Neck dissection in papillary thyroid carcinoma: when and why?

Background Papillary thyroid carcinoma (PTC) is the most common histological subtype of thyroid cancer, occurring in about 80% of cases. Ongoing debates on the best treatment strategy for patients with PTC over the last decades have included the extent of lymphadenectomy, the value of radioactive iodine (RAI) ablation, and the impact of each therapy on the patient’s life. The aim The aim of this study was to compare different surgical procedures with regard to their safety, efficacy, and impact on the patient’s life, as well as compare surgery with other treatment modalities such as RAI ablation. Patients and methods This study was conducted on 142 patients with PTC. Patients were arranged into three groups according to their clinical presentations: Group I included 34 patients who presented with hidden PTC within multinodular goiter; they were treated with total thyroidectomy (TT). Group II included 52 patients with PTC without palpable lymph nodes; they were treated with TT + prophylactic central neck dissection (pCND). Group III included 56 patients with PTC with palpable lymph nodes; they were treated with TT + central neck dissection (CND) + lateral neck dissection. RAI ablation was given to those patients who showed residual disease in the RAI scan. Completion surgery was performed only in relapsed cases with palpable disease. We compared the results of the three groups regarding complications, recurrence, and impact on patients’ life. Results There was a statistically significantly higher incidence of most postoperative complications in groups II and III than in group I, although the final outcome was the same in the three groups. RAI therapy showed a good success rate in ablation of residual impalpable disease. At the end of the follow-up period, all patients were tumor free. Conclusion pCND should be abandoned because of its considerable risks and limited benefit. RAI ablation is a very good treatment option for residual PTC. Completion surgery should be decided only for relapsed bulky disease.