Evaluation of the role of prophylactic bilateral central neck lymph node dissection in patients with papillary thyroid carcinoma: a case controlled study

• Published in: Updates in surgery Vol. 75; no. 3; pp. 679 - 689
• Main Authors: Shahriarirad, Reza, Meshkati Yazd, Seyed Mostafa, Zahedi, Roya, Mokhtari Ardekani, Abnoos, Rekabi, Mohammad Mustafa, Nasiri, Shirzad
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2023
• Subjects: Adult; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Female; Humans; Hypoparathyroidism - etiology; Hypoparathyroidism - prevention & control; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neck Dissection - methods; Original Article; Retrospective Studies; Surgery; Thyroglobulin; Thyroid Cancer, Papillary - pathology; Thyroid Cancer, Papillary - surgery; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy - methods; Young Adult; Lymphatic metastasis; Thyroid cancer; Central neck compartment dissection; Papillary thyroid carcinoma
• ISSN: 2038-131X; 2038-3312
• DOI: 10.1007/s13304-022-01440-0

Thyroid cancer is the most common malignancy in the endocrine system. Papillary thyroid carcinoma (PTC) is the most common differentiated thyroid cancer. There are considerable discrepancies regarding the role and extent of prophylactic central lymph node dissection (PCLND) for patients with PTC. Our primary goal was the evaluation of CLN involvement based on the tumor features and staging on the eight version of the American Joint Committee on Cancer and also the TNM method. Our secondary aim was to evaluate the features of the CLNs with tumoral features and also features associated with the development of transient hypoparathyroidism. This prospective case-controlled study was performed among PTC patients. Total thyroidectomy and bilateral dissection of the CLNs of the central compartment of the neck was performed, and samples were sent for pathological evaluation. CLN involvement, tumoral features and transient hypoparathyroidism were cross-evaluated and analyzed with SPSS version 26.0. In this study, out of 61 patients, 11 (18%) were male, the average age was 37.3 ± 13.7 years, based on AJCC staging, 53 (86.9%) were stage I and 8 (13.1%) were stage II, and based on TNM staging, 39 patients (66.1%) were T1, including 13 (22.0%) T1a and 26 (44.1%) T1b, 15 patients (25.4%) were T2, and five patients (8.5%) were T3. Based on permanent pathology evaluation, the majority of patients ( n  = 48; 78.7%) had CLN involvement. None of the preoperative and tumor features had a significant association with CLN involvement. 75% of stage I and 100% of stage two cases, while 76.9% of T1, 86.7% of T2, and 80.0% of T3 cases had CLN involvement. There was no significant association between the involvement of CLN and the AJCC staging ( P  = 0.184) or TNM staging ( P  = 0.875). The involved to dissected CLN ratio was significantly higher in stage II patients compared to stage I (72.5 vs. 34.8%; P  = 0.006), and also with higher T staging (0.009). There was a statistically significant association between the larger CLN size and older patients’ age, higher postoperative thyroglobulin levels, and smaller tumor size. Higher postoperative thyroglobulin level was significantly associated with larger tumors size and thyroid capsule invasion. Also, 26 (44.8%) of patients developed transient hypoparathyroidism, which was significantly associated with vascular invasion ( P  = 0.048), bilateral location of tumor ( P  = 0.048) or on the right side (0.005), and larger size of the tumor ( P  = 0.016). Tumor features and staging were not associated with CLN involvement features. Therefore, full extent PCLND should be carried out to avoid reoperation or metastasis in PTC patients.