title: Role of prophylactic central compartment lymph node dissection in clinically N0 differentiated thyroid cancer patients: analysis of risk factors and review of modern trends.
abstract: In the last years, especially thanks to a large diffusion of ultrasound-guided FNBs, a surprising increased incidence of differentiated thyroid cancer (DTC), "small" tumors and microcarcinomas have been reported in the international series. This led endocrinologists and surgeons to search for "tailored" and "less aggressive" therapeutic protocols avoiding risky morbidity and useless "overtreatment". Considering the most recent guidelines of referral endocrine societies, we analyzed the role of routine or so-called prophylactic central compartment lymph node dissection (RCLD), also considering its benefits and risks. Literature data showed that the debate is still open and the surgeons are divided between proponents and opponents of its use. Even if lymph node metastases are commonly observed, and in up to 90% of DTC cases micrometastases are reported, the impact of lymphatic involvement on long-term survival is subject to intensive research and the best indications of lymph node dissection are still controversial. Identification of prognostic factors for central compartment metastases could assist surgeons in determining whether to perform RLCD. Considering available evidence, a general agreement to definitely reserve RCLD to "high-risk" cases was observed. More clinical researches, in order to identify risk factors of meaningful predictive power and prospective long-term randomized trials, should be useful to validate this selective approach.
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine-Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine-Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy. ernesto.tartaglia@gmail.com.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Tartaglia
authors.affiliation: Endocrine Surgery Unit, University of Perugia, Perugia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.affiliation: Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Calò
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: de Bellis
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine-Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gambardella
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Iorio
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pasquali
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine-Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
authors.affiliation: Department of Cardio-Thoracic and Respiratory Sciences, Endocrinology Unit, Second University of Naples, Naples, Italy.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Sinisi
authors.affiliation: Department of Cardio-Thoracic and Respiratory Sciences, Endocrinology Unit, Second University of Naples, Naples, Italy.
authors.forename: Antonio Agostino
authors.initials: AA
authors.lastname: Sinisi
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Testini
authors.affiliation: Endocrine Surgery Unit, University of Perugia, Perugia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellastella
mesh_terms: D002454:Cell Differentiation; D006801:Humans; D008197:Lymph Node Excision; D011379:Prognosis; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy
keywords: Lymph node neck dissection; Papillary thyroid cancer; Radioactive iodine ablation; Routine central lymph node dissection; Total thyroidectomy