Management of Central Compartment Lymph Nodes in Patients with Papillary Thyroid Carcinoma

Abstract

Central compartment neck dissection (CCND) in patients with papillary thyroid cancer (PTC) for macroscopic lymph node metastases has been shown to reduce recurrence and improve survival. As a result, CCND is uniformly accepted for treatment of patients with macroscopic lymph node metastases in the central compartment of the neck. Controversy exists regarding the benefit of prophylactic central compartment neck dissection (pCCND) in PTC. Microscopic lymph node metastases are common in PTC, but their presence is not associated with a reduction in survival or an increase in disease recurrence. The only potential benefit of pCCND may be for precise lymph node staging to help determine if postoperative radioactive iodine therapy is necessary and what the dose should be for patients with intermediate-risk PTC; this remains controversial. Patients undergoing pCCND experience a higher rate of temporary hypocalcemia with no reduction in disease recurrence. There is also evidence to suggest that the rate of permanent hypoparathyroidism is higher. Furthermore, there is no clear survival benefit for pCCND. To date, there are a limited number of prospective randomized trials and a limited amount of high-level evidence to guide decision-making in the management of central compartment lymph nodes in PTC. The only clear indication for CCND is for treatment of clinically node-positive PTC. Overall, there is no proven benefit for pCCND in the treatment of clinically node-negative PTC.