Oncologic Results of cN0 Papillary Thyroid Carcinoma Treated with Total Thyroidectomy without Central Neck Dissection

  • INTRODUCTION
    Surgery over the primary and its macroscopic metastases is the recommended treatment for differentiated thyroid carcinoma. Avoiding central lymph node dissection in patients without cervical lymph node metastasis (cN0) is the rule in low-risk carcinomas. However, there is controversy in more advanced tumors.
    The primary objective of this study was to determine the prevalence of central neck structural recurrences to assess if an elective central neck dissection would improve the prognosis of these patients.

    METHODS
    A retrospective review of all subjects diagnosed with cN0 papillary thyroid carcinoma and treated with total thyroidectomy without neck dissection between 2005 and 2013 at our institution was performed.

    RESULTS
    230 patients were recruited. The median follow-up was 7 years. Classic papillary carcinoma was the most frequent histologic finding. 94% of the tumors were classified as T1-T2. Only 4% of the tumors had a macroscopic extrathyroidal extension.
    At the end of the follow-up, 76% of the patients had an excellent response. Disease-specific survival rate was 99.5 in 10 years. Cervical structural disease-free survival rate was 92% in 10 years. When taking into consideration only the central compartment, the structural disease-free survival rate was 97% in 10 years.

    CONCLUSIONS
    Elective central neck dissection would not have supposed any improvement in the prognosis of 97% of our patients. Besides, these patients would have been exposed to complications such as vocal cord paralysis or hypocalcemia. This data leads us to avoid elective central neck dissection in cN0 papillary thyroid carcinomas.

 

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