Is routine dissection of central lymph node and radio-active iodine therapy, necessary for papillary thyroid carcinoma, T1-2 N0? A randomized controlled trial

Abstract

Backgroundprophylactic central neck dissection (pCND) is a subject of discussion for papillary thyroid carcinoma T1-2 N0, our study proves that pCND should be recommended as it is associated with less postoperative residual tumour with increasing recurrence-free survival. ObjectiveThe primary endpoint is the recurrence free survival, study exclusively compares the outcome of surgical ablation with and without CND in PTC T1-2N0. Another endpoint is whether patients with residual disease, need to receive repeated radioactive iodine ablation or completion surgery. Subject and methodA Randomized controlled trial multi-centre study, assigned the patients into two arms, Group I was the control arm underwent total thyroidectomy only, whereas the other arm, included Total thyroidectomy and central neck dissection. Univariate and multivariate analysis was performed to declare risk group for recurrence. Recurrence Free Survival was the main issue of the study and calculated as the time elapsed from the date of surgery to the date of relapse; patients with residual and uTg 0.2–2 ng/ml received radio-active iodine (RAI) therapy versus completion surgery. ResultsLoco-regional recurrence cases were found more in male patients aged more than 45 years old. Size of the primary tumour and the extent of surgery was a significant factor for RFS, patients with PCND in group II, had lower loco-regional recurrence and longer RFS, mean RFS was 25 months with (95%CI) is (23.61–26.38 months). Recurrence was high in the controlled group 38.1%. ConclusionN0 patients will benefit by total thyroidectomy and pCND. pCND is recommended to decreases the residual tumour, increase the RFS. Completion surgery versus RAI for postoperative recurrence needs more number of patients.