Abstract
BackgroundProphylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65 years old. The aim of this study was to compare recurrence rate, complications rate and histological features of tumors in elderly population.MethodsA retrospective study was carried out collecting data from 371 patients with differentiated thyroid cancer without clinical evidence of lymph-nodes involvement in three Italian referral centers from 2005 to 2015. All patients were aged ≥ 65 years and were divided in two groups based on the performed surgery (total thyroidectomy alone or associated with central lymph-nodes dissection). Moreover, patients were stratified according to the age between 65 and 74 years old and over 75 years old.ResultsTotal thyroidectomy alone was performed in 184 patients (group A) and total thyroidectomy with prophylactic central neck dissection was performed in 187 cases (group B). There was a statistically significant difference in complications between the groups in terms of neck hematoma (0.5% group A vs 3.7% group B), temporary hypoparathyroidism (11.4% group A vs 21.4% group B), and temporary unilateral recurrent nerve injury (1.5% group A vs 6.4% group B). Lymph nodes recurrence rate was 9.2% in group A and 8.5% in group B, with no statistically significant difference. There was a statistically significant difference in patients over 75 years old in terms of temporary hypoparathyroidism (24% group A vs 11% group B), permanent hypoparathyroidism (2,7% group A vs 0,3% group B) and recurrent nerve injury (9,5% group A vs 2% group B).ConclusionsThe role of prophylactic central neck dissection is still controversial, especially in elderly patients, and an aggressive surgical approach should be carefully evaluated. The Authors reported a similar low recurrence rate between total thyroidectomy and total thyroidectomy associated with prophylactic central neck dissection, with increased postoperative complications in the lymphadenectomy group and in patients over 75 years old, advocating a tailored surgical approach in elderly population.
Highlights
Prophylactic central neck lymph-nodes dissection is still a topic of major debate in Literature
According to ESMO (European Society of Medical Oncology), BTA (British Thyroid Association), ATA (American Thyroid Association), NCCN (National Comprehensive Cancer Network), therapeutic central neck dissection should be performed in case of a clinical or ultrasonographic evidence of lymph nodes metastases in central compartment [8,9,10,11]
Exclusion criteria were the presence of lymph node metastases in the central or in the lateral compartment discovered during preoperative investigations or during surgery
Summary
Prophylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. Differentiated thyroid cancer (DTC) is the most common tumor among endocrine malignant pathology with an incidence that has dramatically increased in the last few decades (almost 310% from 1950 to 2004). According to ESMO (European Society of Medical Oncology), BTA (British Thyroid Association), ATA (American Thyroid Association), NCCN (National Comprehensive Cancer Network), therapeutic central neck dissection should be performed in case of a clinical or ultrasonographic evidence of lymph nodes metastases in central compartment [8,9,10,11]. Recent papers described a dissimilar incidence of lymph node recurrence after DTC in aged people compared to young ones without reaching definitive conclusions [2, 12,13,14]. The aim of this study was to evaluate the incidence, the risk factors and the recurrence of central compartment lymph nodes in elderly patients (age ≥ 65 years) with cN0 PTMC
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