Abstract
Background and aims
The role of central neck dissection in the treatment of papillary thyroid carcinoma is debated. This retrospective investigation was undertaken to assess whether it augments total thyroidectomy morbidity.
Patients/methods
A total of 305 consecutive patients who had undergone total thyroidectomy for papillary thyroid carcinoma were divided into three groups: group A (n = 64) showed evidence of node metastases and received therapeutic bilateral central node dissection; group B (n = 93) showed negative nodes and received prophylactic ipsilateral central node dissection; group C (n = 148) showed negative nodes and received total thyroidectomy alone. The rates of transient and permanent complications within the three groups were compared.
Results
Histopathological examination detected node metastases in 46 (72%) group A patients and in 20 (21%) group B patients. Parathyroid autotransplantation was carried out in 41 (64%) patients in group A, 55 (59%) in group B, and 43 (29%) in group C (P < 0.001). One or more parathyroid glands were found in 20% of the specimens from group A, 11% of those from group B, and 9% of those from group C. None of the patients in either group A or group B reported permanent laryngeal recurrent nerve paralysis, but two (1.3%) in group C did. Transient laryngeal recurrent nerve paralysis occurred most often in group A patients (7.8% versus 5.4% versus 1.3%, respectively) and was bilateral in two patients (one in group A and one in group B). None of the patients in either group A or group B developed permanent hypoparathyroidism, but four (2.7%) in group C did. Transient hypoparathyroidism was highest in group A patients (31% versus 27% versus 13%, respectively; P = 0.003). Postoperative bleeding requiring reoperation occurred in one group B patient and in two group C patients.
Conclusions
Central neck dissection did not increase permanent morbidity and revealed a significant rate of nonclinically evident node metastases. In experienced hands, central neck dissection should be routinely combined with total thyroidectomy in the primary treatment of pre- or intraoperatively diagnosed papillary thyroid cancer. When no macroscopic evidence of metastasis is present, ipsilateral central neck dissection is the best treatment strategy in a balanced decision between the need for achieving local radical excision, correct disease staging, and reducing the risk of complications.
Similar content being viewed by others
References
Miccoli P, Berti P, Raffaelli M, Conte M, Materazzi G, Galleri D (2001) Minimally invasive video-assisted thyroidectomy. Am J Surg 181:567–570 doi:10.1016/S0002-9610(01)00625-0
Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73:761–768 doi:10.1046/j.1445-2197.2003.02756.x
Robbins KT, Clayman G, Levine PA, Medina J, Session R, Shaha A et al, American Head and Neck Society, American Academy of Otolaryngology–Head and Neck Surgery (2002) 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 128:751–758
UICC International Union Against Cancer (2002) In: Sobin LH, Witteking Ch (eds) TNM classification of malignant tumors. 6th edn. Wiley-Liss, New York
Caron NR, Clark OH (2005) Papillary thyroid cancer: surgical management of lymph node metastases. Curr Treatm Opt Oncol 6:311–322 doi:10.1007/s11864-005-0035-9
Mann B, Buhr HJ (1998) Lymph node dissection in patients with differentiated thyroid carcinoma: who benefits? Langenbecks Arch Surg 383:355–358 doi:10.1007/s004230050148
Scheumann GF, Gimm O, Weneger G, Hundeshagen H, Dralle H (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567 doi:10.1007/BF00353765
Gimm O, Rath FW, Dralle H (1998) Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg 85:252–254 doi:10.1046/j.1365-2168.1998.00510.x
Machens A, Hinze R, Thomusch O, Dralle H (2002) Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26:22–28 doi:10.1007/s00268-001-0176-3
Palazzo FF, Gosnell J, Savio R, Reeve TS, Sidhu SB, Sywak MS et al (2006) Lymphadenectomy for papillary thyroid cancer: changes in practice over four decades. Eur J Surg Oncol 32:340–344 doi:10.1016/j.ejso.2005.12.011
Henry JF, Gramatica L, Denizot A, Kvachenyuk A, Puccini M, Defechereux T (1998) Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinomas. Langenbecks Arch Surg 383:167–169
Lee YS, Kim SW, Kim SW, Kim SK, Kang H-S, Lee ES et al (2007) Extent of routine central lymph node dissection with small papillary thyroid carcinoma. World J Surg 31:1954–1959 doi:10.1007/s00268-007-9171-7
Pereira JA, Jimeno J, Miquel J, Iglesias M, Munné A, Sancho JJ et al (2005) Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 138:1095–1101 doi:10.1016/j.surg.2005.09.013
Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L (2006) Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 140:1000–1007 doi:10.1016/j.surg.2006.08.001
Wada N, Duh Q-Y, Sugino K, Iwasaki H, Kameyama K, Mimura T et al (2003) Lymph node metastasis from 259 papillary thyroid microcarcinomas. Frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 237:399–407 doi:10.1097/00000658-200303000-00015
Palme CE, Freeman JL (2005) Surgical strategy for thyroid bed recurrence in patients with well-differentiated thyroid carcinoma. J Otolaryngol 34:7–12 doi:10.2310/7070.2005.03048
Roh J-L, Park J-Y, Park CI (2007) 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 245:604–610 doi:10.1097/01.sla.0000250451.59685.67
Goropoulos A, Karamoshos K, Christodoulou A, Ntitsias T, Paulou K, Samaras A et al (2004) Value of the cervical compartments in the surgical treatment of papillary thyroid carcinoma. World J Surg 28:1275–1281 doi:10.1007/s00268-004-7643-6
Shindo M, Wu JC, Park EE, Tanzella F (2006) The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 132:650–654 doi:10.1001/archotol.132.6.650
White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904 doi:10.1007/s00268-006-0907-6
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:1–33 doi:10.1089/thy.2006.16.1
Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K et al (2006) Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg 30:91–99 doi:10.1007/s00268-005-0113-y
Biermann E (2001) Operative Behandlung des differenzierten Schilddrüsenkarzinoms. Technik und Morbidität der paratrachealen Lymphadenektomie. HNO 49:914–921 doi:10.1007/s001060170018
Qubain SW, Nakano S, Baba M, Takao S, Aikou T (2002) Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery 131:249–256 doi:10.1067/msy.2002.120657
Author information
Authors and Affiliations
Corresponding author
Additional information
Scientific meeting 3rd Biennial Congress of the European Society of Endocrine Surgeons (ESES). Barcelona, 24–26 April 2008.
Best of Endocrine Surgery in Europe 2008.
Rights and permissions
About this article
Cite this article
Palestini, N., Borasi, A., Cestino, L. et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg 393, 693–698 (2008). https://doi.org/10.1007/s00423-008-0360-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-008-0360-0