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Central Lymph Node Dissection in Differentiated Thyroid Cancer

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Abstract

Background

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.

Methods

Systematic review of the literature using evidence-based criteria.

Results

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.

Conclusion

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

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Authors and Affiliations

  1. Department of Surgery, University of Michigan, 2920 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Matthew L. White MD, Paul G. Gauger MD & Gerard M. Doherty MD

  2. Department of Surgery, St. Joseph Mercy Hospital, Ann Arbor, MI, USA

    Matthew L. White MD

Authors
  1. Matthew L. White MD
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  2. Paul G. Gauger MD
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  3. Gerard M. Doherty MD
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Correspondence to Gerard M. Doherty MD.

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White, M.L., Gauger, P.G. & Doherty, G.M. Central Lymph Node Dissection in Differentiated Thyroid Cancer. World J Surg 31, 895–904 (2007). https://doi.org/10.1007/s00268-006-0907-6

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  • DOI: https://doi.org/10.1007/s00268-006-0907-6

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