title: Total thyroidectomy and central lymph node dissection. Experience of a referral centre for endocrine surgery.
abstract: OBJECTIVE
  Thyroid cancer prognosis is determined by several variables, even with extremely elevated survival rate. The most debated issues are the type of thyroidectomy and extension of lymphadenectomy. Aim of the study is the analysis of benefits of level VI lymphadenectomy associated to total thyroidectomy in the treatment of thyroid cancer.
  
  
  METHODS
  316 total thyroidectomy with central node dissection were carried out in the Unit of Endocrine Surgery, University of Perugia. Direct parathyroid auto-implantation was carried out if damage or accidental excision occurred. High risk patients received radioiodine treatment.
  
  
  RESULTS
  Lymph node metastases in the VI level were observed in 42% of cases with a significant difference (p 0.0042) of positive lymph node in level VI comparing tumor larger than 1 cm vs smaller than 1 cm. No significant differences were observed when considering difference of sex, and age. Significant difference (p 0.005) was shown when considering over 45 years old male patients with tumor larger than 1 cm vs smaller ones. The 78% of patients underwent iodine ablation after surgery. Recurrence rate in these patients was 3.2%, with no significant difference compared to not treated patients. Bilateral temporary recurrent nerves palsy were observed in 0.6% of cases, unilateral temporary recurrent nerves palsy in 3.4%, unilateral permanent palsy in 1.5%, temporary hypoparathyroidism in 17%, permanent hypoparathyroidism in 4.4%.
  
  
  CONCLUSIONS
  Total thyroidectomy combined to central node dissection, even in absence of risk factors and without clinical evident nodes, is the treatment of choice offering clear indications to radioiodine ablation.
authors: M
authors: M
authors: Monacelli
authors: R
authors: R
authors: Lucchini
authors: A
authors: A
authors: Polistena
authors: R
authors: R
authors: Triola
authors: C
authors: C
authors: Conti
authors: S
authors: S
authors: Avenia
authors: M S
authors: MS
authors: Di Patrizi
authors: I
authors: I
authors: Barillaro
authors: A
authors: A
authors: Boccolini
authors: A
authors: A
authors: Sanguinetti
authors: N
authors: N
authors: Avenia
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000601:surgery* / Q000628:therapy; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000601:surgery* / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D013964:Thyroid Neoplasms / Q000601:surgery* / Q000628:therapy; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000517:prevention & control
chemical_list: D007457:Iodine Radioisotopes