Surgery in papillary thyroid carcinoma: a review of 730 patients

Outcomes of Central Neck Dissection for Papillary Thyroid Carcinoma in Primary Versus Revision Setting

Introduction

Surgery in the central compartment after previous thyroidectomy involves an increased risk of injury to critical organs, including the parathyroids and recurrent laryngeal nerve. Contrastingly, primary central neck dissection involves a relatively low operative risk.

Objective

This study aimed to compare the outcomes of central neck dissection in primary versus revision settings with respect to the lymph node yield and complication rates.

Methods

This single-center prospective study included patients who underwent primary or revision neck dissection surgery for histologically confirmed thyroid malignancy between January 2018 and January 2022.

Results

We included 30 patients who underwent total thyroidectomy with primary central neck dissection and 29 patients who underwent central neck dissection following remote thyroidectomy with or without previous central dissection. There was no significant between-group difference in postoperative complications, including permanent hypocalcemia and recurrent laryngeal nerve injury. However, both groups showed a significant postoperative decrease in calcium levels even though calcium and parathyroid hormone levels were within reference range.

Conclusion

Although many surgeons fear revision central neck dissection, it appears to have similar therapeutic outcomes and complication rates as primary neck dissection for papillary thyroid cancer. Specifically, there were no between-group differences in the lymph node yield, hypoparathyroidism, or recurrent laryngeal nerve paralysis. Patients with normocalcemia showed a significant postoperative reduction in calcium levels, suggesting subclinical parathyroid insufficiency.

Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma

BACKGROUND

The main drawback of central neck lymph node dissection is postoperative parathyroid failure. Little information is available concerning inadvertent resection of the parathyroid glands in this setting and its relationship to postoperative hypoparathyroidism. Our aim was to determine the prevalence of inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid cancer and its impact on short-and long-term parathyroid function.

METHODS

This was a prospective observational study of consecutive patients undergoing first-time total thyroidectomy with a central neck dissection for papillary carcinoma >10 mm. Prevalence and risk factors for inadvertent parathyroidectomy were recorded. Serum calcium and intact parathyroid hormone concentrations were determined 24 hours after operation and then periodically in patients developing postoperative hypocalcemia. All patients were followed for a minimum of one year.

RESULTS

Whole gland (n = 33) or microscopic parathyroid fragments (n = 14) were identified in 47/170 (28%) operative specimens. The lower parathyroid glands were involved more often. Variables influencing inadvertent parathyroidectomy were extrathyroidal extension of the tumor and therapeutic lymphadenectomy. Neither lateral neck dissection nor the number of lymph nodes retrieved affected the rate of inadvertent parathyroid resection. Postoperative hypocalcemia and permanent hypoparathyroidism were more frequent after inadvertent parathyroidectomy (64% vs 46% and 15% vs 4%; P ≤ .03 each).

CONCLUSION

Inadvertent parathyroidectomy during total thyroidectomy with central neck dissection for papillary thyroid carcinoma is common and involves the inferior glands more frequently in patients with extended resections and clinical N1a disease. Inadvertent resection of parathyroid glands is associated with greater rates of postoperative hypocalcemia and permanent hypoparathyroidism.

THERAPY OF ENDOCRINE DISEASE: Central neck dissection: a step forward in the treatment of papillary thyroid cancer

Since its introduction in the '70s and '80s, CND for papillary cancer is here to stay. Compartment VI should always be explored during surgery for papillary thyroid carcinoma (PTC) for obvious lymph node metastases. These can be easily spotted by an experienced surgeon or, eventually, by frozen section. No doubt, obvious nodal disease in the Delphian, paratracheal and subithsmic areas should be dissected in a comprehensive manner (therapeutic central neck dissection), avoiding the selective removal of suspicious nodes. Available evidence for routine prophylactic CND is not completely satisfactory. Our group's opinion, however, is that it reduces or even eliminates the need for repeat surgery in the central neck, better defines the extent (and stage) of the disease and provides a further argument against routine radioiodine ablation. Thus, PTC is becoming more and more a surgical disease that can be cured by optimized surgery alone in the majority of cases. Prophylactic CND, however, involves a higher risk for the parathyroid function and should be skilfully performed, preferably only on the same side as the primary tumour and preserving the cervical portion of the thymus.

Local recurrence of papillary thyroid cancer

Management of advanced papillary thyroid cancer (PTC >10 mm) is changing its focus. Mortality was the main outcome measure for patients treated before the 90s. In the past two decades, however, most patients diagnosed with PTC belong to the very low risk of death group. On the other hand, local recurrence of PTC remains a clinical problem, with rates up to 25% depending on the presence of nodal metastasis, tumor diameter, and the skill of the surgeon to completely remove the primary tumor and the associated lymph node metastasis at first-time thyroidectomy. After optimized surgery (total thyroidectomy plus central neck dissection), radioiodine ablation has very little influence on lymph node recurrence that now presents mostly as lateral neck node metastasis that was overlooked or incompletely resected at the time of initial surgery.

Low-risk papillary thyroid cancer: times are changing

The prevalence of papillary thyroid cancer (PTC), particularly of low-risk PTC (MACIS <6), is rising due to the increasingly use of neck imaging techniques, fine-needle aspiration and whole body PET scans. Observational cohort studies carried out in the last two decades suggest that low-risk PTC are being overtreated due to the current management paradigm being built on studies done in the 70s and 80s that still echo in some influential guidelines. With the progressive adoption of total thyroidectomy and central neck dissection as the mainstay of treatment for PTC, and suppressed basal thyroglobulin and neck ultrasound once a year as the essential tools for follow-up, the use of radioiodine ablation, body scans and stimulated thyroglobulin concentrations has become obsolete for the vast majority of patients with low-risk PTC. Future guidelines on the management of differentiated thyroid cancer should discuss separately three different diseases: low-risk PTC, high-risk PTC and follicular cancer.

Multicentricity in the thyroid differentiated carcinoma

The treatment of choice for the well differentiated thyroid carcinoma has always been controversial. Aim: to analyze tumor invasion of the thyroid gland’s contralateral lobe in cases of differentiated carcinoma, correlating risk/benefit with the complications of a second surgical approach. Materials and methods: Retrospective study, from 1998 to 2006, of 27 patients undergoing less than total thyroidectomy: lobectomy (21), subtotal thyroidectomy (5) or isthmusectomy (1). Gender, age, type of surgery, complications, histopathological analysis and invasion of the contralateral lobe were analyzed. Patients’ ages varied from 17 to 89; the most frequent histopathological pattern was the classical papillary carcinoma (18 cases), followed by follicular carcinoma (6); the follicular variant of the papillary carcinoma (2) and the Hürthle cell carcinoma (1). Twenty-one patients underwent full thyroidectomies, from 15 to 30 days after the first intervention. Results: the contralateral lobe analysis was negative for carcinoma in 16 (76.5%) and positive in the other 5 (23.8%) patients. The complications observed were temporary dysphonia (3 cases) and hypoparathyroidism (2 cases, one permanent). Conclusions: total thyroidectomy is important in the treatment of differentiated thyroid carcinomas, because there is a high contralateral spread rate (23.8%). It is a procedure without mortality, which bears few complications.

Estimating the optimal radiotherapy utilization for carcinoma of the central nervous system, thyroid carcinoma, and carcinoma of unknown primary origin from evidence-based clinical guidelines

BACKGROUND

In this one in a series of articles, the objective was to estimate the ideal proportion of patients with cancer who should receive radiotherapy at least once during the course of their illness based on the best available evidence. This estimate should be useful in planning for future radiotherapy facilities. Optimal rates of radiotherapy for patients with central nervous system (CNS) carcinoma, thyroid carcinoma, or carcinoma of unknown primary site (CUP) have not been studied previously.

METHODS

A systematic review of evidence-based treatment guidelines for the treatment of CNS carcinoma, CUP, and thyroid carcinoma was undertaken. An optimal radiotherapy utilization tree was constructed for each of these malignancies depicting the indications for radiotherapy at various stages of disease. The proportion of patients who had clinical attributes that indicated a possible benefit from radiotherapy was calculated by adding epidemiological data to the radiotherapy utilization tree. The optimal proportion of patients who should receive radiotherapy was then calculated using specialized decision-analysis software. Sensitivity analyses using univariate analysis and Monte Carlo simulations were performed.

RESULTS

The optimal rates of radiotherapy utilization for carcinoma of the CNS, thyroid carcinoma, and CUP were 92%, 10%, and 61%, respectively. Comparison with actual rates of utilization in South Australia, Sweden, and the U.S. suggested an under-utilization of radiotherapy for CNS carcinoma and CUP. However, the actual rates of radiotherapy for thyroid carcinoma exceeded the optimal rate for some jurisdictions, although some data may have included radioactive iodine, which was not included in the current project.

CONCLUSIONS

It was possible to estimate optimal radiotherapy utilization rates based on evidence. This methodology allowed a comparison of optimal rates with actual rates to identify areas in which improvements in the evidence-based use of radiotherapy can be made, and it may provide valuable data for future radiotherapy service planning.

Gamma probe-guided lymph node dissection ('gamma picking') in differentiated thyroid carcinoma

The prognostic significance and the optimal management of regional lymph node metastases in patients with well-differentiated thyroid carcinoma continue to be controversial. The current surgical approach for nodal metastases is removal of grossly involved lymph nodes ("berry picking"). In patients with papillary thyroid cancer, this intraoperative sampling technique reveals tumor in only 15% to 60% of excised nodes. However, if a more extensive nodal dissection is undertaken, at least 70% of patients are found to have nodal disease. The authors have successfully used a gamma probe-guided lymph node dissection technique ("gamma picking") to identify visually undetectable micrometastatic lymph nodes at the time of surgical exploration. The authors used this technique in a 52-year-old man with papillary carcinoma of the thyroid that was diagnosed by fine-needle aspiration. Eighteen hours before the planned total thyroidectomy, the patient was given 1 mCi I-123 orally. Operative exploration revealed multiple tumor nodules in both lobes but no palpable lymph nodes in the neck. Total thyroidectomy was performed with complete extracapsular removal of both lobes and isthmus. The thyroid bed and the central and lateral nodal basins were scanned using a gamma probe (Neoprobe). Hot spots were identified, and these counts were compared with that of the background activity in the strap muscles. The gamma probe revealed four distinct foci of increased activity (10 times more than the background). These were resected and labeled separately for histopathologic study. Histologic analysis revealed bilateral, multifocal well-differentiated papillary carcinoma, with the largest tumor focus measuring 0.6 cm. Two of the four hot spots proved to be metastatic foci in small lymph nodes measuring less than 0.5 cm. The other two hot spots were thyroid remnants with no associated nodal tissue.

[Thyroid cancers: the Geneva experience]

AIM OF THE STUDY

To study the survival of patients with thyroid cancer operated in the same centre from 1978 to 1999.

PATIENTS AND METHOD

This retrospective study included 218 patients operated on for thyroid carcinoma from january 1978 to december 1999. Modified neck dissection was performed only in the presence of one or more suspected lymph nodes. The stage of the cancer was defined according to the last TNM classification (1997). Survival data were taken from the Geneva Tumour Registry (168 patients = 77% of the series, 109 papillary carcinomas, 37 follicular, 14 undifferentiated and 8 medullary carcinomas).

RESULTS

The overall 5, 10 and 15-year survival rates were respectively 88%, 84% and 80%. Papillary carcinoma was associated with the best survival at 5, 10 and 15 years (99%, 97% and 93%), despite a recurrence rate of 20% treated mainly by surgery often associated with radioiodine therapy. Follicular carcinoma had a survival rate of 83% at 5 years and 75% at 10 years. Undifferentiated carcinoma had a median survival rate of 56 days. None of the 8 patients with medullary carcinoma had died from that cancer in this series.

CONCLUSION

Thyroid carcinoma carries such a good prognosis (except for undifferentiated carcinoma) that invasive surgery at first operation, like radical neck dissection, is not justified, despite a high rate of recurrence.

Carcinoma diferenciado da tireóide: a validade da complementação da tireoidectomia

OBJETIVO: Analisar a invasão tumoral do lobo contralateral da glândula tireóide no carcinoma diferenciado, correlacionando o risco/benefício com as complicações decorrentes de uma segunda intervenção. MÉTODO: De outubro/93 a dezembro/96 foram operados 20 pacientes com carcinomas diferenciados da glândula tireóide. Os parâmetros analisados foram sexo, idade, tipo de operação, tipo de complicações, histopatológico da peça cirúrgica e invasão do lobo contralateral. Eram dois pacientes do sexo masculino (10%) e 18 do feminino (90%); as idades variaram de 17 a 89 anos; o tipo histológico mais freqüente foi o carcinoma papilífero (13 casos), seguido do folicular (seis casos) e carcinoma de células de Hürthle (um caso). Como primeiro procedimento cirúrgico houve 11 lobectomias + istmectomias, quatro lobectomias subtotais e uma istmectomia. Cinco pacientes não realizaram a totalização (um por fibrose, três por perda de seguimento e um por ser microcarcinoma). RESULTADOS: Na análise do lobo contralateral realizada em 15 pacientes, 11 resultaram negativas e outras quatro positivas (26,6%). As complicações apresentadas foram rouquidão (dois casos revertidos com tratamento fonoterápico), hipoparatireoidismo (dois casos, um transitório e um permanente). CONCLUSÃO: A totalização da tireoidectomia é um procedimento importante no tratamento do tumor maligno da tireóide pela alta porcentagem de metástase contralateral (26,6%). Além disso, é um procedimento com mortalidade nula e pequena incidência de complicações.

Therapeutic strategies and long-term results in differentiated thyroid cancer

Differentiated thyroid carcinoma (DTC) is usually an indolent tumor associated with a low mortality. However, DTC, particularly papillary thyroid carcinoma, happens to be a multicentric tumor and tends to spread to the regional lymph nodes in the early stage of the disease; some patients with DTC do die from metastatic or recurrent disease. Despite the small number of these patients, therapeutic strategies designed to prevent such outcomes should be pursued. In this review, we attempt to evaluate the impact of different therapeutic strategies on survival and recurrence. Consequently, we conclude that the surgical approach to DIC should be individualized on the basis of the biologic behavior of the tumor, rather than on the extent of cancer involvement in the thyroid and regional lymph nodes. It is mandatory to expand our efforts to identify high-risk patients more accurately, thereby facilitating more rational approaches to treatment.

A study of 875 cases of thyroid cancer observed over a fifteen-year period (1975-1989) at the King Faisal Specialist Hospital and Research Centre

Thyroid cancer (TC) is a common malignancy encountered at King Faisal Specialist Hospital and Research Centre (KFSH&RC). Of 19,885 different malignant tumors seen during the period fro 1975 to 1989, there were 875 cases (4.4%) of TC. Of 1374 tumors of endocrine glands seen during the same period, 67% were thyroid neoplasms. TC represented 7.5% (618 cases) of all neoplasms in the females, second only to breast cancer. All types of TC were seen, with papillary thyroid carcinoma (PC) being the most common (79%). Anaplastic, medullary, follicular (FC), malignant lymphoma and Hürthle cell cancer accounted for 5.4%, 5.3%, 4.3%, 3.6% and 0.9% respectively. The frequency of PC was very similar (16%) in each of the third, fourth and fifth decades. The relative frequency (RF) of different types of TC was highest for PC with a ration of 18:1 between PC and FC, which could be the highest ever reported. There was a clearly progressive increase in the number of thyroid tumors referred between 1975 and 1989. Although this increase was evident for both sexes, it was more apparent for females. There was also a distinct increase (P<0.01) in the RF of PC from 76% (1975 to 1980) to 85% (1986 to 1989) with a decrease in FC from 9% to 2.5% over the same periods.

Surgical management of the patient with papillary cancer

Papillary cancer is the most common thyroid cancer occurring in all age groups and is usually an indolent tumor, and patients have an excellent prognosis. The majority of patients with papillary cancer do well. It is for the small number of patients who do poorly that it is critical to carry out the appropriate initial operation. The recognized primary treatment of papillary cancer is surgical excision, and the controversy regarding lobectomy versus total thyroidectomy continues. We favor total thyroidectomy because it eradicates multicentric disease, facilitates postoperative radioactive iodine ablation, and allows thyroglobulin levels to be used as a tumor marker for follow-up. Total thyroidectomy should be done by an experienced surgeon to decrease morbidity. Otherwise a total lobectomy on the side of the nodule with subtotal removal on the opposite side is preferred to avoid serious postoperative complications.

Local complications after surgical resection for thyroid carcinoma

BACKGROUND

One of the issues in the debate surrounding the extent of thyroid excision for localized, well-differentiated thyroid cancer is the low morbidity rate reported after all degrees of thyroid resection. This study was conducted to determine morbidity and mortality after surgical resection for thyroid cancer.

MATERIALS AND METHODS

Ninety-one patients with thyroid carcinoma were identified from tumor registries at a university, veterans administration, and private hospital over a 36-year period. Forty-five patients (49%) underwent total thyroidectomy, 28 (31%) subtotal thyroidectomy, and 18 (20%) thyroid lobectomy.

RESULTS

Permanent postoperative local complications occurred in 4% of patients. Forty-four patients (48%) experienced temporary local complications: transient hypocalcemia in 38 (42%), airway obstruction in 3 (3%), postoperative bleeding in 2 (2%), and recurrent laryngeal nerve injury in 1 (1%). The local complication rate increased in direct relationship to the extent of thyroid resection. There were no postoperative deaths.

CONCLUSION

The most frequent underreported morbidity after thyroid resection is transient hypocalcemia. Compared to other life-threatening or permanent postoperative complications that could occur, transient hypocalcemia is relatively less important, and the significance of its identification is predominantly economic.

Classification of papillary cancer of the thyroid based on prognosis

Between 1965 and 1988 there were 2953 patients with papillary carcinoma treated at Noguchi Thyroid Clinic. Among them 761 patients were excluded because the primary tumor was < 10 mm in maximum diameter, the patient's age was > 80, or the patient underwent noncurative surgery. The remaining 2192 patients, 192 men and 2000 women, were analyzed. The mean follow-up period was 12.5 years. Total thyroidectomy, subtotal thyroidectomy, lobectomy with or without isthmectomy, and less than lobectomy were performed in 2.3%, 40.3%, 44.2%, and 13.2%, respectively. Modified radical neck dissection, partial node excision, and no node excision were performed in 77.8%, 6.4%, and 15.8%, respectively. Men and women were separately analyzed because their risk factors and prognosis were significantly different. Multivariate analysis was carried out according to Cox's regression hazard model. Independently significant factors affecting prognosis in men were aged and gross nodal metastasis; and age, gross nodal metastasis, tumor size, and number of adhered tissues or organs were the factors in women. Based on those risk factors patients were classified into three groups. For men, 65.6% were classified in the excellent group and their 10-year survival was 98.4%; 17.2% were classified as intermediate and 17.2% as poor with survival rates of 90.1% and 74.4%, respectively. For female patients 69.6% were classified in the excellent group, 18.6% in the intermediate group, and 11.9% in the poor group with 10-year survivals of 99.3%, 96.4%, and 88.8%, respectively.

Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer

We studied the records of 342 patients with papillary thyroid carcinoma out of a total of 728 thyroid cancer patients treated at the Medical School of Hannover (MHH) from 1972 through 1992. The comprehensive data-abstracting forms were designed, and the acquired information was coded, stored, maintained, and evaluated by the Clinical Cancer Registry of the MHH. A total of 160 patients (46.8%) initially had lymph node metastases (N1 status). The N status significantly influenced recurrence (p < 0.00001) and survival (p < 0.00001). Excluding other risk factors developed by univariate and multivariate analysis, such as high age (age > 45 years, p < 0.001), tumor invasion (T4 tumor, p < 0.005), and distant metastases (M1, p < 0.001), lymph node metastases remained an independent, highly significant prognostic marker for more aggressive papillary thyroid cancer. N1 status did not influence survival of patients with T4 tumor but did influence those with T1-T3 status (p < 0.001). The influence of N1 status remained significant in patients older (p < 0.001) and younger (p < 0.05) than 45 years of age. Systematic compartment-oriented dissection of lymph node metastases improved survival (p < 0.005, T1-T3) and recurrence (p < 0.00001, T1-T3) especially in patients with T1-T3 tumors. In conclusion, lymph node metastases with a significant incidence at a young age and male sex had a substantial effect on survival and recurrence especially in those with tumor status T1-T3. Systematic compartment-oriented dissection of the lymph node metastases results in better survival and a lower recurrence rate.

Surgical reintervention for differentiated thyroid cancer

Reoperation was performed in 110 of 185 patients with a differentiated thyroid carcinoma. In 25 patients (23 per cent) the indication for reintervention was a large thyroid remnant and in the other 85 (77 per cent) persistent or recurrent cancer was suspected. In 32 (29 per cent) of the 110 patients undergoing reoperation no evidence of cancer tissue was found. Tumour tissue in 33 patients (30 per cent) was resectable. Of 45 patients (41 per cent) with residual tumour after operation 24 showed only occult thyroid carcinoma with a raised serum thyroglobulin level. Eight of 21 patients with macroscopically persistent tumour died from the disease during a mean follow-up of 2.3 years. In 13 of 38 patients the investigated recurrent tumours were histologically less differentiated than the primary lesions, stressing the importance of total tumour clearance. The treatment of choice for persistent and recurrent differentiated thyroid carcinoma is surgical reintervention, if feasible, before radioiodine and radiation therapy are considered.

Thyroid cancer

Management of thyroid cancer varies somewhat between communities and institutions depending on tumor type and individual treatment philosophy. The differentiated thyroid cancers have a significantly better outlook than the medullary and anaplastic. This article provides an overview of the literature that describes pathogenesis, diagnosis, and treatment currently recommended for these thyroid cancers.

Recurrence-associated mortality in patients with differentiated thyroid carcinoma

Differentiated thyroid carcinoma (DTC) is associated with prolonged natural history, and even recurrent tumor is not necessarily followed by increased mortality. Prognostic factors and different treatment strategies, therefore, are difficult to assess. One hundred and fifty-seven patients were followed in our clinic. In an attempt to predict mortality from this tumor, we evaluated the risk factors in 36 patients who presented with recurrent disease. Ten of these patients died. Age above 40 years at initial diagnosis was the predominant risk factor associated with 44% mortality after recurrence. Male sex, lack of radioiodine treatment, and distant site of initial recurrence were all associated with a trend towards increased mortality. Tumor histology and local invasion or extent of initial surgical treatment failed to affect mortality. In conclusion, this approach may be used to identify those patients who will die from their disease, despite currently available treatment. It remains to be seen, however, if new treatment protocols can be developed to improve the prognosis of these patients.

Papillary thyroid cancer and its surgical management

The surgical management in papillary thyroid cancer has been highly controversial. In the Department of Surgery (II), Kanazawa University Hospital, the surgical management especially for cervical lymph node metastases has changed since 1973 from a conservative approach to an aggressive one. In order to determine whether an aggressive approach is warranted, a retrospective multivariate analysis was carried out on 106 cases of papillary thyroid cancer. The patients have been followed for 10-28 years. Multivariate analysis was conducted following Cox's model. By this analysis, aggressive management appeared to have no impact on survival or relapse-free survival. However, age, sex, tumor size, and cervical lymphadenopathy were confirmed to be important prognostic factors in survival and/or relapse-free survival.

Papillary carcinoma of the thyroid

The clinical behavior and mortality rate of papillary carcinoma of the thyroid varies widely, and clinically insignificant microscopic foci of the disease are frequently found. Dietary iodine and radiation to the head and neck in childhood play a role in etiology. Needle aspiration cytology provides a highly accurate diagnosis. Ultrasound, radioactive iodine, and technetium scans are not specific and should only be used to complete diagnostic studies when aspiration cytology is negative for papillary carcinoma. The most important aspect of prognosis of an individual patient with papillary carcinoma of the thyroid is the age at which the disease is diagnosed, with an excellent prognosis, even in advanced primary disease or extensive lymph node involvement, in children and young adults. A multifactorial clinical risk group definition (AMES) is easy to use and reliably separates patients into low risk and high risk. Since 90% of patients with this disease rarely have metastases or late complications from the cancer, total or subtotal thyroidectomy is necessary in only 10% of cases for later use of postoperative radioactive iodine. More conservative surgical procedures are advised in low-risk patients. Papillary carcinoma incidentally found during operation for other conditions such as Graves disease or thyroiditis and reported first on the permanent pathology reports are always clinically insignificant and completely cured by removal; total thyroidectomy should be completely avoided. Postoperatively, thyroid hormone supplementation may be unnecessary after relatively conservative surgery in selected low-risk patients. Thyroid hormone must be maintained permanently after total or subtotal thyroidectomy.

A retrospective study on the efficacy of cervical lymph node dissection in well-differentiated carcinoma of the thyroid

The management of cervical lymph node metastases in well-differentiated carcinoma of the thyroid is controversial. In our department, from 1963 to 1972, node plucking was performed only in patients with cervical lymphadenopathy whereas, from 1973 to 1983, modified radical neck dissection was therapeutically or electively performed. In order to determine whether the more extensive dissection is adequate, a retrospective analysis was performed using two groups of patients who were managed differently with regard to the treatment of cervical lymph node metastases. From this series of 206 patients with more than five years follow-up, it was found that the rates of survival and lymph node recurrence did not differ between the two groups. However, since the well-differentiated carcinoma of the thyroid has relatively indolent biological behaviour, further long-term follow-up seems to be necessary for demonstrating the efficacy of neck dissection.