Rebecca S Sippel1, Sarah E Robbins1,2, Jennifer L Poehls3, Susan C Pitt1, Herbert Chen4, Glen Leverson5, Kristin L Long1, David F Schneider1, Nadine P Connor2. 1. Division of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 2. Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 3. Division of Endocrinology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 4. Department of Surgery, University of Alabama- Birmingham, Birmingham, Alabama. 5. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Abstract
OBJECTIVE: The aim of this prospective randomized-controlled trial was to evaluate the risks/benefits of prophylactic central neck dissection (pCND) in patients with clinically node negative (cN0) papillary thyroid cancer (PTC). BACKGROUND: Microscopic lymph node involvement in patients with PTC is common, but the optimal management is unclear. METHODS:Sixty patients with cN0 PTC were randomized to a total thyroidectomy (TT) or a TT+ pCND. All patients received postoperative laryngoscopies and standardized radioiodine treatment. Thyroglobulin (Tg) levels and/or neck ultrasounds were performed at 6 weeks, 6 months, and 1 year. RESULTS: Tumors averaged 2.2 ± 0.2 cm and 11.9% had extra-thyroidal extension. Thirty patients underwent a pCND and 27.6% had positive nodes (all ≤6 mm). Rates of postoperative PTH < 10 (33.3% vs 24.1%, P = 0.57) and transient nerve dysfunction (13.3% vs 10.3%, P = 1.00) were not significantly different between groups. Six weeks after surgery, both TT and TT + pCND were equally likely to achieve a Tg < 0.2 (54.5% vs 66.7%, P = 0.54) and/or a stimulated Tg (sTg) <1 (59.3% vs 64.0%, P = 0.78). At 1 year, rates of Tg < 0.2 (88.9% vs 90.0%, P = 1.00) and sTg < 1 (93.8% vs 92.3%, P = 1.00) remained similar between groups. Neck ultrasounds at 1 year were equally likely to be read as normal (85.7% in TT vs 85.1% in pCND, P = 1.00). CONCLUSIONS: cN0 PTC patients treated either with TT or TT + pCND had similar complication rates after surgery. Although microscopic nodes were discovered in 27.6% of pCND patients, oncologic outcomes were comparable at 1 year.
RCT Entities:
OBJECTIVE: The aim of this prospective randomized-controlled trial was to evaluate the risks/benefits of prophylactic central neck dissection (pCND) in patients with clinically node negative (cN0) papillary thyroid cancer (PTC). BACKGROUND: Microscopic lymph node involvement in patients with PTC is common, but the optimal management is unclear. METHODS: Sixty patients with cN0 PTC were randomized to a total thyroidectomy (TT) or a TT+ pCND. All patients received postoperative laryngoscopies and standardized radioiodine treatment. Thyroglobulin (Tg) levels and/or neck ultrasounds were performed at 6 weeks, 6 months, and 1 year. RESULTS: Tumors averaged 2.2 ± 0.2 cm and 11.9% had extra-thyroidal extension. Thirty patients underwent a pCND and 27.6% had positive nodes (all ≤6 mm). Rates of postoperative PTH < 10 (33.3% vs 24.1%, P = 0.57) and transient nerve dysfunction (13.3% vs 10.3%, P = 1.00) were not significantly different between groups. Six weeks after surgery, both TT and TT + pCND were equally likely to achieve a Tg < 0.2 (54.5% vs 66.7%, P = 0.54) and/or a stimulated Tg (sTg) <1 (59.3% vs 64.0%, P = 0.78). At 1 year, rates of Tg < 0.2 (88.9% vs 90.0%, P = 1.00) and sTg < 1 (93.8% vs 92.3%, P = 1.00) remained similar between groups. Neck ultrasounds at 1 year were equally likely to be read as normal (85.7% in TT vs 85.1% in pCND, P = 1.00). CONCLUSIONS: cN0 PTC patients treated either with TT or TT + pCND had similar complication rates after surgery. Although microscopic nodes were discovered in 27.6% of pCNDpatients, oncologic outcomes were comparable at 1 year.
Authors: Kathy Bach; Samantha Prince; Susan C Pitt; Sarah Robbins; Nadine P Connor; Cameron Macdonald; Rebecca S Sippel; Kristin L Long Journal: J Surg Res Date: 2021-11-16 Impact factor: 2.192
Authors: Andre Shomorony; Alexander Chern; Sallie M Long; Noah Z Feit; Sarita S Ballakur; Mariam Gadjiko; Katie Liu; Daniel A Skaf; Andrew B Tassler; Anthony P Sclafani Journal: Eur Arch Otorhinolaryngol Date: 2021-07-10 Impact factor: 2.503
Authors: Sandeep Kumar Parvathareddy; Abdul K Siraj; Saeeda O Ahmed; Felisa DeVera; Saif S Al-Sobhi; Fouad Al-Dayel; Khawla S Al-Kuraya Journal: Front Oncol Date: 2022-01-17 Impact factor: 6.244