No Clear Benefit To Prophylactic Central Neck Dissection In Patients With Clinically Node Negative Papillary Thyroid Cancer
Rebecca S Sippel1, *Sarah Robbins1, *Jennifer L Poehls1, *Susan C Pitt1, Herbert Chen2, *Kristin L Long1, *David F Schneider1, *Nadine P Connor1
1University of Wisconsin School of Medicine and Public Health, Madison, WI;2University of Alabama at Birmingham School of Medicine, Birmingham, AL
OBJECTIVE(S): Microscopic lymph node involvement in patients with papillary thyroid cancer (PTC) is common, but the optimal management is unclear. The aim of this prospective randomized-controlled trial was to evaluate the risks/benefits of a prophylactic central neck dissection (pCND) in patients with clinically node negative (cN0) PTC.
METHODS: 59 patients with cN0 PTC were randomized to a Total Thyroidectomy (TT) or a TT+ pCND. All patients received postoperative laryngoscopies and standardized radioiodine treatment. Thyroglobulin (Tg) levels and/or neck ultrasounds (US) were performed at 6 weeks, 6 months and 1 year.
Tumors averaged 2.2 ± 0.2 cm and 16.9% had extra-thyroidal extension. 29 patients underwent a pCND and 27.6% had positive nodes (all ≤6 mm). Rates of post-operative PTH <10 (33.3% vs. 24.1%, p=0.44) and transient recurrent laryngeal nerve dysfunction (13.3% vs. 10.3%, p=0.72) were not significantly different. Six weeks after surgery, prior to radioactive iodine, both TT and pCND were equally likely to achieve a Tg≤0.1 (45.8% vs. 50%, p=0.78) and a stimulated Tg≤2 (61.9% vs. 58.8%, p=0.85). At 1 year, rates of Tg≤0.1 (84.0% vs. 86.4%, p=0.82) and stimulated Tg≤1 (93.8% vs. 100%, p=0.88), both considered an excellent response, were similar between TT and pCND groups. However, the TT patients were more likely to have a questionable finding on US (15.4% vs. 0%, p=0.06).
cN0 PTC patients treated either with TT or TT+pCND had similar complication rates after surgery. While microscopic nodes were discovered in 27.6% of pCND patients, oncologic outcomes were equivalent at 1 year.
Back to 2020 Abstracts