title: The pros and cons of routine central compartment neck dissection for clinically nodal negative (cN0) papillary thyroid cancer.
abstract: Metastatic disease to regional lymph nodes (LNs) is common in papillary thyroid carcinoma (PTC). LN dissection is increasingly performed as part of the surgical management of PTC. The role of prophylactic central neck dissection (pCND) in PTC is unclear. There is limited evidence to support a routine pCND in clinical setting for nodal negative (cN0) PTC. The aim of this review was to examine the pros and cons of prophylactic neck dissection in cN0 PTC. In summary, the advantages of pCND are: removal of the central LNs that potentially harbor micro-metastases, more accurate staging of disease in order to plan more individualized management, reducing the need for re-operation to remove the metastatic LNs which have developed later and possible improvement in overall survival. The disadvantages are: an extensive surgery but lack of evidence of survival benefit, higher incidence of complications with little impact on local recurrence rate, possibility of over treating in cN0 patients and it does not sound like a cost effective approach in the management of small thyroid cancer. Considering low frequency of permanent morbidity, some authors believe that prophylactic neck dissection is safe in experienced hands even though its prognostic benefit has yet to be demonstrated.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Ai Chen
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Brian Hung Hin
authors.initials: BH
authors.lastname: Lang
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Kai Pun
authors.initials: KP
authors.lastname: Wong
keywords: Central compartment neck dissection; nodal negative papillary thyroid cancer; prophylactic central neck dissection (pCND)
references.citation: Ann Surg Oncol. 2007 Feb;14(2):730-8
references.pmid: 17103065
references.citation: Eur J Endocrinol. 2008 Apr;158(4):551-60
references.pmid: 18362303
references.citation: Surgery. 2010 Dec;148(6):1108-12
references.pmid: 21134540
references.citation: Thyroid. 2009 Nov;19(11):1167-214
references.pmid: 19860577
references.citation: Laryngoscope. 2011 Mar;121(3):487-91
references.pmid: 21344423
references.citation: Surgery. 2009 Dec;146(6):1063-72
references.pmid: 19958933
references.citation: World J Surg. 2010 Jun;34(6):1187-91
references.pmid: 20130868
references.citation: Arch Otolaryngol Head Neck Surg. 2009 Nov;135(11):1087-91
references.pmid: 19917919
references.citation: J Am Coll Surg. 2003 Aug;197(2):182-90
references.pmid: 12892795
references.citation: Otolaryngol Head Neck Surg. 1995 Oct;113(4):356-63
references.pmid: 7567004
references.citation: J Natl Compr Canc Netw. 2007 Jul;5(6):623-30
references.pmid: 17623613
references.citation: J Clin Endocrinol Metab. 1997 May;82(5):1638-41
references.pmid: 9141564
references.citation: Thyroid. 2012 Nov;22(11):1144-52
references.pmid: 23083442
references.citation: Surg Today. 2004;34(11):891-5
references.pmid: 15526121
references.citation: Ann Surg. 2007 Apr;245(4):604-10
references.pmid: 17414610
references.citation: Eur J Surg Oncol. 2010 Aug;36(8):777-82
references.pmid: 20584589
references.citation: Ann Surg Oncol. 2012 Jan;19(1):60-7
references.pmid: 21681379
references.citation: Arch Otolaryngol Head Neck Surg. 2006 Jun;132(6):650-4
references.pmid: 16785411
references.citation: J Clin Endocrinol Metab. 2001 Apr;86(4):1447-63
references.pmid: 11297567
references.citation: Surgery. 2012 Dec;152(6):957-64
references.pmid: 23158170
references.citation: Ann Surg Oncol. 2007 May;14(5):1551-9
references.pmid: 17318278
references.citation: Surgery. 2009 Oct;146(4):696-703; discussion 703-5
references.pmid: 19789029
references.citation: Ann Surg Oncol. 2010 Dec;17(12):3287-93
references.pmid: 20596784
references.citation: Surgery. 2010 Dec;148(6):1191-6; discussion 1196-7
references.pmid: 21134551
references.citation: Arch Surg. 2006 May;141(5):489-94; discussion 494-6
references.pmid: 16702521
references.citation: Arch Surg. 2010 Mar;145(3):272-5
references.pmid: 20231628
references.citation: Thyroid. 2012 Apr;22(4):347-55
references.pmid: 22280230
references.citation: Arch Otolaryngol Head Neck Surg. 2010 Jun;136(6):584-7
references.pmid: 20566909
references.citation: Acta Otorhinolaryngol Ital. 2009 Apr;29(2):61-9
references.pmid: 20111614
references.citation: Eur J Surg Oncol. 2008 Feb;34(2):202-7
references.pmid: 18023321
references.citation: Thyroid. 2009 Dec;19(12):1373-80
references.pmid: 20001719
references.citation: Thyroid. 2012 Sep;22(9):911-7
references.pmid: 22827494
references.citation: Eur J Nucl Med Mol Imaging. 2008 Oct;35(10):1941-59
references.pmid: 18670773
references.citation: Surgery. 2008 Dec;144(6):1070-7; discussion 1077-8
references.pmid: 19041020
references.citation: J Oncol. 2012;2012:707156
references.pmid: 23193402
references.citation: Surgery. 2012 Feb;151(2):192-8
references.pmid: 21497873
references.citation: Eur J Surg. 1992 Nov-Dec;158(11-12):583-9
references.pmid: 1363062
references.citation: Thyroid. 2013 Sep;23(9):1087-98
references.pmid: 23402640
references.citation: Am J Med. 1994 Nov;97(5):418-28
references.pmid: 7977430
references.citation: Ann Surg. 2007 Jul;246(1):114-21
references.pmid: 17592299
references.citation: Thyroid. 2006 Feb;16(2):109-42
references.pmid: 16420177
references.citation: Ann Surg Oncol. 2012 Dec;19(13):4217-22
references.pmid: 23010732
references.citation: J Natl Compr Canc Netw. 2010 Nov;8(11):1277-86; quiz 1287
references.pmid: 21081784
references.citation: J Clin Endocrinol Metab. 2007 Sep;92(9):3590-4
references.pmid: 17609301
references.citation: Surgery. 2010 Sep;148(3):526-31
references.pmid: 20189620
references.citation: World J Surg. 1996 Sep;20(7):860-6; discussion 866
references.pmid: 8678963
references.citation: J Oncol. 2011;2011:127929
references.pmid: 21977029
references.citation: Surgery. 2006 Dec;140(6):1000-5; discussion 1005-7
references.pmid: 17188149
references.citation: J Surg Oncol. 2009 Jan 1;99(1):28-31
references.pmid: 18942072
references.citation: Laryngoscope. 2009 Jun;119(6):1135-9
references.pmid: 19358241
references.citation: Arch Otolaryngol Head Neck Surg. 2004 Oct;130(10):1214-6
references.pmid: 15492172
references.citation: World J Surg. 1996 Sep;20(7):854-9
references.pmid: 8678962
references.citation: Langenbecks Arch Surg. 2007 Jul;392(4):417-22
references.pmid: 17562092
references.citation: G Chir. 2010 Mar;31(3):112-8
references.pmid: 20426924
references.citation: Thyroid. 2008 Apr;18(4):411-8
references.pmid: 18358074
references.citation: Surgery. 2010 Dec;148(6):1100-6; discussion 1006-7
references.pmid: 21134539
references.citation: Ann Surg. 2003 Mar;237(3):399-407
references.pmid: 12616125
references.citation: Cancer. 1998 Dec 15;83(12):2638-48
references.pmid: 9874472
references.citation: World J Surg. 1990 Nov-Dec;14(6):837-41; discussion 841-2
references.pmid: 2256356
references.citation: Langenbecks Arch Surg. 2008 Sep;393(5):693-8
references.pmid: 18592264
references.citation: Thyroid. 2003 Apr;13(4):381-7
references.pmid: 12804106
references.citation: Surgery. 1999 Oct;126(4):673-7; discussion 677-9
references.pmid: 10520914
references.citation: Am Surg. 2005 Sep;71(9):731-4
references.pmid: 16468507