What is the role of central neck dissection in the treatment of papillary thyroid carcinoma (PTC)?

Updated: Jun 18, 2020
  • Author: Ponnandai S Somasundar, MD, MPH, FACS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

The routine addition of central neck dissection to total thyroidectomy has been debated over the years. Advocates cite a lower risk of later reoperation, since reoperations for recurrence can lead to higher rates of recurrent nerve injury. Critics cite the fact the upfront recurrent nerve injury rate may be higher and that no survival benefit has been demonstrated over total thyroidectomy alone.In a retrospective cohort study of 812 patients with papillary thyroid carcinoma, including 102 who underwent total thyroidectomy with elective central neck dissection and 478 who underwent total thyroidectomy alone, elective central neck dissection increased the risk for complications, but did not decrease local recurrence rates. [50]

A study by Roh et al found that subclinical metastases are highly prevalent in the ipsilateral central neck of patients with papillary thyroid carcinoma. The study also revealed that although contralateral central metastases are uncommon, they are associated with ipsilateral central metastases. The authors conclude that these findings may suggest the necessity and extent of prophylactic unilateral or bilateral central lymph node dissection. [51]

A study by Popadich et al found that the addition of routine central lymph node dissection in patients with cN0 papillary thyroid carcinoma reduced the need for reoperation in the central compartment and was associated with lower postoperative thyroglobulin levels. [52]


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