Prophylactic Ipsilateral Central Neck Dissection can be Important Risk Stratification Factor in the Management of Low Risk Papillary Thyroid Cancer

  • Purpose: The aim of our study was to identify risk factors which could help to distinguish patients with small, clinically low-risk papillary thyroid cancer (PTC) who would need additional treatment after surgery.

    Methods: A total of 312 patients with PTC with diameter ? 20 mm who underwent thyroid surgery in our clinical setting between 2007-2015 were retrieved. Patients with known  metastatic lymph nodes in the lateral neck compartment (LC) or local invasion  before surgery (44) were excluded. Overall 268 patients fulfilled inclusion criteria (39 men, 229 women, median age 49 years) with a median follow-up of 117 months. Total thyroidectomy was performed in 252 cases (94%), in 221 (82.5%) cases with central neck compartment (CC) dissection. The outcome – a more aggressive disease – was defined as the presence of metastases in the lymph nodes of LC or distant organs found in follow-up. The associations between the outcome and patients’ characteristics were statistically evaluated.

    Results: Overall 41 patients (15.3%) experienced the outcome with a median follow-up of 18 months. Male gender (OR = 2.2, P = 0.049), extra-thyroidal extension (OR = 2.61, P = 0.015), and metastases in CC (OR = 2.61, P = 0.015) were associated with worse outcome. Metastases in CC were expectedly strongly associated with the performance of CC dissection (OR > 10, P < 0.0001).

    Conclusion: The CC dissection performed on the side of tumour as well as the presence of extra-thyroidal extension could play an important role in the stratification of patients with small-size PTC.

 

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