BACKGROUND: The role of prophylactic central neck dissection (CND) in the management of papillary thyroid cancer (PTC) is controversial. This report describes outcomes of an observational approach in patients without clinical evidence of nodal disease in PTC. METHODS: All patients who had surgery between 1986 and 2010 without CND for PTC were identified. All patients had careful clinical assessment of the central neck during preoperative and perioperative evaluation, with any suspicious nodal tissue excised for analysis. The cohort included patients in whom lymph nodes had been removed, but no patient had undergone a formal neck dissection. Recurrence-free survival (RFS), central neck RFS and disease-specific survival (DSS) were calculated using the Kaplan-Meier method. RESULTS: Of 1798 patients, 397 (22.1 per cent) were men, 1088 (60.5 per cent) were aged 45 years or more, and 539 (30.0 per cent) had pT3 or pT4 disease. Some 742 patients (41.3 per cent) received adjuvant treatment with radioactive iodine. At a median follow-up of 46 months the 5-year DSS rate was 100 per cent. Five-year RFS and central neck RFS rates were 96.6 and 99.1 per cent respectively. CONCLUSION: Observation of the central neck is safe and should be recommended for all patients with PTC considered before and during surgery to be free of central neck metastasis.
BACKGROUND: The role of prophylactic central neck dissection (CND) in the management of papillary thyroid cancer (PTC) is controversial. This report describes outcomes of an observational approach in patients without clinical evidence of nodal disease in PTC. METHODS: All patients who had surgery between 1986 and 2010 without CND for PTC were identified. All patients had careful clinical assessment of the central neck during preoperative and perioperative evaluation, with any suspicious nodal tissue excised for analysis. The cohort included patients in whom lymph nodes had been removed, but no patient had undergone a formal neck dissection. Recurrence-free survival (RFS), central neck RFS and disease-specific survival (DSS) were calculated using the Kaplan-Meier method. RESULTS: Of 1798 patients, 397 (22.1 per cent) were men, 1088 (60.5 per cent) were aged 45 years or more, and 539 (30.0 per cent) had pT3 or pT4 disease. Some 742 patients (41.3 per cent) received adjuvant treatment with radioactive iodine. At a median follow-up of 46 months the 5-year DSS rate was 100 per cent. Five-year RFS and central neck RFS rates were 96.6 and 99.1 per cent respectively. CONCLUSION: Observation of the central neck is safe and should be recommended for all patients with PTC considered before and during surgery to be free of central neck metastasis.
Authors: Mauricio A Moreno; Beth S Edeiken-Monroe; Eric R Siegel; Steven I Sherman; Gary L Clayman Journal: Thyroid Date: 2012-01-26 Impact factor: 6.568
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Authors: Aleksandra Popadich; Olga Levin; James C Lee; Stephanie Smooke-Praw; Kevin Ro; Maisam Fazel; Asit Arora; Neil S Tolley; Fausto Palazzo; Diana L Learoyd; Stan Sidhu; Leigh Delbridge; Mark Sywak; Michael W Yeh Journal: Surgery Date: 2011-12 Impact factor: 3.982
Authors: Iain J Nixon; Ian Ganly; Snehal G Patel; Frank L Palmer; Monica M Whitcher; Rony Ghossein; R Michael Tuttle; Ashok R Shaha; Jatin P Shah Journal: Int J Surg Date: 2012-11-02 Impact factor: 6.071
Authors: Pietro Giorgio Calò; Celestino Pio Lombardi; Francesco Podda; Luca Sessa; Luigi Santini; Giovanni Conzo Journal: Updates Surg Date: 2017-04-13