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World J Surg. 2007 May;31(5):895-904.

Central lymph node dissection in differentiated thyroid cancer.

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  • 1Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.

Abstract

BACKGROUND:

There has been renewed interest in extensive lymph node dissection for papillary thyroid cancer (PTC), and a number of reports have been published concerning compartment-oriented dissection of regional lymph nodes in PTC. A comprehensive review of this body of literature using evidence-based methodology is pending.

METHODS:

Systematic review of the literature using evidence-based criteria.

RESULTS:

Issue 1: Systematic compartment-oriented central lymph node dissection (CLND) may decrease recurrence of PTC (Levels IV and V data, no recommendation) and likely improves disease-specific survival (grade C recommendation). Limited level III data suggest survival benefit with the addition of prophylactic dissection to thyroidectomy (grade C recommendation). The addition of CLND to total thyroidectomy can significantly reduce levels of serum thyroglobulin and increase rates of athyroglobulinemia (level IV data, no recommendation). Issue 2: There may be a higher rate of permanent hypoparathyroidism and unintentional permanent nerve injury when CLND is performed with total thyroidectomy than for total thyroidectomy alone (grade C recommendation). Issue 3: Reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury when compared with total thyroidectomy with or without CLND (grade C recommendation), supporting a more aggressive initial operation.

CONCLUSION:

Evidence-based recommendations support CLND for PTC in patients under the care of experienced endocrine surgeons.

PMID:
17347896
[PubMed - indexed for MEDLINE]
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