Outcomes for patients with papillary thyroid cancer who do not undergo prophylactic central neck dissection.
BACKGROUND
The role of prophylactic central neck dissection (CND) in the management of papillary thyroid cancer (PTC) is controversial. This report describes outcomes of an observational approach in patients without clinical evidence of nodal disease in PTC.


METHODS
All patients who had surgery between 1986 and 2010 without CND for PTC were identified. All patients had careful clinical assessment of the central neck during preoperative and perioperative evaluation, with any suspicious nodal tissue excised for analysis. The cohort included patients in whom lymph nodes had been removed, but no patient had undergone a formal neck dissection. Recurrence-free survival (RFS), central neck RFS and disease-specific survival (DSS) were calculated using the Kaplan-Meier method.


RESULTS
Of 1798 patients, 397 (22.1 per cent) were men, 1088 (60.5 per cent) were aged 45 years or more, and 539 (30.0 per cent) had pT3 or pT4 disease. Some 742 patients (41.3 per cent) received adjuvant treatment with radioactive iodine. At a median follow-up of 46 months the 5-year DSS rate was 100 per cent. Five-year RFS and central neck RFS rates were 96.6 and 99.1 per cent respectively.


CONCLUSIONS
Observation of the central neck is safe and should be recommended for all patients with PTC considered before and during surgery to be free of central neck metastasis.
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
I J
IJ
Nixon
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
L Y
LY
Wang
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
I
I
Ganly
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
S G
SG
Patel
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
L G
LG
Morris
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
J C
JC
Migliacci
Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, USA.
R M
RM
Tuttle
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
J P
JP
Shah
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
A R
AR
Shaha
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D002291:Carcinoma, Papillary; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult