Total thyroidectomy, without prophylactic central lymph node dissection, in the treatment of differentiated thyroid cancer. Clinical retrospective study on 221 cases.

Abstract Background Total thyroidectomy (TT) is the standard of care for differentiated thyroid cancer (DTC), but still there is no consensus about the role of routine central lymph node dissection (RCLD). The aim of this study was to analyze the results of TT “alone” without RCLD in the treatment of DTC. Methods Clinical records, between January 1998 and December 2005, of 221 patients undergoing TT “alone”, without RCLND, were retrospectively evaluated. Two hundred and eleven patients (95.47%) also underwent radioiodine (RAI) ablation followed by Thyroid Stimulating Hormone (TSH) suppression therapy. In patients with loco regional lymph nodal recurrence, central (VI) and ipsilateral (III-IV) lymph node dissection was performed. Results Incidence of permanent hypoparathyroidism (iPTH < 10 pg/ml) and permanent vocal fold paralysis were respectively 0.91% and 0,91%. After a 9.6 ± 3.5 years mean follow-up, the rate of loco regional recurrence, with positive cervical lymph nodes, was 3.16% - 7/221 patients. In these cases, a central (VI) and ipsilateral (III-IV) selective neck dissection was carried out without significant complications. Conclusions Our results showed that TT without RCLD, followed by RAI ablation, was associated with low morbidity and low loco regional recurrence rate. RCLD may be indicated in cases of “microcarcinoma” or in high risk patients, where loco regional recurrence is more frequent. Given the trend in the literature towards prophylactic lymphadenectomy, and the avoidance of RAI treatment, prospective randomized trials should be conducted to clarify this issue.