Bilateral central lymph node dissection with thyroidectomy for papillary thyroid cancer

Abstract

Objectives The aims of the study were to evaluate the frequency and pattern of central neck lymph node metastasis in papillary thyroid cancer and its relation to the lateral neck lymph node metastasis. Also, this study aimed to evaluate the complications of central neck dissection. Background The indications and extent of central lymph node dissection (CLND) in the treatment of papillary thyroid carcinoma remain controversial, and its therapeutic effect remains debatable. Patients and methods A total of 30 patients diagnosed with papillary thyroid cancer were treated from 2011 to 2013. All patients underwent total thyroidectomy and bilateral central neck dissection. In patients with positive central lymph node metastases in frozen section, we performed ipsilateral lateral lymph node dissection removing levels II to V. Central lymph node metastases were analyzed. In addition, we investigated postoperative complications after total thyroidectomy and CLND. Results Among 30 patients, 12 (40%) had central lymph node metastases, with the ipsilateral paratracheal lymph nodes most commonly affected (40%). Of the 12 patients with positive central lymph node metastases, only two had positive lateral lymph node metastases. The frequency of temporary hypocalcemia, permanent hypocalcemia, and temporary vocal cord paralysis was 16.7, 6.7, and 6.7%, respectively. Conclusion CLND prevents nodal recurrence in the central compartment, which carries a high incidence of morbidity during surgery for recurrence. In addition, CLND, in good hands, does not contribute to the morbidity of total thyroidectomy (hypoparathyroidism and recurrent laryngeal nerve injury). We propose that total thyroidectomy and bilateral CLND are the least-recommended surgical treatments. Also, in clinically negative lateral nodes, we conclude that lateral lymph node dissection is not important even if central lymph nodes were positive for metastases.