Prophylactic central lymph node dissection in differentiated thyroid cancer – benefits and risk

Abstract

Introduction: Papillary thyroid cancer is the most common thyroid malignancy. Lymph nodes involvement is common in differentiated thyroid cancer, and cervical lymph node micrometastases are observed in up to 85% of patients with papillary thyroid cancer during surgery. While the therapeutic central lymph node dissection has been accepted, the debate on the prophylactic in differentiated thyroid carcinoma (DTC) continues. Aim: To evaluate the benefits and risk of prophylactic central lymph node dissection in differentiated thyroid cancer. Materials and methods: Between January 2014 and December 2018, 223 total thyroidectomies due to papillary thyroid cancer were performed in the Kaspela University Hospital in Plovdiv. The patients were allocated into two groups: group A consisting of 36 patients with total thyroidectomy alone, and group B - 178 patients with total thyroidectomy and prophylactic central lymph node dissection. Results: In 36 (21.6%) patients, we found metastases only in ipsilateral side. In 24 (13.4%) of them we found metastatic spread in both ipsilateral and contralateral lymph nodes. In 7 (3.9%) patients, the metastasis was found only in the contralateral nodes. A pre-laryngeal lymph node was found and removed in 79 patients. Metastases were found in 12 of these 79 nodes. Analysis of complications showed no significant differences in its rate in patients with TT+ PCLND vs. patients with TT alone. Conclusions: The present study suggests that the realization of total thyroidectomy with prophylactic central lymph node dissection in papillary thyroid cancer patients has neither substantial advantages nor significant complications for the short period of observation.