Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? our experience

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.

Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00423-008-0360-0Authors
N. Palestini, University of Turin General Surgery 1, Department of Medical and Surgical Sciences Ospedale Molinette, Corso Dogliotti 14 10126 Turin ItalyA. Borasi, University of Turin General Surgery 1, Department of Medical and Surgical Sciences Ospedale Molinette, Corso Dogliotti 14 10126 Turin ItalyL. Cestino, University of Turin General Surgery 1, Department of Medical and Surgical Sciences Ospedale Molinette, Corso Dogliotti 14 10126 Turin ItalyM. Freddi, University of Turin General Surgery 1, Department of Medical and Surgical Sciences Ospedale Molinette, Corso Dogliotti 14 10126 Turin ItalyC. Odasso, University of Turin General Surgery 1, Department of Medical and Surgical Sciences Ospedale Molinette, Corso Dogliotti 14 10126 Turin ItalyA. Robecchi, University of Turin General Surgery 1, Department of Medical and Surgical Sciences Ospedale Molinette, Corso Dogliotti 14 10126 Turin Italy

Journal Langenbeck's Archives of SurgeryOnline ISSN 1435-2451Print ISSN 1435-2443 (Source: Langenbeck's Archives of Surgery)