Impact of prophylactic central compartment neck dissection on locoregional recurrence of differentiated thyroid cancer in clinically node-negative patients: A retrospective study of a large clinical series

Background In clinically node-negative patients with differentiated thyroid cancer (DTC), indications for routine central lymph node dissection (RCLD) are the subject of intensive research, and surgeons are divided between the pros and cons of this surgery. To better define the role of neck dissection in the treatment of DTC, we retrospectively analysed multi-centre clinical experiences. Methods The clinical records of 752 clinically node-negative DTC patients who underwent surgical treatment between January 1998 and December 2005 in three endocrine surgery referral units were retrospectively evaluated. The complications and medium- and long-term outcomes of total thyroidectomy (TT) alone (performed in 390 patients: group A) and TT combined with bilateral RCLD (362 patients: group B) were analysed and compared. Results The incidence of permanent hypoparathyroidism and permanent unilateral vocal folds were 1.03% and 0.77% in group A and 3.59% and 1.65% in the group B, respectively. Bilateral temporary recurrent nerve palsy was observed in one patient in group B (0.28%). After a 9.5±3.5 SD year mean follow-up, the locoregional recurrence rate with positive cervical lymph nodes was not statistically significantly different between the two groups. Conclusions In our series, TT combined with bilateral RCLD was associated with a higher rate of transient and definitive complications. Similar incidences of locoregional recurrence were reported in the two groups of patients. Considering a recent trend toward routine central lymphadenectomy, further studies are needed to evaluate the benefits of different surgical approaches.