Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study

Ibtsam Shehta Harera; Gamal Osman; Rehab Hemeda; Shady Emad Shaker; Mohamed Abdallah Zaitoun

doi:doi:10.11648/j.js.20200803.13

| Peer-Reviewed

Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study

Ibtsam Shehta Harera, Gamal Osman, Rehab Hemeda, Shady Emad Shaker, Mohamed Abdallah Zaitoun

Published in Journal of Surgery (Volume 8, Issue 3)

Received: 28 April 2020 Accepted: 20 May 2020 Published: 4 June 2020

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Context: central neck dissection in addition to total thyroidectomy as a management procedure of patients with papillary carcinoma of the thyroid [PTC] was previously found to decrease the incidence of lymph node recurrence and allow and accurate PTC surgical staging that allow making a better decision regarding adjuvant radioactive iodine (RAI) ablation. But recently, central neck dissection in patients with clinical and radiological evidences of negative cervical lymph nodes was found to have many post-operative complications. Aim: to assess benefits, complications and drawbacks of performing central neck dissection by in PTC patients. Patients and methods: This is a prospective randomized study which included 70 PTC patients who was subjected to total thyroidectomy with or without neck dissection; all included patients have clinically negative cervical lymph nodes, 40 (60%) underwent total thyroidectomy in addition to central neck dissection and 30 (40%) patients were subjected to only total thyroidectomy without central neck dissection. We followed our patients for five years to detect recurrence, RFS and OS rates. Results: We found that operative time was longer in patients underwent central block dissection (p=0.049). Recurrence free survival and overall survival rates were not significantly different among both included groups, which denoted that central block neck dissection has no survival benefits in PTC patients. Conclusions: We have concluded that performing central neck dissection in PTC with clinically and radiologically negative lymph nodes has no benefits in increasing patients’ survival or decreasing recurrence rate and might lead to prolongation of operation time, increasing post-operative morbidity.

Published in	Journal of Surgery (Volume 8, Issue 3)
DOI	10.11648/j.js.20200803.13
Page(s)	90-96
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Central Neck Dissection, Papillary Thyroid Carcinoma, Recurrence, Survival

References

[1]	Gambardella C, Patrone R, DiCapua F, Offi CH, Mauriello C, Clarizia G et al., The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study BMC Surgery 2019, 18: 110.
[2]	Yoo BJ, Song CM, Ji YB, Lee JY, Park HJ and Tae K. Efficacy of Central Neck Dissection for Clinically Node-Negative Papillary Thyroid Carcinoma: Propensity Scoring Matching. Front. Endocrinol. 2019; 10: 172.
[3]	Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 2009; 19: 683–9.
[4]	Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008; 144: 1070–8.
[5]	Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005; 71: 731–4.
[6]	Zuniga S, Sanabria A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2009; 135: 1087–91.
[7]	Zhao WJ, Luo H, Zhou YM, Dai WY, Zhu JQ. Evaluating the effectiveness of prophylactic central neck dissection with total thyroidectomy for cN0 papillary thyroid carcinoma: An update meta-analysis. Eur J Surg Oncol. (2017a) 43: 1989–2000.
[8]	Zhao W, You L, Hou X, Chen S, Ren X, Chen G, et al. The effect of prophylactic central neck dissection on locoregional recurrence in papillary thyroid cancer after total thyroidectomy: a systematic review and metaanalysis. Ann Surg Oncol. (2017b) 24: 2189–98.
[9]	Popadich A, Levin O, Lee JC, Smooke-Praw S, Ro K, Fazel M, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery. (2011) 150: 1048–57.
[10]	Garcia A, Palmer BJ, Parks NA, Liu TH. Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective. Clin Endocrinol. (2014) 81: 754–61.
[11]	Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. (2012) 22: 911–7.
[12]	Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope. (2009) 119: 1135–9.
[13]	Kim SK, Woo JW, Lee JH, Park I, Choe JH, Kim JH, et al. Prophylactic central neck dissection might not be necessary in papillary thyroid carcinoma: analysis of 11,569 cases from a single institution. J Am Coll Surg. (2016) 222: 853–64.
[14]	Zheng CM, Ji YB, Song CM, Ge MH, Tae K. Number of metastatic lymph nodes and ratio of metastatic lymph nodes to total number ofretrieved lymph nodes are risk factors for recurrence in patients with clinically node negative papillary thyroid carcinoma. Clin ExpOtorhinolaryngol. (2018) 11: 58.
[15]	Calò PG, Lombardi CP, Podda F, Sessa L, Santini L, Conzo G. Role of prophylactic central neck dissection in clinically node-negative differentiated thyroid cancer: assessment of the risk of regional recurrence. Updates Surg. (2017) 69: 241–8.
[16]	Raffaelli M, De Crea C, Sessa L, Giustacchini P, Revelli L, Bellantone C, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node–negative papillary thyroid carcinoma. Surgery. (2012) 152: 957–64.
[17]	Ji YB, Song CM, Sung ES, Jeong JH, Lee CB, Tae K. Postoperative hypoparathyroidism and the viability of the parathyroid glands during thyroidectomy. Clin Exp Otorhinolaryngol. (2017) 10: 265–71.
[18]	Zetoune T, Keutgen X, Buitrago D, Aldailami H, Shao H, Mazumdar M, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol. (2010) 17: 3287–93.
[19]	Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid. (2009) 19: 1167–214.
[20]	Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, 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) 6: 1–133.
[21]	Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol. (2014) 81: 1–122.
[22]	Viola D, Materazzi G, Valerio L, Molinaro E, Agate L, Faviana P, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab. (2015) 100: 1316–24.
[23]	Network NCC. NCCN Clinical Practice Guidelines in Oncology. Thyroid Carcinoma V. 1 2018 (2018).
[24]	Su H, Li Y. Prophylactic central neck dissection and local recurrence in papillary thyroid microcarcinoma: a meta-analysis. Braz. J. Otorhinolaryngol. 2019; 85: 237-43.
[25]	Calo PG, Conzo G, Raffaelli M, Medas F, Gambardella C, De Crea C, et al. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study. Eur J Surg Oncol. (2017) 43: 126–32.
[26]	Shen WT, Ogawa L, Ruan D, Suh I, Duh QY, Clark OH. Central neck lymph node dissection for papillary thyroid cancer: the reliability of surgeon judgment in predicting which patients will benefit. Surgery. 2010; 148: 398-403.
[27]	So YK, Son YI, Hong SD, Seo MY, Baek CH, Jeong HS, et al. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery. 2010; 148: 526-31.

Cite This Article

Plain Text BibTeX RIS

APA Style

Ibtsam Shehta Harera, Gamal Osman, Rehab Hemeda, Shady Emad Shaker, Mohamed Abdallah Zaitoun. (2020). Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study. Journal of Surgery, 8(3), 90-96. https://doi.org/10.11648/j.js.20200803.13

Copy | Download

ACS Style

Ibtsam Shehta Harera; Gamal Osman; Rehab Hemeda; Shady Emad Shaker; Mohamed Abdallah Zaitoun. Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study. J. Surg. 2020, 8(3), 90-96. doi: 10.11648/j.js.20200803.13

Copy | Download

AMA Style

Ibtsam Shehta Harera, Gamal Osman, Rehab Hemeda, Shady Emad Shaker, Mohamed Abdallah Zaitoun. Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study. J Surg. 2020;8(3):90-96. doi: 10.11648/j.js.20200803.13

Copy | Download

@article{10.11648/j.js.20200803.13,
  author = {Ibtsam Shehta Harera and Gamal Osman and Rehab Hemeda and Shady Emad Shaker and Mohamed Abdallah Zaitoun},
  title = {Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study},
  journal = {Journal of Surgery},
  volume = {8},
  number = {3},
  pages = {90-96},
  doi = {10.11648/j.js.20200803.13},
  url = {https://doi.org/10.11648/j.js.20200803.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200803.13},
  abstract = {Context: central neck dissection in addition to total thyroidectomy as a management procedure of patients with papillary carcinoma of the thyroid [PTC] was previously found to decrease the incidence of lymph node recurrence and allow and accurate PTC surgical staging that allow making a better decision regarding adjuvant radioactive iodine (RAI) ablation. But recently, central neck dissection in patients with clinical and radiological evidences of negative cervical lymph nodes was found to have many post-operative complications. Aim: to assess benefits, complications and drawbacks of performing central neck dissection by in PTC patients. Patients and methods: This is a prospective randomized study which included 70 PTC patients who was subjected to total thyroidectomy with or without neck dissection; all included patients have clinically negative cervical lymph nodes, 40 (60%) underwent total thyroidectomy in addition to central neck dissection and 30 (40%) patients were subjected to only total thyroidectomy without central neck dissection. We followed our patients for five years to detect recurrence, RFS and OS rates. Results: We found that operative time was longer in patients underwent central block dissection (p=0.049). Recurrence free survival and overall survival rates were not significantly different among both included groups, which denoted that central block neck dissection has no survival benefits in PTC patients. Conclusions: We have concluded that performing central neck dissection in PTC with clinically and radiologically negative lymph nodes has no benefits in increasing patients’ survival or decreasing recurrence rate and might lead to prolongation of operation time, increasing post-operative morbidity.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study
AU  - Ibtsam Shehta Harera
AU  - Gamal Osman
AU  - Rehab Hemeda
AU  - Shady Emad Shaker
AU  - Mohamed Abdallah Zaitoun
Y1  - 2020/06/04
PY  - 2020
N1  - https://doi.org/10.11648/j.js.20200803.13
DO  - 10.11648/j.js.20200803.13
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 90
EP  - 96
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20200803.13
AB  - Context: central neck dissection in addition to total thyroidectomy as a management procedure of patients with papillary carcinoma of the thyroid [PTC] was previously found to decrease the incidence of lymph node recurrence and allow and accurate PTC surgical staging that allow making a better decision regarding adjuvant radioactive iodine (RAI) ablation. But recently, central neck dissection in patients with clinical and radiological evidences of negative cervical lymph nodes was found to have many post-operative complications. Aim: to assess benefits, complications and drawbacks of performing central neck dissection by in PTC patients. Patients and methods: This is a prospective randomized study which included 70 PTC patients who was subjected to total thyroidectomy with or without neck dissection; all included patients have clinically negative cervical lymph nodes, 40 (60%) underwent total thyroidectomy in addition to central neck dissection and 30 (40%) patients were subjected to only total thyroidectomy without central neck dissection. We followed our patients for five years to detect recurrence, RFS and OS rates. Results: We found that operative time was longer in patients underwent central block dissection (p=0.049). Recurrence free survival and overall survival rates were not significantly different among both included groups, which denoted that central block neck dissection has no survival benefits in PTC patients. Conclusions: We have concluded that performing central neck dissection in PTC with clinically and radiologically negative lymph nodes has no benefits in increasing patients’ survival or decreasing recurrence rate and might lead to prolongation of operation time, increasing post-operative morbidity.
VL  - 8
IS  - 3
ER  -

Copy | Download

Author Information

Ibtsam Shehta Harera

General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Gamal Osman

General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Rehab Hemeda

Clinical Oncology and Nuclear Medicine Department, Zagazig University, Zagazig, Egypt
Shady Emad Shaker

Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Mohamed Abdallah Zaitoun

General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Ibtsam Shehta Harera, Gamal Osman, Rehab Hemeda, Shady Emad Shaker, Mohamed Abdallah Zaitoun. (2020). Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study. Journal of Surgery, 8(3), 90-96. https://doi.org/10.11648/j.js.20200803.13

Copy | Download

ACS Style

Ibtsam Shehta Harera; Gamal Osman; Rehab Hemeda; Shady Emad Shaker; Mohamed Abdallah Zaitoun. Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study. J. Surg. 2020, 8(3), 90-96. doi: 10.11648/j.js.20200803.13

Copy | Download

AMA Style

Ibtsam Shehta Harera, Gamal Osman, Rehab Hemeda, Shady Emad Shaker, Mohamed Abdallah Zaitoun. Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study. J Surg. 2020;8(3):90-96. doi: 10.11648/j.js.20200803.13

Copy | Download

@article{10.11648/j.js.20200803.13,
  author = {Ibtsam Shehta Harera and Gamal Osman and Rehab Hemeda and Shady Emad Shaker and Mohamed Abdallah Zaitoun},
  title = {Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study},
  journal = {Journal of Surgery},
  volume = {8},
  number = {3},
  pages = {90-96},
  doi = {10.11648/j.js.20200803.13},
  url = {https://doi.org/10.11648/j.js.20200803.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200803.13},
  abstract = {Context: central neck dissection in addition to total thyroidectomy as a management procedure of patients with papillary carcinoma of the thyroid [PTC] was previously found to decrease the incidence of lymph node recurrence and allow and accurate PTC surgical staging that allow making a better decision regarding adjuvant radioactive iodine (RAI) ablation. But recently, central neck dissection in patients with clinical and radiological evidences of negative cervical lymph nodes was found to have many post-operative complications. Aim: to assess benefits, complications and drawbacks of performing central neck dissection by in PTC patients. Patients and methods: This is a prospective randomized study which included 70 PTC patients who was subjected to total thyroidectomy with or without neck dissection; all included patients have clinically negative cervical lymph nodes, 40 (60%) underwent total thyroidectomy in addition to central neck dissection and 30 (40%) patients were subjected to only total thyroidectomy without central neck dissection. We followed our patients for five years to detect recurrence, RFS and OS rates. Results: We found that operative time was longer in patients underwent central block dissection (p=0.049). Recurrence free survival and overall survival rates were not significantly different among both included groups, which denoted that central block neck dissection has no survival benefits in PTC patients. Conclusions: We have concluded that performing central neck dissection in PTC with clinically and radiologically negative lymph nodes has no benefits in increasing patients’ survival or decreasing recurrence rate and might lead to prolongation of operation time, increasing post-operative morbidity.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Performing Central Neck Dissection in Patients with Papillary Thyroid Carcinoma with Clinically Node Negative, Benefits and Drawbacks: A Comparative Study
AU  - Ibtsam Shehta Harera
AU  - Gamal Osman
AU  - Rehab Hemeda
AU  - Shady Emad Shaker
AU  - Mohamed Abdallah Zaitoun
Y1  - 2020/06/04
PY  - 2020
N1  - https://doi.org/10.11648/j.js.20200803.13
DO  - 10.11648/j.js.20200803.13
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 90
EP  - 96
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20200803.13
AB  - Context: central neck dissection in addition to total thyroidectomy as a management procedure of patients with papillary carcinoma of the thyroid [PTC] was previously found to decrease the incidence of lymph node recurrence and allow and accurate PTC surgical staging that allow making a better decision regarding adjuvant radioactive iodine (RAI) ablation. But recently, central neck dissection in patients with clinical and radiological evidences of negative cervical lymph nodes was found to have many post-operative complications. Aim: to assess benefits, complications and drawbacks of performing central neck dissection by in PTC patients. Patients and methods: This is a prospective randomized study which included 70 PTC patients who was subjected to total thyroidectomy with or without neck dissection; all included patients have clinically negative cervical lymph nodes, 40 (60%) underwent total thyroidectomy in addition to central neck dissection and 30 (40%) patients were subjected to only total thyroidectomy without central neck dissection. We followed our patients for five years to detect recurrence, RFS and OS rates. Results: We found that operative time was longer in patients underwent central block dissection (p=0.049). Recurrence free survival and overall survival rates were not significantly different among both included groups, which denoted that central block neck dissection has no survival benefits in PTC patients. Conclusions: We have concluded that performing central neck dissection in PTC with clinically and radiologically negative lymph nodes has no benefits in increasing patients’ survival or decreasing recurrence rate and might lead to prolongation of operation time, increasing post-operative morbidity.
VL  - 8
IS  - 3
ER  -

Copy | Download