Central compartment dissection for well differentiated thyroid cancer … and the band plays on.
OBJECTIVE
The role of central compartment dissection in the surgical management of well differentiated thyroid cancer is controversial. Lack of high-quality prospective studies results in management decisions being based on expert opinions and weaker levels of evidence. The American Thyroid Association has recently revised its management guidelines with particular emphasis on this topic, and a separate working group has set out to define the surgical anatomy that encompasses this procedure.


RESULTS
Central compartment dissection comprises the removal of nodal tissue from the prelaryngeal, pretracheal and paratracheal compartments, with no role for berry-picking procedures. There is universal agreement that therapeutic nodal dissection should be performed in patients with metastatic disease detected either through preoperative imaging or during intraoperative evaluation of the central compartment, with either visual inspection or frozen-section pathology. In contrast, there may be limited benefit from routine prophylactic central compartment dissection, for either disease recurrence or survival outcomes. As such, it should be performed only in patients deemed high risk: larger tumors, extra-thyroidal extension or aggressive histologic subtypes.


CONCLUSIONS
Future studies should focus on identifying the subpopulation of patients who would most benefit from these procedures and spare low-risk patients from the unwanted complications.
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
N Gopalakrishna
NG
Iyer
Ashok R
AR
Shaha
D018450:Disease Progression; D005629:Frozen Sections; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D037981:Neck Dissection / Q000379:methods*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012086:Reoperation; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*