Lobectomy and Prophylactic Central Neck Dissection for Papillary Thyroid Microcarcinoma: Do Involved Lymph Nodes Mandate Completion Thyroidectomy?

• DOI: 10.1007/s00268-013-2348-3
• Publication Date: 2013-12-03T20:44:31Z
• Authors: Cho Rok Lee; Haiyoung Son; Sohee Lee; Sang‐Wook Kang; Jong Ju Jeong; Kee‐Hyun Nam; Woong Youn Chung; Cheong Soo Park
• Keywords: Adult; Male; Central Lymph Node; 610; 03 medical and health sciences; 0302 clinical medicine; 80 and over; 617; Papillary/pathology; Completion Thyroidectomy; Humans; Thyroid Neoplasms; Aged; Retrospective Studies; Aged, 80 and over; Carcinoma; Papillary/surgery*; Thyroid Neoplasms/surgery*; Papillary Thyroid Carcinoma; Middle Aged; Thyroid Neoplasms/pathology; Survival Analysis; Carcinoma, Papillary; 3. Good health; Neck Dissection*/methods; Treatment Outcome; National Comprehensive Cancer Network; American Thyroid Association; Lymphatic Metastasis; Thyroidectomy/methods*; Thyroidectomy; Neck Dissection; Female; Follow-Up Studies

AbstractBackgroundThe present study was designed to investigate the necessity of completion thyroidectomy for patients who underwent thyroid lobectomy for low‐risk papillary thyroid microcarcinoma (PTMC) that was later pathologically diagnosed as central lymph node (CLN) metastasis.MethodsBetween 1986 and 2001, we assessed 551 patients who underwent thyroidectomy with prophylactic ipsilateral central compartment neck dissection, and 409 patients were followed‐up completely. Thyroid lobectomy were performed in 281 and 128 patients, respectively. The patients were divided into two groups according to CLN metastasis. Clinicopathological profiles and follow‐up details were investigated by retrospective chart review.ResultsThe CLN‐positive and ‐negative groups were comprised of 43 (15.2 %) and 238 patients (84.8 %), respectively. The mean ages of the two groups were not significantly different (p > 0.05). The mean tumor size of the CLN‐positive group (6.8 mm) was significantly larger than that of the CLN‐negative group (5.6 mm; p < 0.05). Microscopic capsular invasion was significantly higher in the CLN‐positive group (51.2 vs. 23.9 %; p < 0.05). Overall, 21 patients (7.4 %, 21/281) experienced recurrence. Among these, 2 (4.7 %, 2/43) and 19 (8.0 %, 19/238) were in the CLN‐positive and ‐negative groups, respectively. There was no significant correlation between CLN metastasis and tumor recurrence.ConclusionsPostoperative recurrence was lower in the CLN‐positive group, and there was no significant correlation between CLN metastasis and tumor recurrence. Our results suggest that it is not necessary to perform completion thyroidectomy for PTMC patients who have undergone thyroid lobectomy and who have been pathologically diagnosed with CLN metastasis.