Utility of prophylactic central dissection in papillary thyroid carcinoma with clinically apparent lymph node metastases isolated to the lateral neck

Abstract

Background

The utility of prophylactic ipsilateral central neck dissection in papillary thyroid carcinoma presenting with clinically/sonographically apparent lymph node metastases isolated to the lateral neck is unclear. The study assessed whether prophylactic central neck dissection was associated with improved recurrence-free survival.

Methods

Single-center retrospective cohort study of patients undergoing thyroidectomy and lateral neck dissection for initial treatment of papillary thyroid carcinoma with clinically/sonographically apparent lymph node metastases isolated to the lateral neck from 2006 to 2022. We compared patients who underwent prophylactic central neck dissection with those who did not. Primary outcome was estimated recurrence-free probability, calculated using the Kaplan-Meier method and log-rank test.

Results

The study cohort comprised 65 patients, 53 (81.5%) of whom received prophylactic central neck dissection in addition to total thyroidectomy and lateral neck dissection. Clinicopathologic features in the 2 groups were similar. Median follow-up was 50.2 months. The estimated 10-year recurrence-free probability was 92.5% for patients who received prophylactic central neck dissection and 66.7% for those who did not receive prophylactic central neck dissection (P = .013). Two of the 6 structural recurrences in the non–prophylactic central neck dissection group were found in the central neck and could potentially have been prevented by prophylactic central neck dissection. Patients who received prophylactic central neck dissection had a higher likelihood of achieving excellent response to therapy compared to patients who did not (59% vs 25%, P = .05). The rate of permanent hypoparathyroidism was comparable among patients who underwent prophylactic central neck dissection versus those who did not (P = .3), and no vocal cord palsy was observed in either group.

Conclusions

In patients initially presenting with clinically apparent nodal metastases of papillary thyroid carcinoma isolated to the lateral neck, prophylactic central neck dissection performed concurrently with total thyroidectomy and lateral neck dissection is associated with improved recurrence-free survival and greater likelihood of excellent response to therapy.