Advertisement

Central Lymph Node Dissection for Well-Differentiated Cancer

  • Allan Siperstein

Abstract

The goal of any operation for well-differentiated thyroid cancer is to provide the best oncologic outcome, individualized to the patient, but avoid the morbidity of excessively radical procedures. Clinically involved central neck lymph nodes require removal. A major area of controversy is whether prophylactic central neck dissection is required for thyroid cancer of follicular cell origin. The exact definition of a prophylactic versus a therapeutic neck dissection varies. When neck dissection is performed, there is varied practice in terms of how thoroughly the central compartment is cleared of its nodal burden. There is also controversy as to whether a unilateral versus a bilateral central neck dissection should be performed. How to interpret or act on the final pathologic findings is also an area of controversy. Although any nodal involvement is staged as N1 disease, biologically the findings of microscopic nodal involvement are clearly different than that of nodal replacement or extranodal extension. In terms of gaining a better perspective into any of these areas, it is important to understand that with well-differentiated thyroid cancer, although this may impact the recurrence rate in the neck, given the excellent long-term survival, mortality is unlikely to be affected.

Keywords

Central neck dissection Thyroid cancer Prophylactic neck dissection 

References

  1. 1.
    Milas M, Shin J, Gupta M, Novosel T, Nasr C, Brainard J, Mitchell J, Berber E, Siperstein A. Circulating thyrotropin receptor mRNA as a novel marker of thyroid cancer: clinical applications learned from 1758 samples. Ann Surg. 2010;252(4):643–51.PubMedGoogle Scholar
  2. 2.
    Xing M, Alzahrani AS, Carson KA, Viola D, Elisei R, Bendlova B, Yip L, Mian C, Vianello F, Tuttle RM, Robenshtok E, Fagin JA, Puxeddu E, Fugazzola L, Czarniecka A, Jarzab B, O'Neill CJ, Sywak MS, Lam AK, Riesco-Eizaguirre G, Santisteban P, Nakayama H, Tufano RP, Pai SI, Zeiger MA, Westra WH, Clark DP, Clifton-Bligh R, Sidransky D, Ladenson PW, Sykorova V. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA. 2013;309(14):1493–501.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Crile G, Suhrer J, Hazard J. Results of conservative operations for malignant tumors of the thyroid. J Clin Endocrinol Metab. 1955;15(11):1422–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, Randolph GW, Stack Jr BC, Steward DL, Terris DJ, Thompson GB, Tufano RP, Tuttle RM, Udelsman R. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer: the American thyroid association surgery working group with participation from the American association of endocrine surgeons, American academy of otolaryngology—head and neck surgery, and American head and neck society. Thyroid. 2009;19(11):1153–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Carling T, Carty SE, Ciarleglio MM, Cooper DS, Doherty GM, Kim LT, Kloos RT, Mazzaferri Sr EL, Peduzzi PN, Roman SA, Sippel RS, Sosa JA, Stack Jr BC, Steward DL, Tufano RP, Tuttle RM, Udelsman R, American Thyroid Association Surgical Affairs Committee. American thyroid association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22(3):237–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW. Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol. 2012;19(13):4217–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Moreno MA, Edeiken-Monroe BS, Siegel ER, Sherman SI, Clayman GL. In papillary thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. GL. thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. Thyroid. 2012;22(4):347–55.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, Barbieri V. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. 2012;22(9):911–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol. 2013;20(11):3477–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, Tufano RP, Tuttle RM. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22(11):1144–52.CrossRefPubMedGoogle Scholar
  11. 11.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Endocrine Surgery DepartmentCleveland ClinicClevelandUSA

Personalised recommendations