Elsevier

Surgery

Volume 148, Issue 6, December 2010, Pages 1100-1107
Surgery

American Association of Endocrine Surgeon
Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer

https://doi.org/10.1016/j.surg.2010.09.019Get rights and content

Background

Prophylactic central lymph node dissection with total thyroidectomy (TT) for the treatment of papillary thyroid cancer (PTC) is controversial because of the possibility of increased morbidity with uncertain benefit. The purpose of this study is to determine whether prophylactic central neck dissection provides any advantages over TT alone.

Methods

Retrospective cohort study of patients with PTC without preoperative evidence of lymph node involvement undergoing either TT or TT with bilateral central lymph node dissection (TT + BCLND).

Results

From 2002 to 2009, 143 patients with clinically node-negative PTC underwent either TT (n = 65) or TT + BCLND (n = 78). The groups were similar in age, gender, tumor size, multifocality, angioinvasion, and metastasis/age/completeness-of-resection/invasion/size score. The presence of involved central neck lymph nodes upstaged 28.6% of patients in the TT + BCLND group to stage III disease, which resulted in higher radioactive iodine ablation doses. Stimulated serum thyroglobulin levels and the number of patients with undetectable stimulated thyroglobulin levels before and 1 year after radioactive iodine ablation were equivalent.

Conclusion

The addition of routine central lymph node dissection to TT for the treatment of PTC upstages nearly one third of patients over the age of 45 thereby changing the dose of radioactive iodine ablative therapy, but does not change postoperative thyroglobulin levels after completion of radioiodine treatment.

Section snippets

Patients

After approval by the institutional review board, a retrospective cohort review was performed of a single institutional database of consecutive patients who had operative treatment of PTC at the University of Michigan from 2002 to 2009. Patients who underwent TT were designated as group TT, whereas those undergoing TT with prophylactic bilateral central compartment lymph node dissection (BCLND) were designated group TT + BCLND. Patients with a primary tumor size <1 cm, evident preoperative

Results

Of the 390 patients treated surgically for PTC from 2002 to 2009, 143 patients met inclusion criteria; 247 patients were excluded based on the following criteria: 44 for previous operation for thyroid cancer, 39 for tumor size <1 cm, 22 for preoperative abnormal lymph nodes, 36 for incomplete data, 3 for distant metastasis at diagnosis, and 103 for nodal dissection outside the central neck. Sixty-five patients underwent TT alone and 78 underwent TT + BCLND. Patient characteristics are presented

Discussion

All endocrine surgeons agree that grossly involved lymph nodes in the central neck of patients with thyroid cancer should be managed by clearance of the central neck compartment lymph nodes.1 The management of the central lymph nodes for clinically node-negative PTC, however, continues to be a controversial issue. The case for routine central neck dissection cites the >50% incidence of metastatic cervical lymph node involvement in PTC and the associated increase in local recurrence rates and

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