Effectiveness of prophylactic central compartmental neck dissection in papillary thyroid cancer

Abstract

INTRODUCTION: Standard treatment for Papillary thyroid cancer is Total Thyroidectomy (TT) and selective block dissection for node positive disease. Incidence of central compartmental nodal (CCN) involvement esimated to be 30-70% though preoperative staging is suboptimal due to anatomical location. Therefore, many advocate Prophylactic Central Compartmental Neck Dissection (PCCND) as a staging and therapeutic procedure, but others believe no added therapeutic value despite higher incidence of complications. MATERIAL AND METHODS: All pathological reports of patients who have undergone TT with PCCND for Papillary thyroid cancer in a single unit from 2014 January to 2015 June was collected and entered into a database. Clinical node negativity was considered when both examination and pre-op USS was negative. This is a single unit experience and our routine practice is to do PCCND in all clinically node negative disease patients. Pearson's chisquare test and Fishers exact statistical tools were used to assess predictors of CCN involvement. P < 0.05 was considered as significant. RESULTS: Total of 27 cases found and 20 (74%) cases didn't reveal a single positive node. Nineteen had unifocal disease of thryroid and only 5 (26%) had ipsilateral CCN positivity. Six patients had multifocal disease and 3 had positive CCN disease. Positive predictors of CCN: Clinical stage, Multifocal disease, Histological type, Vascular invasion and age are not significantly associated. Fourteen (52%) patients had at least 1 parathyroid gland included in the specimen. CONCLUSIONS: Nearly 3/4 of patients undergo unnecessary PCCND. Further studies are needed assess the predictors of CCN involvement.