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01.12.2016 | Review | Ausgabe 1/2016 Open Access

World Journal of Surgical Oncology 1/2016

Role of prophylactic central compartment lymph node dissection in clinically N0 differentiated thyroid cancer patients: analysis of risk factors and review of modern trends

Zeitschrift:
World Journal of Surgical Oncology > Ausgabe 1/2016
Autoren:
Giovanni Conzo, Ernesto Tartaglia, Nicola Avenia, Pier Giorgio Calò, Annamaria de Bellis, Katherine Esposito, Claudio Gambardella, Sergio Iorio, Daniela Pasquali, Luigi Santini, Maria Antonia Sinisi, Antonio Agostino Sinisi, Mario Testini, Andrea Polistena, Giuseppe Bellastella
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CG participated substantially in conception, design and execution of the study; also participated substantially in the drafting and editing of the manuscript. TE participated substantially in conception, design and execution of the study; also participated substantially in the drafting and editing of the manuscript. AN participated substantially in conception, design and execution of the study. CPG participated substantially in conception, design and execution of the study. dBA participated substantially in conception, design and execution of the study. EK participated substantially in conception, design and execution of the study. GC participated substantially in conception, design and execution of the study; also participated substantially in the drafting and editing of the manuscript. IS participated substantially in conception, design and execution of the study. PD participated substantially in conception, design and execution of the study. SL participated substantially in conception, design and execution of the study. SMA participated substantially in conception, design and execution of the study. SAA participated substantially in conception, design and execution of the study. TM participated substantially in conception, design and execution of the study. PA participated substantially in conception, design and execution of the study. BG participated substantially in conception, design and execution of the study. All authors read and approved the final manuscript.

Abstract

In the last years, especially thanks to a large diffusion of ultrasound-guided FNBs, a surprising increased incidence of differentiated thyroid cancer (DTC), “small” tumors and microcarcinomas have been reported in the international series. This led endocrinologists and surgeons to search for “tailored” and “less aggressive” therapeutic protocols avoiding risky morbidity and useless “overtreatment”. Considering the most recent guidelines of referral endocrine societies, we analyzed the role of routine or so-called prophylactic central compartment lymph node dissection (RCLD), also considering its benefits and risks. Literature data showed that the debate is still open and the surgeons are divided between proponents and opponents of its use. Even if lymph node metastases are commonly observed, and in up to 90 % of DTC cases micrometastases are reported, the impact of lymphatic involvement on long-term survival is subject to intensive research and the best indications of lymph node dissection are still controversial. Identification of prognostic factors for central compartment metastases could assist surgeons in determining whether to perform RLCD. Considering available evidence, a general agreement to definitely reserve RCLD to “high-risk” cases was observed. More clinical researches, in order to identify risk factors of meaningful predictive power and prospective long-term randomized trials, should be useful to validate this selective approach.
Literatur
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