title: Prophylactic lymph node dissection in papillary thyroid carcinoma: is there a place for lateral neck dissection?
abstract: BACKGROUND
  Cervical lymph node (LN) metastases are common in patients with papillary thyroid carcinoma (PTC), and they have a negative impact on recurrence. The management of preoperatively node-negative (N0) PTC is still controversial. The aim of our study was to describe the results of a prophylactic bilateral lymph node dissection (LND) and to investigate its impact on recurrence.
  
  
  METHODS
  From 2003 to 2011, we analyzed 603 consecutive preoperatively N0 PTC patients. For each patient, we reviewed demographics data, tumor characteristics, pattern and risk factors of LN metastasis, and outcome.
  
  
  RESULTS
  Lymph node metastases were found in 23 % of patients: 19 % in the central compartment and 8 % in the lateral compartment, including 1 % in the lateral compartment on the opposite side from the tumor. Multivariate analysis showed that hyperthyroidism and extrathyroidal invasion of the tumor were significantly associated with LN metastasis. Further analysis showed that localization of the tumor in the upper third of the thyroid lobe and metastatic LN in the central compartment were independent risk factors for lateral LN metastasis. During the 4.3-year follow-up, 23 recurrences were observed (4 %), including 5 in the central compartment. Recurrence rates were 2 % in the N0 group, 5 % in N1a patients, and 22 % in N1b patients (p < 0.001).
  
  
  CONCLUSIONS
  In preoperatively N0 PTC patients, LN metastases are frequent in central and ipsilateral lateral compartments. Prophylactic LND in the central and ipsilateral lateral compartments should therefore be recommended in the presence of PTC to identify high-risk patients.
authors.affiliation: Department of General and Endocrine Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie (Paris VI), Paris, France. romainducoudray@free.fr
authors.forename: Romain
authors.initials: R
authors.lastname: Ducoudray
authors.forename: Christophe
authors.initials: C
authors.lastname: Trésallet
authors.forename: Gaelle
authors.initials: G
authors.lastname: Godiris-Petit
authors.forename: Frédérique
authors.initials: F
authors.lastname: Tissier
authors.forename: Laurence
authors.initials: L
authors.lastname: Leenhardt
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D002291:Carcinoma, Papillary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Surgery. 2009 Feb;145(2):176-81
references.pmid: 19167972
references.citation: Eur J Endocrinol. 2012 Aug;167(2):267-75
references.pmid: 22648965
references.citation: Ann Surg. 2007 Apr;245(4):604-10
references.pmid: 17414610
references.citation: Clin Endocrinol (Oxf). 2011 Jul;75(1):112-9
references.pmid: 21521273
references.citation: BMC Cancer. 2011 Jan 11;11:8
references.pmid: 21223538
references.citation: Ann Endocrinol (Paris). 2008 Dec;69(6):472-86
references.pmid: 19137632
references.citation: Eur J Endocrinol. 2006 Jun;154(6):787-803
references.pmid: 16728537
references.citation: World J Surg. 2010 Jun;34(6):1239-46
references.pmid: 20012290
references.citation: Surgery. 2010 Sep;148(3):526-31
references.pmid: 20189620
references.citation: Surgery. 2006 Dec;140(6):1000-5; discussion 1005-7
references.pmid: 17188149
references.citation: J Clin Endocrinol Metab. 2005 Oct;90(10):5723-9
references.pmid: 16030160
references.citation: Eur J Endocrinol. 2008 Apr;158(4):551-60
references.pmid: 18362303
references.citation: J Clin Endocrinol Metab. 2009 Apr;94(4):1162-7
references.pmid: 19116234
references.citation: World J Surg. 2004 May;28(5):498-501
references.pmid: 15085396
references.citation: World J Surg. 2007 Nov;31(11):2085-91
references.pmid: 17885787
references.citation: Oral Oncol. 2012 Mar;48(3):262-5
references.pmid: 22047924
references.citation: Arch Surg. 2004 Jan;139(1):43-5
references.pmid: 14718274
references.citation: J Clin Endocrinol Metab. 2012 Aug;97(8):2706-13
references.pmid: 22639292
references.citation: Ann Surg Oncol. 2011 May;18(5):1312-8
references.pmid: 21140230
references.citation: AJR Am J Roentgenol. 2009 Sep;193(3):871-8
references.pmid: 19696304
references.citation: Ann Surg. 2012 Apr;255(4):777-83
references.pmid: 22418010
references.citation: Thyroid. 2009 Nov;19(11):1167-214
references.pmid: 19860577
references.citation: Mol Cell Endocrinol. 2010 May 28;321(1):86-93
references.pmid: 19883729
references.citation: Surgery. 2004 Dec;136(6):1310-22
references.pmid: 15657592
references.citation: Thyroid. 2009 Mar;19(3):241-6
references.pmid: 19265495
references.citation: Thyroid. 2012 May;22(5):501-8
references.pmid: 22435914
references.citation: Cancer. 2006 Feb 1;106(3):524-31
references.pmid: 16369995
references.citation: Ann Surg. 2009 May;249(5):840-4
references.pmid: 19387316