title: Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience.
abstract: OBJECTIVE
  The role of central neck dissection in the treatment of papillary thyroid carcinoma is debated. This retrospective investigation was undertaken to assess whether it augments total thyroidectomy morbidity.
  
  
  METHODS
  A total of 305 consecutive patients who had undergone total thyroidectomy for papillary thyroid carcinoma were divided into three groups: group A (n = 64) showed evidence of node metastases and received therapeutic bilateral central node dissection; group B (n = 93) showed negative nodes and received prophylactic ipsilateral central node dissection; group C (n = 148) showed negative nodes and received total thyroidectomy alone. The rates of transient and permanent complications within the three groups were compared.
  
  
  RESULTS
  Histopathological examination detected node metastases in 46 (72%) group A patients and in 20 (21%) group B patients. Parathyroid autotransplantation was carried out in 41 (64%) patients in group A, 55 (59%) in group B, and 43 (29%) in group C (P < 0.001). One or more parathyroid glands were found in 20% of the specimens from group A, 11% of those from group B, and 9% of those from group C. None of the patients in either group A or group B reported permanent laryngeal recurrent nerve paralysis, but two (1.3%) in group C did. Transient laryngeal recurrent nerve paralysis occurred most often in group A patients (7.8% versus 5.4% versus 1.3%, respectively) and was bilateral in two patients (one in group A and one in group B). None of the patients in either group A or group B developed permanent hypoparathyroidism, but four (2.7%) in group C did. Transient hypoparathyroidism was highest in group A patients (31% versus 27% versus 13%, respectively; P = 0.003). Postoperative bleeding requiring reoperation occurred in one group B patient and in two group C patients.
  
  
  CONCLUSIONS
  Central neck dissection did not increase permanent morbidity and revealed a significant rate of nonclinically evident node metastases. In experienced hands, central neck dissection should be routinely combined with total thyroidectomy in the primary treatment of pre- or intraoperatively diagnosed papillary thyroid cancer. When no macroscopic evidence of metastasis is present, ipsilateral central neck dissection is the best treatment strategy in a balanced decision between the need for achieving local radical excision, correct disease staging, and reducing the risk of complications.
authors.affiliation: General Surgery 1, Department of Medical and Surgical Sciences, University of Turin, Ospedale Molinette, Corso Dogliotti 14, 10126, Turin, Italy. npalestini@molinette.piemonte.it
authors.forename: N
authors.initials: N
authors.lastname: Palestini
authors.forename: A
authors.initials: A
authors.lastname: Borasi
authors.forename: L
authors.initials: L
authors.lastname: Cestino
authors.forename: M
authors.initials: M
authors.lastname: Freddi
authors.forename: C
authors.initials: C
authors.lastname: Odasso
authors.forename: A
authors.initials: A
authors.lastname: Robecchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000473:pathology / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000209:etiology; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology; D055815:Young Adult