Impact of combined prophylactic unilateral central neck dissection and hemithyroidectomy in patients with papillary thyroid microcarcinoma.

Abstract

Lymph node metastases occur frequently in patients with papillary thyroid carcinoma (PTC), and the central compartment of the neck is the most frequently involved site. Some authors advocate prophylactic central neck dissection (CND) during total thyroidectomy. However, little is known about the effects of prophylactic unilateral CND in papillary thyroid microcarcinoma (PTMC) patients who undergo hemithyroidectomy. This study was designed to investigate the impact of prophylactic unilateral CND in this population. The clinical records of 152 patients with a PTMC ≤1 cm according to preoperative ultrasonography who underwent hemithyroidectomy between 2002 and 2009 were assessed retrospectively. Outcomes were compared between the 65 (43%) patients who underwent hemithyroidectomy with elective unilateral CND (CND+ group) and the 87 (57%) patients who underwent hemithyroidectomy only (CND- group). In the CND- group, 37 patients (43%) had microscopic extrathyroidal extension (ETE). In the CND+ group, 33 patients (50.7%) had ETEs or nodal metastases. During follow-up, recurrence was observed in 14 patients (n = 1, CND+ group; n = 13, CND- group). Prophylactic unilateral CND was associated with a significantly lower rate of locoregional recurrence (P = 0.017). Compared with hemithyroidectomy alone, prophylactic unilateral CND may decrease the rate of locoregional recurrence in patients with PTMC.