Necessity of Prophylactic Central Lymphadenectomy in the Treatment of Thyroid Papillary Carcinoma: A Preliminary Report

Park, Young Kyu; Roh, Jong Lyel; Park, Seok Won; Koo, Bon Seok; Park, Yong Ho; Rha, Ki Sang; Park, Chan Il

Abstract

BACKGROUND AND OBJECTIVES
Papillary thyroid carcinoma (PTC) tends to have highly metastatic property, especially in the central compartment, and central lymphadenectomy (CL) in patients with PTC is still controversial. This study determines the necessity of prophylactic central lymphadenectomy with total thyroidectomy in patients with PTC based on metastatic probability of tumors and lymph nodes, and surgical morbidity following CL. SUBJECTS AND METHOD: Extracapsular spread, endolymphatic tumor emboli, and the location of metastatic lymph nodes in the central compartment were analyzed according to pertinent pathological methods. The complications following CL were compared between CL and control groups. RESULTS: A total of 43 patients with PTC underwent CL. Forty of them (95%) presented extracapsular spread of the primary tumor and 42 patients (98%) presented tumor emboli in lymphovascular space of tumors. Twenty-nine patients (67%) had lymph node metastasis in the central compartment. No statistical correlation between tumor size or location of primary tumor and subsites of the metastatic lymph nodes was found. The complication rates of vocal cord paralysis or hypocalcemia showed no statistical difference between groups. Seven patients with previous history of total thyroidectomy underwent central lymphadenectomy for recurred PTC and one hypocalcemia and two vocal cord paralysis were encountered, respectively. CONCLUSION: Our results suggest that high nodal metastases rates of PTC into the central compartment and no significant increase of postoperative morbidity can justify CL combined with total thyroidectomy in patients with PTC.