title: Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study.
abstract: BACKGROUND
  The benefits of prophylactic central compartment lymph node dissection (pCCND) in papillary thyroid cancer (PTC) are still under investigation. This treatment seems to reduce PTC recurrence/mortality rates but has a higher risk of surgical complications. The lack of prospective randomized trials does not allow definitive recommendations. The aim of this prospective randomized controlled study was to evaluate the clinical advantages and disadvantages of pCCND.
  
  
  METHODS
  A total of 181 patients with PTC without evidence of preoperative/intraoperative lymph node metastases (cN0) were randomly assigned to either Group A (n = 88) and treated with total thyroidectomy (TTx) or Group B (n = 93) and treated with TTx + pCCND.
  
  
  RESULTS
  After 5 years of followup, no difference was observed in the outcome of the two groups. However, a higher percentage of Group A were treated with a higher number of (131)I courses (P = .002), whereas a higher prevalence of permanent hypoparathyroidism was observed in Group B (P = .02). No preoperative predictors of central compartment lymph node metastases (N1a) were identified. Only three patients were upstaged, and the therapeutic strategy changed in only one case.
  
  
  CONCLUSIONS
  cN0 patients with PTC treated either with TTx or TTx + pCCND showed a similar outcome. One advantage of TTx + pCCND was a reduced necessity to repeat (131)I treatments, but the disadvantage was a higher prevalence of permanent hypoparathyroidism. Almost 50% of patients with PTC had micrometastatic lymph nodes in the central compartment, but none of the presurgical features analyzed, including BRAF mutation, was able to predict their presence; moreover, to be aware of their presence does not seem to have any effect on the outcome.
authors.affiliation: Endocrine Section, Department of Clinical and Experimental Medicine, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders (D.V., L.V., E.M., L.A., C.R., P.P., P.V., R.E.), Surgery Section (G.M, P.M.), Pathology Section (P.F., E.S., L.T., F.B.), and Otorhinolaryngology Section (V.S., S.S.-F.), Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56124 Pisa, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Viola
authors.forename: G
authors.initials: G
authors.lastname: Materazzi
authors.forename: L
authors.initials: L
authors.lastname: Valerio
authors.forename: E
authors.initials: E
authors.lastname: Molinaro
authors.forename: L
authors.initials: L
authors.lastname: Agate
authors.forename: P
authors.initials: P
authors.lastname: Faviana
authors.forename: V
authors.initials: V
authors.lastname: Seccia
authors.forename: E
authors.initials: E
authors.lastname: Sensi
authors.forename: C
authors.initials: C
authors.lastname: Romei
authors.forename: P
authors.initials: P
authors.lastname: Piaggi
authors.forename: L
authors.initials: L
authors.lastname: Torregrossa
authors.forename: S
authors.initials: S
authors.lastname: Sellari-Franceschini
authors.forename: F
authors.initials: F
authors.lastname: Basolo
authors.forename: P
authors.initials: P
authors.lastname: Vitti
authors.forename: R
authors.initials: R
authors.lastname: Elisei
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery*; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D065286:Prophylactic Surgical Procedures; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery*; D055815:Young Adult