title: Surgical treatment of papillary thyroid carcinoma without lymph nodal involvement.
abstract: BACKGROUND
  In the treatment of differentiated thyroid cancer (DTC), in absence of enlarged lymph nodes, the role of routine central lymph node dissection (RCLD) remains controversial. The aim of this study is to analyze data resulting from total thyroidectomy (TT) not combined with RCLD in the treatment of DTC.
  
  
  METHODS
  We retrospectively evaluated the clinical records of 80 patients treated between January 1996 and December 2003 with TT without RCLND, in absence of suspected enlarged lymph nodes at preoperative ultrasonography and intraoperatively during neck exploration. In this series, 75 patients (93.7%) underwent radioiodine (RAI) ablation, followed by Thyroid Stimulating Hormone (TSH) suppression therapy. In case of locoregional lymph nodal recurrence, a central (VI) and ipsilateral (III-IV) selective lymph node dissection was performed.
  
  
  RESULTS
  Incidence of permanent hypoparathyroidism (iPTH < 10 pg/ml) and unilateral temporary vocal fold paralysis were respectively 2.55% and 2.55%. Locoregional recurrence, with positive cervical lymph nodes, after a 10.3 ± 4.7 years mean follow-up was observed in 3 patients (3.75%). They were submitted to a central (VI) and ipsilateral (III-IV) selective neck dissection without significant complications.
  
  
  CONCLUSIONS
  In our series, TT not combined with RCLD was associated to a low locoregional recurrence rate, even if the lack of a control group treated with RCLD does not allow any generalized assumption. RCLD may be indicated in high risk patients, in whom lymph nodal recurrence is more frequent. More prospective randomized studies are needed to better define the role of RCLD and postoperative radioiodine ablation.
authors.affiliation: Department of Anaesthesiologic, VII Division of General and Endocrine Surgery, Surgical and Emergency Sciences, Second University of Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Conzo
authors.forename: G
authors.initials: G
authors.lastname: Docimo
authors.forename: R
authors.initials: R
authors.lastname: Ruggiero
authors.forename: S
authors.initials: S
authors.lastname: Napolitano
authors.forename: A
authors.initials: A
authors.lastname: Palazzo
authors.forename: C
authors.initials: C
authors.lastname: Gambardella
authors.forename: C
authors.initials: C
authors.lastname: Mauriello
authors.forename: E
authors.initials: E
authors.lastname: Tartaglia
authors.forename: F
authors.initials: F
authors.lastname: Cavallo
authors.forename: L
authors.initials: L
authors.lastname: Santini
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D012189:Retrospective Studies; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy