Prophylactic neck dissection for low-risk differentiated thyroid cancers: Risk-benefit analysis

Head Neck. 2016 Jul;38(7):1091-6. doi: 10.1002/hed.24402. Epub 2016 Feb 13.

Abstract

Background: The benefit of neck dissection is the subject of debate in differentiated thyroid cancer (DTC). We analyze the risk-benefit of neck dissection for low-risk DTC without detectable lymph nodes.

Methods: We conducted a retrospective study from 1983 to 2003; which included 295 patients without detectable lymph nodes who were treated by thyroidectomy with (C+) or without (C-) neck dissection. All patients had iodine131 therapy. We compared the frequency of remission, disease progression, and permanent complications between groups.

Results: Two hundred twelve patients comprised the C+ group, and 83 patients the C- group. Respectively for C+ versus C-, remission rates were 92% versus 89.2% (p = .40), and progressive disease observed was 3.3% versus 7.2% (p = .10). Permanent hypoparathyroidism occurred in 15.1% in C+ versus 3.6% in C- (p = .006).

Conclusion: The risk-benefit analysis of neck dissection in patients with low-risk DTC shows no benefit in terms of complete remission or occurrence of progression. However, risk of complications seems to be higher in patients with neck dissection. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1091-1096, 2016.

Keywords: cancers; dissection; low-risk; prophylactic; thyroid.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Papillary / pathology*
  • Carcinoma, Papillary / surgery*
  • Chi-Square Distribution
  • Cohort Studies
  • Combined Modality Therapy
  • Female
  • Humans
  • Lymph Nodes / pathology
  • Male
  • Middle Aged
  • Neck Dissection / adverse effects
  • Neck Dissection / methods*
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Primary Prevention / methods
  • Prognosis
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Thyroid Cancer, Papillary
  • Thyroid Neoplasms / pathology*
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy / adverse effects
  • Thyroidectomy / methods*
  • Treatment Outcome