Central Neck Dissection for Papillary Thyroid Carcinoma

Kang Dae Lee; Hyoung Shin Lee

doi:10.11106/cet.2014.7.2.140

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Lee and Lee: Central Neck Dissection for Papillary Thyroid Carcinoma

Review Article

Clin Exp Thyroidol 2014;7(2):140-148.

Published online: 7 November 2014

DOI: https://doi.org/10.11106/cet.2014.7.2.140

Central Neck Dissection for Papillary Thyroid Carcinoma

Kang Dae Lee, Hyoung Shin Lee

Department of Otolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea

Correspondence: Kang Dae Lee, MD, PhD, Department of Otolaryngology Head and Neck Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea Tel: 82-51-990-6136, Fax: 82-51-245-8539, E-mail: kdlee59@gmail.com

Received 24 April 2014 Accepted 9 June 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Considering the relatively good prognosis of papillary thyroid carcinoma, surgical treatment should be conducted with an adequate method and extent of surgery with minimal complications. The optimal indications and extent of central neck dissection in papillary thyroid carcinoma has been introduced by variable guidelines. However, there have been controversies in several aspects regarding central neck dissection (i.e., prophylactic versus therapeutic, unilateral versus bilateral), which will remain until a large prospective study is completed. Successful management of cervical lymph node metastasis in papillary thyroid carcinoma requires thorough preoperative evaluation, knowledge on adequate indications and extent of surgery and considerations on surgical anatomy. In this article, we reviewed the rationales for optimal central neck dissection in papillary thyroid carcinoma based on recent studies and presented the surgical strategy and skills based on personal experience of a single surgeon.

Keywords: Thyroid cancer, Papillary thyroid carcinoma, Lymph node, Central neck dissection

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Fig. 1.

Detailed anterior view of the central neck compartment indicating locations of lymph node basins. Prelaryngeal (Delphian, A), pre-tracheal (C), right (B) and left (D) paratracheal nodes.

Table 1.

Pros and Cons of prophylactic central neck dissection for papillary thyroid carcinom

Pros	Cons
High incidence of occult LN metastasis Staging procedure for prognostication: guide for RI Tx and f/u Decrease postoperative TG level May improve outcome of RI resistant patients Performed with low morbidity Increased morbidity for reoperative CND	No proven benefit on recurrence and survival
	Increased temporary hypoparathyroidism Comparable morbidity in experienced hands

CND: central neck dissection, LN: lymph node, RI Tx: radioiodine therapy, TG: thyroglobuline

Table 2.

Indications of prophylactic central neck dissection from variable guidelines

ATA 2009	May be performed for T3 or T4
KTA 2011	May be considered for T3 or T4
BTA 2007	Male, age >45 years, tumor size >4 cm, extracapsular or extrathyroidal disease
NCCN 2012	Can be considered for indications of total thyroidectomy (<15 years old or >45 years old, radiation history, distant metastasis, bilateral nodularity, extrathyroidal extension, tumor size >4 cm, aggressive variant)
JSTS/JAES 2011	Routinely recommended
AACE/AAES 2001	No description

AACE: American Association of Clinical Endocrinologists, AAES: American Association of Endocrine Surgeons, ATA: American Thyroid Association, BTA: British Thyroid Association, JAES: Japanese Association of Endocrine Surgeons, JSTS: Japanese Society of Thyroid Surgeons, KTA: Korean Thyroid Association, NCCN: National Comprehensive Cancer Network

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