Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node–negative papillary thyroid carcinoma

BackgroundProphylactic central neck dissection (PCND) for papillary thyroid carcinoma (PTC) is controversial. We compared 3 different approaches to the management of central compartment nodes in patients with clinically unifocal and N0 PTC.MethodsA total of 186 patients were prospectively assigned to one of the following procedures: total thyroidectomy (TT), TT plus ipsilateral PCND (Ipsi-PCND), and TT plus bilateral PCND (Bil-PCND).ResultsNo difference was found concerning demographic, clinical or pathologic characteristics (P = NS). More patients in the Bil-PCND group had transient hypocalcemia (P < .001). One patient in the Bil-PCND group experienced permanent hypoparathyroidism (P = NS). One transient and one permanent unilateral laryngeal nerve palsy occurred in the Ipsi-PCND group (P = NS). Significantly more patients in the Bil-PCND and Ipsi-PCND groups had node metastases recognized (26 vs 18 vs 6; P < .001). Six of 26 pN1 patients (23%) in the Bil-PCND group had bilateral metastases. No difference was found concerning mean postoperative basal and stimulated thyroglobulin and mean postoperative radioiodine uptake. One patient in the Ipsi-PCND group experienced recurrent disease (P = NS).ConclusionTT seems adequate treatment for most patients with clinically N0 PTC. PCND could be considered for a more accurate staging. Ipsi-PCND could be a valid option, but it includes the risk of overlooking contralateral metastases.