Central neck dissection for papillary thyroid cancer.

Archives of otolaryngology--head & neck surgery

PubMedID: 19917920

Rosenbaum MA, McHenry CR. Central neck dissection for papillary thyroid cancer. Arch Otolaryngol Head Neck Surg. 2009;135(11):1092-7.
OBJECTIVE
To examine the role of central neck dissection (CND) in patients with papillary thyroid cancer (PTC).

DESIGN
Retrospective analysis of patients treated for PTC between 1993 and 2008.

SETTING
Academic institution.

PATIENTS
All patients diagnosed with PTC who underwent surgical therapy at our institution.

MAIN OUTCOME MEASURES
Recurrence, hypocalcemia, hypoparathyroidism, and recurrent laryngeal nerve (RLN) injury.

RESULTS
A total of 136 patients were treated for PTC, 26 of whom were excluded because their initial resection was performed at another institution. Of the 110 patients who underwent initial surgical therapy, CND was performed in 22 patients (20%), 18 with and 4 without enlarged nodes at the time of surgery. A mean (SD) of 11 (4) lymph nodes were removed, and lymph node metastases were identified in 17 patients (77%). One patient developed a recurrence in the lateral neck at 15 months' follow-up. Eighty-eight patients had no abnormal lymph nodes and did not undergo CND, 2 of whom developed a recurrence (2%) (P = .49) in the central neck at 14 months' and 11 years' follow-up. Permanent RLN injury occurred in no patient who underwent CND and in 1 patient without a CND (1%). Transient hypocalcemia occurred in 19 patients who underwent CND (86%) compared with 54 patients without a CND (61%) (P = .01). Permanent hypoparathyroidism occurred in 1 patient who underwent a CND (5%).

CONCLUSION
After total thyroidectomy and CND, recurrence in the central neck is uncommon, but hypocalcemia is more common, raising questions about the use of routine CND in patients with PTC.