Prophylactic central lymph node dissection in differentiated thyroid cancer

Excerpt

Conzo et al. [1] describe their experience of treating differentiated thyroid carcinoma in patients who lack clinically evident nodal disease (cN0) with total thyroidectomy, without prophylactic central lymph node dissection, followed by radioactive iodine (RAI). 93.8 % of their 221 patients had AJCC Stage I or II papillary thyroid carcinoma. They report a low locoregional recurrence rate of 3.16 % after almost 10 years as well as low complication rates (0.91 % for both permanent hypoparathyroidism and permanent vocal fold paralysis). The merits of prophylactic lymph node dissection are debated in these patients with early-stage disease, and the authors’ discussion highlights this debate. They note that the current literature lacks conclusive evidence of survival or recurrence benefit, but has established an increase in complication rates (specifically, transient hypocalcemia) associated with prophylactic central nodal dissection compared with total thyroidectomy alone. Based on their results and their scrutiny of this literature, those authors have come to conclude that their treatment paradigm is acceptable and that prophylactic central neck dissection can be avoided [1]. …