Prophylactic central compartment neck dissection for papillary thyroid cancer: The search for justification continues

Abstract

MACROSCOPIC LYMPH NODE METASTASES in patients with papillary thyroid cancer are associated with a higher recurrence rate. Lundgren et al, in a large population-based case-control study, demonstrated an increased mortality rate in patients 45 years of age and older with regional lymph node metastases. There is evidence that, for patients with macroscopic nodal disease, lymphadenectomy may reduce recurrence and mortality. As a result, there is general agreement that patients with clinically involved lymph nodes in the central neck should be managed with a central compartment neck dissection. A central compartment neck dissection consists of the removal of all nodal and fibrofatty tissue between the right and left common carotid arteries from the hyoid bone superiorly to the innominate artery inferiorly. This includes removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes, collectively classified as level VI lymph nodes. Prophylactic central neck dissection, defined as a compartment-orientated level VI lymph node dissection performed in patients with no evidence lymph node metastases on preoperative clinical examination, imaging studies, or intraoperative assessment, is controversial. Occult micrometastasis in the lymph nodes of the central neck are known to occur in 31–62% of patients with papillary carcinoma, yet most remain dormant and rarely become clinically important. The