Abstract
IntroductionIn Japan, prophylactic central node dissection (p-CND) for papillary thyroid carcinoma (PTC) has been routinely performed in many institutions, including ours (Kuma Hospital, Japan). We evaluated the recurrence to a central lymph node in patients with cN0M0 PTC who underwent routine p-CND.Materials and methodsWe enrolled 4301 patients with cN0M0 PTC who underwent an initial surgery between 1987 and 2005 (median age 51 years). The postoperative follow-up periods ranged from 4 to 362 months (median 164 months). Only 15 patients underwent radioactive iodine (RAI) ablation (≥30 mCi) after total or near total thyroidectomy.ResultsOf the 4301 patients with N0M0 PTC who underwent p-CND, 2548 (59%) were diagnosed as pN1a on postoperative pathological examination. To date, only 52 cases (1.2%) showed recurrence to a central lymph node. The 10-year and 20-year central node recurrence-free survival rates were excellent at 99.1 and 98.2%, respectively. On multivariate analysis, age ≥55 years, significant extrathyroid extension, tumor size >2 cm, and ≥5 pathologically confirmed central node metastases (but not the presence of central node metastasis) independently affected central node recurrence.ConclusionsUnder the situation of routine p-CND, the central node recurrence-free survival of cN0M0 PTC is excellent. However, future studies, including double-arm studies from Japan, should examine whether the omission of p-CND cN0M0 PTC is appropriate without RAI ablation in consideration of various factors, including the pros and cons of p-CND.
Highlights
Introduction InJapan, prophylactic central node dissection (p-CND) for papillary thyroid carcinoma (PTC) has been routinely performed in many institutions, including ours (Kuma Hospital, Japan)
We evaluated the recurrence to a central lymph node in patients with cN0M0 PTC who underwent routine p-CND
Future studies, including double-arm studies from Japan, should examine whether the omission of p-CND cN0M0 PTC is appropriate without radioactive iodine (RAI) ablation in consideration of various factors, including the pros and cons of p-CND
Summary
Prophylactic central node dissection (p-CND) for papillary thyroid carcinoma (PTC) has been routinely performed in many institutions, including ours (Kuma Hospital, Japan). We evaluated the recurrence to a central lymph node in patients with cN0M0 PTC who underwent routine p-CND. Materials and methods We enrolled 4301 patients with cN0M0 PTC who underwent an initial surgery between 1987 and 2005 (median age 51 years). Surgeons/Japanese Society of Thyroid Surgery, prophylactic central node dissection (p-CND) is accepted as a surgical strategy for cNM0 PTC [5]. It is not evident that p-CND improves patients’ prognoses, but the Japanese guidelines recognize the benefit of p-CND toward preventing the need for a second surgery for recurrence to the central compartment, which has a risk of recurrent laryngeal nerve injury and permanent hypoparathyroidism. Wound extension is not needed for p-CND and the procedure is not time-consuming; these factors contribute to the acceptance of p-CND in the Japanese guidelines
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