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Lymph node dissection should be part of regular thyroid cancer surgery
Popadich A. Surgery. 2011;epub ahead of print.
Requiring patients to undergo routine central lymph node dissection when having surgery for papillary thyroid cancer resulted in lower post-operative thyroglobulin levels and lower rates of central neck re-operation.
Although central lymph node dissection is standard in some surgical centers, the practice is not agreed upon worldwide, according to background information in the article.
The researchers conducted a retrospective multicenter study using pooled data from 606 patients who received care in the endocrine units at one of three international hospitals in the United States, England or Australia.
The patients were separated into two groups. Patients in Group A (n=347) underwent total thyroid removal for cancer alone. Patients in Group B (n=259) underwent total thyroid removal and central lymph node dissection.
Overall, 6.9% of the study population had disease recurrence. Patients in Group B had a significantly lower rate of central neck re-operation (1.5%) compared with patients in Group A (6.1%; P=.004). In addition, patients in Group B had nonsignificantly lower rates of stimulated thyroglobulin compared with patients in Group A (15 ng/mL vs. 6.6 ng/mL).
However, patients in Group B also had significantly higher rates of temporary hypocalcemia (9.7%) compared with patients in Group A (4.1%; P=.03), a finding that can be “explained by the higher rate of parathyroid autotransplantation in Group B,” the researchers said.
“If performed as a matter of routine, [central lymph node dissection] in addition to total thyroidectomy is associated with a trend toward lower recurrence rates of papillary thyroid cancer and an apparent reduction in the need for re-operation in the central compartment,” the researchers concluded.
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