Efficacy of prophylactic central neck dissection in hemithyroidectomy for papillary thyroid carcinoma

  • Seok Hyun Jin
  • In-Sik Kim
  • Yong Bae Ji
  • Chang Myeon Song
  • Min Sung Chung
  • Kyung TaeEmail author
Head and Neck



To evaluate the efficacy of prophylactic central neck dissection (pCND) in hemithyroidectomy for clinically node-negative papillary thyroid carcinoma (PTC).


We retrospectively analyzed 299 patients who underwent thyroid lobectomy with or without pCND for unilateral PTC. Of the 299 patients, 245 (81.9%) underwent unilateral pCND along with lobectomy, and 54 (18.1%) patients underwent lobectomy without pCND. Propensity score matching was performed for five covariates to reduce selection bias.


In the baseline cohort of 299 patients, mean age, extrathyroidal extension, T classification and stage were higher in the cases undergoing pCND than in those not undergoing pCND. After propensity score matching, the significant differences between the two groups seen in the baseline cohort disappeared. Recurrence rates and recurrence-free survival curves did not differ between the 2 matched groups each of 54 patients.


The value of pCND in hemithyroidectomy for PTC is limited.


Papillary thyroid carcinoma Hemithyroidectomy Thyroid lobectomy Prophylactic central neck dissection Propensity score matching 


Compliance with ethical standards

Conflict of interest

The authors have no funding, financial relationships, or conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were done so in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567CrossRefGoogle Scholar
  2. 2.
    Ji YB, Lee DW, Song CM, Kim KR, Park CW, Tae K (2014) Accuracy of intraoperative determination of central node metastasis by the surgeon in papillary thyroid carcinoma. Otolaryngol Head Neck Surg 150:542–547CrossRefGoogle Scholar
  3. 3.
    Ji YB, Yoo HS, Song CM, Park CW, Lee CB, Tae K (2016) Predictive factors and pattern of central lymph node metastasis in unilateral papillary thyroid carcinoma. Auris Nasus Larynx 43:79–83CrossRefGoogle Scholar
  4. 4.
    Shah JP, Loree TR, Dharker D, Strong EW, Beqq C, Vlamis V (1992) Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 164:658–661CrossRefGoogle Scholar
  5. 5.
    Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH (2003) Papillary microcarcinoma of the thyroid—prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40CrossRefGoogle Scholar
  6. 6.
    Podnos YD, Smith D, Wagman LD, Ellenhorn JD (2005) The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg 71:731–734PubMedGoogle Scholar
  7. 7.
    Zaydfudim V, Feurer ID, Griffin MR, Phay JE (2008) The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery 144:1070–1077CrossRefGoogle Scholar
  8. 8.
    Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS (1993) Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1058PubMedGoogle Scholar
  9. 9.
    Shaga AR, Shah JP, Loree TR (1996) Risk group stratification and prognostic factors in papillary carcinoma of the thyroid. Ann Surg Oncol 3:534–538CrossRefGoogle Scholar
  10. 10.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–131CrossRefGoogle Scholar
  11. 11.
    Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G et al (2014) British thyroid association guidelines for the management of thyroid cancer. Clin Endocrinol Oxf 81:1–122CrossRefGoogle Scholar
  12. 12.
    Tuttle RM, Haddad RI, Ball DW et al (2014) Thyroid carcinoma, version 2.2014. J Natl Compr Canc Netw 12:1671–1680CrossRefGoogle Scholar
  13. 13.
    Chisholm EJ, Kulinskaya E, Tolley NS (2009) Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope 119:1135–1139CrossRefGoogle Scholar
  14. 14.
    Barczynski M, Konturek A, Stopa M, Nowak W (2013) Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg 100:410–418CrossRefGoogle Scholar
  15. 15.
    Popadich A, Levin O, Lee JC, Smooke-Praw S, Ro K, Fazel M et al (2011) A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery 150:1048–1057CrossRefGoogle Scholar
  16. 16.
    Lee DW, Ji YB, Sung ES, Park JS, Lee YJ, Park DW, Tae K (2013) Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol 39:191–196CrossRefGoogle Scholar
  17. 17.
    Ji YB, Lee KJ, Park YS, Hong SM, Paik SS, Tae K (2012) Clinical efficacy of sentinel lymph node biopsy using methylene blue dye in clinically node negative papillary thyroid carcinoma. Ann Surg Oncol 19:1868–1873CrossRefGoogle Scholar
  18. 18.
    Raffaelli M, De Crea C, Sessa L, Giustacchini P, Revelli L, Bellantone C et al (2012) Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery 152:957–964CrossRefGoogle Scholar
  19. 19.
    Mazzaferri EL, Kloos RT (2001) Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 86:1447–1463CrossRefGoogle Scholar
  20. 20.
    Barney BM, Hitchcock YJ, Sharma P, Shrieve DC, Tward JD (2011) Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer. Head Neck 33:645–649CrossRefGoogle Scholar
  21. 21.
    Mendelsohn AH, Elashoff DA, Abemayor E, St John MA (2010) Surgery for papillary thyroid carcinoma: is lobectomy enough? Arch Otolaryngol Head Neck Surg 136:1055–1061CrossRefGoogle Scholar
  22. 22.
    Lee J, Park JH, Lee CR, Chung WY, Park CS (2013) Long-term outcomes of total thyroidectomy versus thyroid lobectomy for papillary thyroid microcarcinoma: comparative analysis after propensity score matching. Thyroid 23:1408–1415CrossRefGoogle Scholar
  23. 23.
    Yoo BJ, Song CM, Ji YB, Lee JY, Park HJ, Tae K (2019) Efficacy of central neck dissection for clinically node-negative papillary thyroid carcinoma: propensity scoring matching. Front Endocrinol 10:172CrossRefGoogle Scholar
  24. 24.
    Mazzaferri EL, Doherty GM, Steward DL (2009) The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid 19:683–689CrossRefGoogle Scholar
  25. 25.
    Hughes DT, White ML, Miller BS, Gauger PG, Burney RE, Doherty GM (2010) Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery 148:1100–1106CrossRefGoogle Scholar
  26. 26.
    Bonnet S, Hartl D, Leboulleux S, Baudin E, Lumbroso JD, Al Ghuzlan A et al (2009) Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab 94:1162–1167CrossRefGoogle Scholar
  27. 27.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142CrossRefGoogle Scholar
  28. 28.
    Sancho JJ, Lennard TW, Paunovic I, Triponez F, Sitges-Serra A (2014) Prophylactic central neck dissection in papillary thyroid cancer: a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 399:155–163CrossRefGoogle Scholar
  29. 29.
    Hyun SM, Song HY, Kim SY, Nam SY, Roh JL, Han MW et al (2012) Impact of combined prophylactic unilateral central neck dissection and hemithyroidectomy in patients with papillary thyroid microcarcinoma. Ann Surg Oncol 19:591–596CrossRefGoogle Scholar
  30. 30.
    Lee DK (2016) An introduction to propensity score matching methods. Anesth Pain Med 11:130–148CrossRefGoogle Scholar
  31. 31.
    Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424CrossRefGoogle Scholar
  32. 32.
    Shan CX, Zhang W, Jiang DZ, Zheng XM, Liu S, Qiu M (2012) Routine central neck dissection in differentiated thyroid carcinoma: a systematic review and meta-analysis. Laryngoscope 122(4):797–804CrossRefGoogle Scholar
  33. 33.
    Zheng CM, Ji YB, Song CM, Ge MH, Tae K (2018) Number of metastatic lymph nodes and ratio of metastatic lymph nodes to total number of retrieved lymph nodes are risk factors for recurrence in patients with clinically node negative papillary thyroid carcinoma. Clin Exp Otorhinolaryngol 11(1):58–64CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology-Head and Neck Surgery, College of MedicineHanyang UniversitySeoulRepublic of Korea
  2. 2.Graduate of Medicine, College of MedicineHanyang UniversitySeoulRepublic of Korea
  3. 3.Department of Surgery, College of MedicineHanyang UniversitySeoulRepublic of Korea

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