Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma

Background. The role of central neck dissection (CAD) in differentiated thyroid cancer remains controversial. This study aims at elucidating the potential benefits and drawbacks of CAD associated to total thyroidectomy in papillary cancer. Methods. Protocols of patients undergoing total thyroidectomy and CAD for papillary cancer were reviewed. The following data were recorded: macroscopic appearance of central nodes; nodes obtained at operation; number of metastatic nodes and parathyroid glands incidentally resected; metastases, age, completeness, invasiveness, size score; postoperative s-Ca; complications; and recurrences. Differences between therapeutic (gross nodal involvement) and prophylactic (no apparent node involvement) CNDs were studied. Results. Forty-three patients (mean age, 52 +/- 17 years) were studied. A mean of 8.4 +/- 6.6 nodes were resected per patient. A 60% prevalence (26143) of presence of nodal involvement (N+) was found with no difference between low- and high-risk patients. Twenty-five (60%) patients developed transient hypocalcemia, which was associated with incidental parathyroidectomy, number of nodes resected, and thymectomy. Two patients (4.6%) developed permanent hypoparathyroidism and 3 (7%), transient vocal cord paralysis. Parathyroid glands were found in 19% of the specimens. At follow-up, there were no central neck recurrences, but 5 patients developed lateral recurrences despite treatment with I-131. All 5 patients had had therapeutic CAD with 6 or more metastatic nodes obtained in the CAD specimen. No lateral neck recurrences were observed, after prophylactic CAD or in patients with < 6 nodes involved. Conclusions. CAD prevents central neck recurrences. Morbidity of bilateral CAD is significant, and its systematic implementation in the absence on gross nodal involvement requires reassessment.