Background: Prophylactic central compartment clearance has been a debate for early papillary thyroid carcinoma (PTC). The American Thyroid Association recommends total thyroidectomy alone for small tumors without clinical nodes. However, we note a high incidence of nodal disease within our practice. This study aims to evaluate the incidence of metastatic central compartment nodes in small (<4 cm) PTC. Secondary aims included postoperative hypoparathyroidism and recurrent laryngeal nerve injury.
Materials and methods: A retrospective cohort study was performed evaluating patients who had thyroid surgery from January 2011 to October 2016. Patients with total thyroidectomy alone were compared with those with prophylactic central neck dissection (pCND). Histology was reviewed for tumor size and nodal disease.
Results: One hundred and six patients were recruited for this study. More than half of thyroidectomies with pCND were found to be positive (36/57). This is regardless of tumor size, although tumor >20 mm was more likely to have a nodal disease (OR 2.40 95%; CI 0.58–9.87; p = 0.23). T3 disease was more likely to have a nodal disease (15/21 sides) (OR 1.79; 95% CI 0.56–5.67; p = 0.33). More patients in the pCND arm developed transient hypoparathyroidism (14/22 vs 4/17) but all resolved within a year. One patient developed hoarseness alone while three patients reported dysphagia in the pCND arm compared to one patient in the total thyroidectomy arm with dysphagia.
Conclusion: More than half of patients with PTC (<4 cm) have metastatic central compartment nodes. Prophylactic central neck dissection can be safely performed. However, we still lack adequate data on long-term effects.
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