title: Preferential Use of Total Thyroidectomy without Prophylactic Central Lymph Node Dissection for Early-Stage Papillary Thyroid Cancer: Oncologic Outcomes in an Integrated Health Plan.
abstract: The oncologic benefit of prophylactic central lymph node dissection (pCLND) in node-negative papillary thyroid cancer has been debated.
  
  
  
  To determine the use of pCLND in an integrated health care system and to evaluate recurrence in the cohort.
  
  
  
  Retrospective cohort study of patients with clinically node-negative papillary thyroid cancer who underwent total thyroidectomy with or without pCLND in Kaiser Permanente Southern California Region hospitals between January 1996 and December 2008. Chart review of all patients was performed to collect demographic data, tumor features, stage, and recurrences.
  
  
  
  Proportion undergoing pCLND and recurrence rate of papillary thyroid cancer.
  
  
  
  There were 864 patients identified (mean age, 46.1 years). Almost all patients had total thyroidectomy alone, and 34 (3.9%) underwent pCLND. The TNM (tumor, node, metastasis) stages for the 2 groups were not significantly different (p = 0.18). Overall recurrence was 24 (2.8%). There were 23 (2.8%) recurrences in the no-pCLND group and 1 (2.9%) recurrence in the pCLND group (p = 0.95). The rate of recurrence in the central neck compartment in those without pCLND was 1.1% and 0% in the pCLND group (p = 0.54). The recurrence rate in the lateral neck compartment in the no-pCLND group was 2.2%, and this rate was 2.9% in the pCLND group (p = 0.76). The no-pCLND group had a recurrence-free survival rate of 96.4% at 10 years vs 96.8% in the pCLND patients (p = 0.80).
  
  
  
  Presently, routine pCLND is difficult to advocate in our medical system.
authors.affiliation: General and Endocrine Surgeon at Providence Saint John's Health Center in Santa Monica, CA. mnsaid8@yahoo.com.
authors.forename: Meena
authors.initials: M
authors.lastname: Said
authors.affiliation: General Surgeon at the Santa Rosa Medical Center in CA. michele.a.fujimoto@kp.org.
authors.forename: Michele
authors.initials: M
authors.lastname: Fujimoto
authors.affiliation: General Surgeon at the Modesto Medical Center in CA. cara.franken@kp.org.
authors.forename: Cara
authors.initials: C
authors.lastname: Franken
authors.affiliation: Former General Surgery Resident at the Los Angeles Medical Center in CA. sunee.s.woo@kp.org.
authors.forename: Sunee
authors.initials: S
authors.lastname: Woo
authors.affiliation: Former General Surgery Resident at the Los Angeles Medical Center in CA. brookevuong@gmail.com.
authors.forename: Brooke
authors.initials: B
authors.lastname: Vuong
authors.affiliation: Oncologic and Endocrine Surgeon at the Los Angeles Medical Center in CA. philip.i.haigh@kp.org.
authors.forename: Philip I
authors.initials: PI
authors.lastname: Haigh
mesh_terms: D000328:Adult; D002140:California; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome