Publication:

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Background Papillary thyroid carcinoma (PTC) is one of the commonest thyroid cancers. While there is consensus of block node dissection in nodal positive patients, there is controversy in dealing with nodal negative patients regarding the need of block node dissection. We aimed to evaluate prophylactic central lymph node dissection (pCLND) versus conservative management in PTC with N0 neck.

Methods This was a prospective randomized study conducted at General Surgery Department, Sohag University Hospital, from August 2013 to September 2017. It included fifty-five patients diagnosed to have PTC with N0 neck randomly divided into two groups; (Group A) included 25 patients who underwent total thyroidectomy (TT) alone and (Group B) included 30 patients who underwent TT with pCLND. We compared both groups regarding the operative and post-operative outcomes.

Results There was temporary hypoparathyroidism with an incidence of 12% for Group A and 23% for Group B (P=0.01). Permanent hypocalcemia occurred in 1 patient in each group (P=0.75). Unilateral recurrent laryngeal nerve (RLN) temporary palsy occurred in 10% for Group B patients and in 8% for Group A patients, (P=0.46). Node metastases were observed in 43% in group B upstaging the disease. Both univariate and multivariate analyses showed that CLN metastasis was significantly associated with age 2.0cm, bilaterality, and multifocality. Locoregional recurrence was observed in 4% of patients in group A and in 0% in B.

Conclusions TT+pCLND is a safe treatment in patients with N0 PTC and it can be done without a high complication rate and without recurrence compared to TT without CLND.