title: Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma.
abstract: BACKGROUND
  Prophylactic central neck dissection (PCND) for papillary thyroid carcinoma (PTC) is controversial. We compared 3 different approaches to the management of central compartment nodes in patients with clinically unifocal and N0 PTC.
  
  
  METHODS
  A total of 186 patients were prospectively assigned to one of the following procedures: total thyroidectomy (TT), TT plus ipsilateral PCND (Ipsi-PCND), and TT plus bilateral PCND (Bil-PCND).
  
  
  RESULTS
  No difference was found concerning demographic, clinical or pathologic characteristics (P = NS). More patients in the Bil-PCND group had transient hypocalcemia (P < .001). One patient in the Bil-PCND group experienced permanent hypoparathyroidism (P = NS). One transient and one permanent unilateral laryngeal nerve palsy occurred in the Ipsi-PCND group (P = NS). Significantly more patients in the Bil-PCND and Ipsi-PCND groups had node metastases recognized (26 vs 18 vs 6; P < .001). Six of 26 pN1 patients (23%) in the Bil-PCND group had bilateral metastases. No difference was found concerning mean postoperative basal and stimulated thyroglobulin and mean postoperative radioiodine uptake. One patient in the Ipsi-PCND group experienced recurrent disease (P = NS).
  
  
  CONCLUSIONS
  TT seems adequate treatment for most patients with clinically N0 PTC. PCND could be considered for a more accurate staging. Ipsi-PCND could be a valid option, but it includes the risk of overlooking contralateral metastases.
authors.affiliation: Division of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.forename: Carmela
authors.initials: C
authors.lastname: De Crea
authors.forename: Luca
authors.initials: L
authors.lastname: Sessa
authors.forename: Piero
authors.initials: P
authors.lastname: Giustacchini
authors.forename: Luca
authors.initials: L
authors.lastname: Revelli
authors.forename: Chiara
authors.initials: C
authors.lastname: Bellantone
authors.forename: Celestino Pio
authors.initials: CP
authors.lastname: Lombardi
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D002291:Carcinoma, Papillary / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult