title: Total thyroidectomy, without prophylactic central lymph node dissection, in the treatment of differentiated thyroid cancer. Clinical retrospective study on 221 cases.
abstract: Total thyroidectomy (TT) is the standard of care for differentiated thyroid cancer (DTC), but still there is no consensus about the role of routine use of prophylactic central lymph node dissection. The aim of this study was to analyze our results of TT without prophylactic central lymphadenectomy in the treatment of DTC. Clinical records, between January 1998 and December 2005, of 221 patients undergoing TT, without prophylactic central lymph node dissection, were retrospectively evaluated. Two hundred and eleven patients (95.47 %) also underwent radioiodine (RAI) ablation followed by thyroid stimulating hormone (TSH) suppression therapy. In patients with loco-regional lymph nodal recurrence, lateral and central lymph node dissection was performed. The incidence of permanent hypoparathyroidism (iPTH <10 pg/ml) and permanent vocal fold paralysis were, respectively, 0.91 and 0.91 %. After a 9.6 ± 3.5 years mean follow-up, the rate of loco-regional recurrence, with positive cervical lymph nodes, was 3.16 % (7/221 patients). In these cases a lateral and central lymphadenectomy was carried out without significant complications. Our results showed that TT without prophylactic central lymph node dissection, followed by RAI ablation, was associated with low morbidity and low loco-regional recurrence rate, even if the lack of a control group treated with TT plus prophylactic central lymphadenectomy suggests caution against generalization of our assumption. Such last combined procedure could be indicated in high-risk patients, in whom loco-regional recurrence is more frequent. However, given the trend in the literature toward prophylactic lymphadenectomy and the avoidance of RAI treatment, prospective randomized trials should be conducted to better clarify this issue.
authors: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General and Endocrine Surgery, Second University of Naples, Via Pansini 5, Build 17, 80131, Naples, Italy, giovanni.conzo@unina2.it.
authors: Giovanni
authors: G
authors: Conzo
authors: Daniela
authors: D
authors: Pasquali
authors: Giuseppe
authors: G
authors: Bellastella
authors: Katherine
authors: K
authors: Esposito
authors: Carlo
authors: C
authors: Carella
authors: Annamaria
authors: A
authors: De Bellis
authors: Giovanni
authors: G
authors: Docimo
authors: Michele
authors: M
authors: Klain
authors: Sergio
authors: S
authors: Iorio
authors: Salvatore
authors: S
authors: Napolitano
authors: Antonietta
authors: A
authors: Palazzo
authors: Alessandra
authors: A
authors: Pizza
authors: Antonio Agostino
authors: AA
authors: Sinisi
authors: Emilia
authors: E
authors: Zampella
authors: Antonio
authors: A
authors: Bellastella
authors: Luigi
authors: L
authors: Santini
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D055502:Secondary Prevention; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000706:statistics & numerical data
chemical_list: D007457:Iodine Radioisotopes