The implement of prophylactic central neck dissection in patients with cN0 papillary thyroid carcinoma

Background: Central lymph node metastasis of papillary thyroid carcinoma (PTC) is common, however, routine central lymph node dissection (CLND) is still controversial because of the uncertain efficacy and possible increased morbidity. The purpose of this study is to determine when prophylactic central neck dissection should be performed in patients with cN0 papillary thyroid carcinoma. Methods: A protocol on the indication for prophylactic CLND in PTC was designed according to our experience combined with international guidelines, and PTC patients during 2005-2006 who qualified for this protocol were included in this study. Patients who underwent prophylactic CLND were designed as CLND group, and patients who underwent thyroidectomy alone were designed as Tx group. The 10-year recurrence rate of two groups was compared. Results: 170 PTC cases were included in this study. CLND group had 119 patients, Tx group had 51 patients. In CLND group, the incidence of involved central neck lymph nodes was 71%. During a follow-up of over 10 years, More patients had recurrences in CLND group than in Tx group (11% vs 3.9%; P<0.01). Conclusion: This protocol was an accurate way to select high risk PTC patients, and at the same time, allow low risk PTC patients to avoid unnecessary CLND, which is helpful for implementing personalized therapy for PTC.