Morbidity of Prophylactic Node Dissection in Thyroid Cancer

Abstract

Objective: Determine if the implementation of prophylactic neck dissection of the central compartment as a routine procedure increases the risk of injury over the recurrent laryngeal nerve and parathyroid glands in patients with clinical stage T1N0M0 compared with patients who underwent total thyroidectomy only.

Method: Retrospective study of 46 patients undergoing total thyroidectomy plus prophylactic central lymph node dissection for papillary cancer with preoperative staging T1N0M0 from March 2008 to July 2010. The outcomes were compared with 107 patients in the same conditions and period undergoing total thyroidectomy alone.

Results: The 2 groups (with and without neck dissection) were similar in age, gender, pathologic features, and completeness of thyroidectomy. Of the 46 patients who underwent neck dissection, 6 (13.0%) had vocal fold paralysis with one (2.1%) permanent. In patients who underwent only total thyroidectomy, 9 (8.4%) had transient paralysis, with no cases of permanent paralysis. Regarding hypoparathyroidism 15 patients (32.6%) had transient and 2 (4.3%) had permanent among those who underwent neck dissection, but in patients who underwent only total thyroidectomy, the total rate of hypoparathyroidism was 7.4% (8 cases) with 2 cases (1.8%) of permanent hypoparathyroidism.

Conclusion: Even though the prophylactic neck dissection of the central compartment did not cause a statistically significant increase in injuries on the recurrent laryngeal nerve, its realization is associated with high rates of hypoparathyroidism. These results make it difficult to indicate this procedure as a routine treatment for early thyroid tumors.