Total Thyroidectomy versus Total Thyroidectomy with Prophylactic Central Compartment Neck Dissection in Early Papillary Thyroid Cancer

Abstract

Abstract Background: Thyroid cancer has the highest increase in incidence rate among all cancers, and this is largely but not full attributed to the increased detection of subclinical papillary carcinomas, the high incidence of occult nodal metastasis in PTC, advocating prophylactic central compartment neck dissection (pCCND) for the initial management of these tumors is, in theory, the ideal thing to do. Nevertheless, the role of pCCND in the management of PTC remains contro-versial regarding its benefits and risks. Aim of Study: The aim of this study is to compare between total thyroidectomy with or without prophylactic central compartment neck dissection in case of papillary thyroid cancer with clinically negative cervical LN metastasis, focusing mainly on the rate of complications and the risk of recurrence of the disease. Patients and Methods: This is a retrospective comparative study was conducted in the Department of Endocrine Surgery Unit, Ain Shams University hospitals and Shefa Elorman hospital, the study included 40 cases diagnosed with papillary thyroid cancer with clinical negative LNs, operated between March 2013 and March 2018. Sampling Method: we collected 40 cases of papillary thyroid cancer with clinical negative LNs operated in the department of endocrine surgery unit, Ain Shams University hospitals and Shefa Elorman hospital, between March 2013 and March 2018, 20 of them (group 1) underwent total thy-roidectomy and 20 cases (group 2) underwent total thyroid-ectomy and prophylactic central compartment neck dissection. Results: Females to male ratio was 17:3 in both groups with no statistical significant difference (p=1), the mean age of the participants in group (1) was 39.5±10.1 years while in group (2) was 37.5±7.4, with no statistical significant difference between both groups (p= 0.742), the mean operative time in group (1) patients was (122.1±19.1 min.) while in group (2) patients was (182.2±15.3 min.) with statistically significant relationship, only one case 5% in group (2) patients suffered hoarseness of voice.5% of group (1) patients and 10% of group (2) patients suffered from transient hypocalcemia, one patient (5%) in group (1) patients had recurrence and 4 patients (20%) of group (2) patients suffered from recurrence. Conclusion: Total thyroidectomy with prophylactic central LN dissection done in cases suffering from PTC with clinically negative cervical LNs increase operative time and post-operative hospital stay in comparison to total thyroidectomy with no statistical difference as regard to surgical complications and post-operative recurrence especially with presence of post-operative radioactive ablation.