Impact of Prophylactic Central Lymph Node Dissection on the Complications and Recurrence Rates in Papillary Thyroid Carcinoma — An AFCE (French-speaking Association of Endocrine Surgery) multicentre study based on the EUROCRINE® national data.

Abstract

Abstract Purpose Prophylactic central neck dissection (pCND) remains controversial during the initial surgery for preoperative and intraoperative node-negative (cN0) papillary thyroid carcinoma (PTC). Methods Patients undergoing thyroidectomy with or without pCND (Nx) for PTC in nine French surgical departments, registered in the EUROCRINE® national data in France between January 2015 and June 2021, were included in a cohort study. Demographic and clinicopathological characteristics, complications, and recurrence rates were compared using multivariate regression analysis. Results A total of 1,905 patients with cN0 PTC were enrolled, including 1,534 who had undergone pCND and 371 who hadn’t (Nx). Of these, 1,546 (81.2%) were female, and the median age was 49 years (range:15–89 years). Patients who had undergone pCND were more likely to have multifocal tumors (n = 524[34.2%] vs. n = 68[18.3%], p < 0.001) and larger tumors (15.3 mm vs. 10.2 mm, p = 0.01) than patients with Nx. Of the patients with pCND, 553 (36%) had positive central LN (N1a), with a median of 1 N1 (IQR 0–5). pCND was associated with a higher temporary hypocalcemia rate (n = 25 [8%] vs. n = 15 [4%], p < 0.001). The rates of permanent hypocalcemia and temporary and permanent recurrent laryngeal nerve (RLN) palsy were not significantly different between the two groups (p > 0.2). After adjusting for covariates (age, sex, multifocality, and pathological T stage) in a multivariable Cox PH model, the performance of lymph node dissection (pCND vs. no-pCND) was not associated with PTC recurrence (p = 0.2). Conclusion pCND in PTC does not reduce recurrence and is associated with a two-fold increase in the incidence of transient hypoparathyroidism. These data should be considered while issuing further guidelines regarding the treatment of patients with cN0 PTC.