Endocrine Abstracts

Background: Prophylactic central neck dissection (pCND) in patients with no clinical nodal disease (cN0) is one of the major concern and ongoing controversy in thyroid surgery. However, there are no clear evidence because prospective randomized clinical tirals are still not enough to make definite recommendations. The purpose of our study was to investigate prognostic pros & cons of pCND to provide reliable evidence on this topic.

Method: A total of 2,100 PTC patients were randomly assigned to two groups according to pCND status between March 2013 and November 2022 at Samsung Medical Center (SMC). After dropping 299 patients who met exclusion criteria such as gross invasion or central lymph node metastasis or refuse study enrollment\..etc, a total of 1,801 PTC patients were included for the final analysis. We compared recurrence and surgery-related outcomes between the two groups- with pCND group (C group) and without pCND group (N group) according to surgery extent.

Results: Mean follow-up duration was 51.2 months (range, 6.8-106.7months). Overall recurrence was detected in 19 (1.0%) patients: 17 (0.9%) in the N group and 2 (0.1%) in the C group regardless of surgery extent. In 1259 lobectomy patients, recurrence occurred in 15 (1.2%) patients: 13 (1.0%) in the N group and 2 (0.2%) in the C group. Recurrence in pre-existing nodule of contralateral lobe was the most frequent. In 542 total thyroidectomy patients, there were 4 (0.7%) patients with recurrence: 4 (0.7%) in the N group and 0 (0.0%) in the C group. Of 4 recurred patients in N group, 3 patients had lateral neck recurrence and only one patients present central neck recurrence. Unfavorable surgery-related outcomes such as transient hypocalcemia, transient VCP, and the incidence of inadvertent parathyroidectomy were significantly higher in the C group.

Conclusion: Despite of rare recurrence(1.1%), pCND decreased overall recurrence, however, we hardly found a relevant relationship between pCND and central neck recurrence in cN0 patients because recurrence in this study seemed to be related to surveillance of the nodules in the contralateral lobe, not pCND per se. Regarding surgical complication, pCND increased the risk of unintentional removal of parathyroid gland, transient hypoparathyroidism, and transient RLN injury. Considering balance between the risk and benefit of pCND, pCND should be considered in advanced cases and performed by experienced surgeon if needed. Personalized decision making is recommended in PTC patients without evident node metastasis. Further follow-up is required to elucidate a practical role of pCND.