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Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma.

OBJECTIVE
To assess the disease-free survival results of prophylactic central neck dissection for papillary thyroid carcinoma preoperatively staged as N0.


DESIGN
Inception cohort.


SETTING
Head and neck surgery unit at a national oncologic center.


PATIENTS
Patients with a histologically confirmed diagnosis of stage N0 papillary thyroid cancer but no previous oncologic treatment, no recurrent tumor, and no distant metastasis.


INTERVENTION
Central neck dissection intended as curative treatment.


MAIN OUTCOME MEASURE
Disease-free survival. Demographic, clinical, therapeutic, pathologic, and neck recurrence information was also collected.


RESULTS
A total of 266 patients were included. Mean (SD) follow-up time was 6.9 (4.3) years. Ninety percent of patients had a follow-up longer than 2 years. Prophylactic central neck dissection was performed in 136 patients (51.3%). Of those patients who underwent central neck dissection, 112 had metastatic lymph nodes (82.3%). Neck recurrence occurred in 45 patients (16.9%). Overall, 5-year neck disease-free survival was 86.8%; it was 88.2% in the central neck dissection group vs 85.6% in the group that did not undergo central neck dissection (P = .72). In the multivariate analysis, factors related to central neck dissection were macroscopic extrathyroidal extension (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.19-3.79) and multifocality (OR, 3.96; 95% CI, 2.08-7.53). In Cox multivariate analysis for disease-free survival, central neck dissection did not show any significant effect.


CONCLUSION
Prophylactic central neck dissection did not show any advantage in the rate of neck recurrence in patients with N0 clinical stage disease.