Total thyroidectomy versus Total thyroidectomy with prophylactic central compartment neck dissection in early papillary thyroid cancer

Abstract

Thyroid cancer is relatively common compared to other cancers, the incidence of papillary thyroid cancer is increasing, and approximately 64, 300 new cases of thyroid cancer diagnosed in the U.S. in 2016. Papillary thyroid cancer is the most common type of thyroid cancer. Papillary thyroid cancer represents (>85%) of all thyroid cancer patients. Papillary thyroid cancer typically starts within the thyroid as growth, or bump (nodule) on the thyroid that grows out of the otherwise normal thyroid tissue. Papillary thyroid cancer is clearly increasing in its incidence globally, and papillary thyroid cancer is often described as the “good cancer” because of its treatability and relatively favorable survival rates. Papillary thyroid cancer usually treated with the traditional therapeutic triad for this disorder (i.e., total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid- stimulating hormone with levothyroxine). Prophylactic central compartment neck dissection (pCCND) in addition to total thyroidectomy (TT) defined as removal of central compartment lymph nodes in the absence of clinical involvement on preoperative and intraoperative evaluation. Most patients with PTC will undergo surgical treatment consisting of thyroidectomy with or without lymph node dissection as dictated by the extent of disease noted on preoperative evaluation and intraoperative inspection. The typical preoperative workup for patients should include cervical ultrasound and/ or cross-sectional imaging to evaluate cervical lymph node metastasis in the central and lateral neck compartments. For patients with a suspicion of cervical lymph node metastases, a therapeutic compartment-orientated neck dissection of the involved lymph node basins should be included at the time of total thyroidectomy (TT). However, for patients without evidence of lymph node metastases on preoperative evaluation, the additive value of a prophylactic central compartment neck dissection (pCCND) at the time of thyroidectomy has been debated in the literature. Approximately 50% of patients with PTC treated with TT and pCCND will have lymph node metastasis found on final pathologic evaluation of the surgical specimen. The finding of occult central neck lymph node metastasis may change postoperative management with regard to the use of adjuvant radioiodine therapy and the intensity of surveillance, but this should be considered in the context of a higher risk of hypoparathyroidism compared with TT alone. There are multiple studies comparing TT alone to TT with pCCND, as regard to complications, recurrence rates, and patient outcomes, have had varying conclusions. The aim of our study is to compare between total thyroidectomy with or without prophylactic central compartment neck dissection, focusing mainly on the rate of complications and the risk of recurrence of the disease. The present study was carried out on 40 patients diagnosed with papillary thyroid cancer. This study was conducted in Ain shams university hospital and Shefa Elorman hospital. The study period was from March 2013 to March 2018.