Role of Prophylactic Central Compartment Lymph Node Dissection on the Outcome Of Patients With Papillary Thyroid Carcinoma and Synchronous Ipsilateral Cervical Lymph Node Metastases.

Abstract

OBJECTIVE:

Prophylactic central compartment lymph node dissection (pCCND) results in a higher percentage of surgical-related complications. To date, no evidence of the impact of pCCND on the clinical outcome of papillary thyroid carcinoma (PTC) patients with synchronous ipsilateral cervical lymph node metastases has been reported.

METHODS:

We evaluated all consecutive patients affected by PTC and synchronous ipsilateral cervical, but without evidence of central compartment, lymph node metastases. We selected 54 consecutive patients (group A) treated by total thyroidectomy, ipsilateral cervical lymph node dissection, and pCCND and 115 patients (group B) matched for sex, age at diagnosis, number and dimension of the metastatic lateral cervical lymph nodes, without pCCND. Clinical outcome after a median of 5 years and surgical-related complications were assessed.

RESULTS:

The two groups were completely similar in terms of clinical features. Clinical outcomes showed a higher percentage of biochemical and indeterminate but not structural response in group B. Group B required significantly more radioiodine treatments, but no difference was shown in the need to repeat surgery for recurrences. Conversely, the prevalence of permanent hypoparathyroidism was significantly higher in group A (14.8%) than in group B (4.3%).

CONCLUSION:

In PTC patients with synchronous ipsilateral cervical lymph node metastases, in absence of clinically evident lymph node metastases of the central compartment, performing pCCND does not improve the 5-year outcome in terms of structural disease, despite a greater number of 131I treatments. However, pCCND is severely affected by a higher percentage of permanent hypoparathyroidism, even in the hands of expert surgeons.

ABBREVIATIONS:

IQR = interquartile range; pCCND = prophylactic central compartment lymph node dissection; PTC = papillary thyroid carcinoma; Tg = thyroglobulin; US = ultrasound.

• Authors: Luigi De Napoli, Antonio Matrone, Karin Favilla, Paolo Piaggi, David Galleri, Carlo Enrico Ambrosini, Alexander Aghababyan, Piermarco Papini, Laura Valerio, David Viola, Liborio Torregrossa, Clara Ugolini, Agnese Proietti, Fulvio Basolo, Paolo Miccoli, Rossella Elisei, Gabriele Materazzi
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 26 Issue 8 Pg. 807-817 (Aug 2020) ISSN: 1530-891X [Print] United States
• PMID: 33471672 (Publication Type: Journal Article)
• Copyright: © 2020 American Association of Clinical Endocrinologists. Published by Elsevier, Inc. All rights reserved.

Chemical References

• Iodine Radioisotopes

Topics

• Carcinoma, Papillary (surgery)
• Humans
• Iodine Radioisotopes
• Lymph Node Excision
• Lymph Nodes (surgery)
• Lymphatic Metastasis
• Neck Dissection
• Neoplasm Recurrence, Local
• Thyroid Cancer, Papillary (surgery)
• Thyroid Neoplasms (surgery)
• Thyroidectomy