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Management of Differentiated Thyroid Cancer pp 181–188Cite as

The Debate against Elective Lymph Node Dissection in Papillary Thyroid Carcinoma

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Abstract

In this chapter we set out the debate against elective neck dissection for differentiated thyroid cancer. We critically analyze the arguments that this practice results in improved survival and reduced rates of recurrence and prevents complications from avoiding future salvage surgery and that it streamlines treatment by selecting those patients most likely to benefit from adjuvant therapy. We go on to consider the morbidity of the procedure in the hands of the majority of surgeons who treat differentiated thyroid cancer and discuss the indolent biology of occult metastases during observation. We highlight the cost arguments against elective neck dissection and describe in detail the incidence and operative findings in salvage surgery which refute the claims that prophylactic surgery prevents future morbidity. The accepted calculation which shows that oncological benefit will never be proven statistically means that the clinical significance of increased morbidity and cost will always outweigh any marginal oncological benefit derived. We conclude that elective neck surgery cannot be justified in differentiated thyroid cancer, especially in low-risk patients.

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Abbreviations

ATA:

American Thyroid Association

DTC:

Differentiated thyroid cancer

ECND:

Elective central neck dissection

ELND:

Elective lateral neck dissection

END:

Elective neck dissection

PTC:

Papillary thyroid cancer

RAI:

Radioactive iodine

Tg:

Thyroglobulin

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Author information

Authors and Affiliations

  1. Edinburgh University, Edinburgh, UK

    Iain J. Nixon Ph.D.

  2. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10061, USA

    Ashok R. Shaha M.D.

Authors
  1. Iain J. Nixon Ph.D.
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  2. Ashok R. Shaha M.D.
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Corresponding author

Correspondence to Iain J. Nixon Ph.D. .

Editor information

Editors and Affiliations

  1. General Surgery, Central Arkansas Veterans Healthcare System, University of Arkansas, Little Rock, Arkansas, USA

    Anne T. Mancino

  2. Division of Surgical Oncology, University of North Carolina, Chapel Hill, North Carolina, USA

    Lawrence T. Kim

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Nixon, I.J., Shaha, A.R. (2017). The Debate against Elective Lymph Node Dissection in Papillary Thyroid Carcinoma. In: Mancino, A., Kim, L. (eds) Management of Differentiated Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-54493-9_15

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