invasion. Also, 26 (44.8%) of patients developed transient hypoparathyroidism, which was significantly associated with vascular invasion (P = 0.048), bilateral location of tumor (P = 0.048) or on the right side (0.005), and larger size of the tumor (P = 0.016). Tumor features and staging were not associated with CLN involvement features. Therefore, full extent PCLND should be carried out to avoid reoperation or metastasis in PTC patients.

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Abbreviations

AJCC:

American joint committee on cancer

ATA:

American thyroid association

CLND:

Central lymph node dissection

cN0:

Clinically node negative

LN:

Lymph node

PCLD:

Prophylactic central lymph node dissection

PTC:

Papillary thyroid carcinoma

RAI:

Radioactive iodine

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Acknowledgements

None to declare.

Funding

The study was financially supported by the office of the vice-chancellor for research at the Tehran University of Medical Sciences.

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Authors and Affiliations

  1. Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran

    Reza Shahriarirad

  2. School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Reza Shahriarirad

  3. Tehran University of Medical Sciences, Department of Surgery, Tehran, Iran

    Seyed Mostafa Meshkati Yazd, Mohammad Mustafa Rekabi & Shirzad Nasiri

  4. Department of Operation Room, Faculty of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran

    Roya Zahedi

  5. Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Science, and Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran

    Abnoos Mokhtari Ardekani

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  1. Reza Shahriarirad
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Contributions

SN: designed the study while SMM, KR, SS : collected the data. RS: performed the literature review, analyzed the data and drafted the manuscript. SMM and SN: revised the manuscript. All authors proofread the final version of the manuscript.

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Correspondence to Shirzad Nasiri.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval and consent to participate

Iran University of Medical Sciences Human Ethics Committee approved the study (IR.TUMS.MED.REC.1394.1972). A written informed consent form was obtained from all the participants enrolled in this trial. All patients’ information was de-identified and documented confidentially, and patients were able to exit any time during the trial if they desired. All ethical principles of the Declaration of Helsinki were considered in this trial.

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Not applicable.

Research involving human participants and/or animals

A written informed consent form was obtained from all the participants enrolled in this trial. All patients' information was de-identified and documented confidentially, and patients were able to exit any time during the trial if they desired.

Informed consent

All ethical principles of the Declaration of Helsinki were considered in this trial. Iran University of Medical Sciences Human Ethics Committee approved the study (IR.TUMS.MED.REC.1394.1972).

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Shahriarirad, R., Meshkati Yazd, S.M., Zahedi, R. et al. Evaluation of the role of prophylactic bilateral central neck lymph node dissection in patients with papillary thyroid carcinoma: a case controlled study. Updates Surg 75, 679–689 (2023). https://doi.org/10.1007/s13304-022-01440-0

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