Central lymph node dissection in differentiated thyroid cancer.
BACKGROUND
There has been renewed interest in extensive lymph node dissection for papillary thyroid cancer (PTC), and a number of reports have been published concerning compartment-oriented dissection of regional lymph nodes in PTC. A comprehensive review of this body of literature using evidence-based methodology is pending.


METHODS
Systematic review of the literature using evidence-based criteria.


RESULTS
Issue 1: Systematic compartment-oriented central lymph node dissection (CLND) may decrease recurrence of PTC (Levels IV and V data, no recommendation) and likely improves disease-specific survival (grade C recommendation). Limited level III data suggest survival benefit with the addition of prophylactic dissection to thyroidectomy (grade C recommendation). The addition of CLND to total thyroidectomy can significantly reduce levels of serum thyroglobulin and increase rates of athyroglobulinemia (level IV data, no recommendation). Issue 2: There may be a higher rate of permanent hypoparathyroidism and unintentional permanent nerve injury when CLND is performed with total thyroidectomy than for total thyroidectomy alone (grade C recommendation). Issue 3: Reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury when compared with total thyroidectomy with or without CLND (grade C recommendation), supporting a more aggressive initial operation.


CONCLUSIONS
Evidence-based recommendations support CLND for PTC in patients under the care of experienced endocrine surgeons.
White
Matthew L
ML
Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
Gauger
Paul G
PG
Doherty
Gerard M
GM
D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D019317:Evidence-Based Medicine; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local; D012086:Reoperation; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods