OP42 – Elective central neck dissection in papillary thyroid carcinoma. Our experience

      Castro, Alejandro1; Mateos, Blanca1;  Bernáldez, Ricardo1; Rodrigañez, Laura1; del Palacio, Antonio1; Aragón, Paula1; Sánchez-Ocando María1; Gavilán, Javier1. 1 Department of Otolaryngology, La Paz University Hospital, Madrid, Spain   Background: Avoiding lymph node dissection in patients without cervical lymph node metastasis in papillary thyroid carcinomas (cN0) is almost the rule in T1-T2 tumors. However, there is still controversy in T3-T4 carcinomas. The main objective of this study was to determine the prevalence of central 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 of cN0 papillary thyroid carcinoma between 2005 and 2010 at our institution was performed. Total thyroidectomy (followed by RAI treatment and TSH suppressed or kept at low reference range) was performed in every patient. Follow-up responses were defined following 2015 ATA guidelines. Results: 131 patients were recruited. The median follow-up was 7 years. 89% of tumors were classified as T1-T2. Excellent response was seen in 70% of patients during the follow-up. On the other hand, 9% of the patients presented incomplete structural responses, even if only 3% were central. Disease-specific survival rate was 99.2% in 10 years. Cervical structural disease-free survival rate was 89% in 10 years. When taking into consideration only the central compartment, structural disease-free survival rate was 96.7% in 10 years. Conclusions: Elective central neck dissection would not have supposed any improvement in the prognosis of 96.7% of our patients. Besides, this strategy would lead to an increase rate of complications such as vocal cord paralysis or hypocalcemia. This data supports our decision to avoid elective central neck dissection in cN0 papillary thyroid carcinomas.   References:
    1. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.
    2. Tobias Carling, Sally E. Carty, Maria M. Ciarleglio, David S. Cooper, Gerard M. Doherty, Lawrence T. Kim, Richard T. Kloos, Ernest L. Mazzaferri, Sr, Peter N. Peduzzi, Sanziana A. Roman, et al. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012 Mar; 22(3): 237–244.
    3. Tuttle RM, Tala H, Shah J, et al. Estimating Risk of Recurrence in Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation: Using Response to Therapy Variables to Modify the Initial Risk Estimates Predicted by the New American Thyroid Association Staging System. Thyroid. 2010;20(12):1341-1349.


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