P0014 Prophylactic central node dissection in well differentiated thyroid cancers: Does this increase morbidity?

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Background Prophylactic central neck dissection (pCND) in well differentiated thyroid cancers (WDTC) remains controversial. As there are no level 1 evidence to evaluate the efficacy of pCND, evidence comes from case series or retrospective cohort or analysis, and is predominantly dichotomous. We aimed to compare the additional morbidity of total thyroidectomy with pCND with that of total thyroidectomy alone and to identify specific risk factors that might facilitate selection of cases for the procedure. Methods A prospective study was conducted from August 2011 to June 2013 that selected 50 consecutive patients with WDTC and no clinical and sonographic evidence of lymph nodes who presented to the Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati. Patients were non-randomly assigned to two equal groups: total thyroidectomy (A) or total thyroidectomy with pCND (B). All patients were evaluated preoperatively and postoperatively for cord mobility with either indirect laryngoscopy or telelaryngoscopy. Age, sex, size of the nodule, cytology report, and other details were recorded. Postoperatively, all patients were evaluated for voice change or symptoms of hypocalcaemia. Serum calcium and albumin were measured postoperatively on day 2 after surgery in all patients. The final histopathology reports were analysed. Findings Incidence of temporary recurrent laryngeal nerve (RLN) paresis was similar in groups A and B (three vs four patients). There were no permanent RLN palsies in both groups. The incidence of temporary hypocalcaemia was higher in group B (32%) than in group A (20%), but there were no patients with permanent hypocalcaemia in group B. One patient had permanent hypocalcaemia in group A. A total of 80% or more patients in both groups had pT1 or pT2 cancer. Incidence of lymph node positivity in group B was 44% (11/25), and in only those with pT1/pT2, it was 40%. Interpretation Our study shows that pCND does not cause any additional morbidity, and with the high incidence of occult metastases even in pT1 and pT2 tumours, pCND should form an essential part of surgical management of all well differentiated thyroid cancers, although tangible recurrence-free or survival benefit may not be immediately apparent.