title: A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer.
abstract: BACKGROUND
  The role of routine central lymph node dissection (CLND) for papillary thyroid cancer (PTC) remains controversial. The aim of this study was to evaluate the impact of routine CLND after total thyroidectomy (TTx) in the management of patients with PTC who were clinically node negative at presentation with emphasis on stimulated thyroglobulin (Tg) levels and reoperation rates.
  
  
  METHODS
  This retrospective, multicenter, cohort study used pooled data from 3 international Endocrine Surgery units in Australia, the United States, and England. All study participants had PTC >1 cm without preoperative evidence of lymph node disease (cN0). Group A patients had TTx alone and group B had TTx with the addition of CLND.
  
  
  RESULTS
  There were 606 patients included in the study. Group A had 347 patients and group B 259 patients. Stimulated Tg values were lower in group B before initial radioiodine ablation (15.0 vs 6.6 ng/mL; P = .025). There was a trend toward a lower Tg at final follow-up in group B (1.9 vs 7.2 ng/mL; P = .11). The rate of reoperation in the central compartment was lower in group B (1.5 vs 6.1%; P = .004). The number of CLND procedures required to prevent 1 central compartment reoperation was calculated at 20.
  
  
  CONCLUSIONS
  The addition of routine CLND in cN0 papillary thyroid carcinoma is associated with lower postoperative Tg levels and reduces the need for reoperation in the central compartment.
authors.affiliation: University of Sydney Endocrine Surgical Unit, Sydney, Australia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Popadich
authors.forename: Olga
authors.initials: O
authors.lastname: Levin
authors.forename: James C
authors.initials: JC
authors.lastname: Lee
authors.forename: Stephanie
authors.initials: S
authors.lastname: Smooke-Praw
authors.forename: Kevin
authors.initials: K
authors.lastname: Ro
authors.forename: Maisam
authors.initials: M
authors.lastname: Fazel
authors.forename: Asit
authors.initials: A
authors.lastname: Arora
authors.forename: Neil S
authors.initials: NS
authors.lastname: Tolley
authors.forename: Fausto
authors.initials: F
authors.lastname: Palazzo
authors.forename: Diana L
authors.initials: DL
authors.lastname: Learoyd
authors.forename: Stan
authors.initials: S
authors.lastname: Sidhu
authors.forename: Leigh
authors.initials: L
authors.lastname: Delbridge
authors.forename: Mark
authors.initials: M
authors.lastname: Sywak
authors.forename: Michael W
authors.initials: MW
authors.lastname: Yeh
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D002277:Carcinoma; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013954:Thyroglobulin / Q000097:blood; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D007457:Iodine Radioisotopes; D013954:Thyroglobulin