PROPHYLACTIC CENTRAL COMPARTMENT LYMPH NODE DISSECTION IN CN0 PAPILLARY THYROID CANCER: NO IMPACT ON SURGICAL AND ONCOLOGICAL OUTCOMES AFTER 10 YEARS OF FOLLOW-UP - FINDINGS FROM A PROSPECTIVE RANDOMIZED CONTROLLED SINGLE INSTITUTION STUDY

AUTHORS:
P. Papini (Pisa, Italy) , L. Rossi (Pisa, Italy) , A. De Renzis (Pisa, Italy) , L. Sacco (Pisa, Italy) , C. Becucci (Pisa, Italy) , C.E. Ambrosini (Pisa, Italy) , A. Matrone (Pisa, Italy) , R. Elisei (Pisa, Italy) , G. Materazzi (Pisa, Italy)
Background:
Papillary thyroid cancer (PTC) is the dominant histotype in thyroid tumors, with reported central compartment metastases in 65% of cases. Prophylactic central compartment dissection(pCCND) in cN0 patients is debated. This prospective randomized study aims to assess the clinical, surgical, and oncological benefits and drawbacks of pCCND over ten years of follow-up
Methods:
Between 2008 and 2010, 181 cN0 PTC patients were randomly assigned to two groups. Group A underwent total thyroidectomy(TT), and Group B underwent TT+pCCND. Post-surgery, following European guidelines, patients received low-dose radioiodine treatment(30 mCi), with additional doses(100-150 mCi) as needed. Monitoring, including serum Thyroglobulin(Tg), Tg Antibodies(AbTg), and neck ultrasounds, occurred every 12-18 months.
Results:
At the end of the follow-up, 31 patients were lost, leaving 150 in the study (Group A: 70,Group B: 80). Both groups were comparable in age(p=0.641), BMI(p=0.113), nodule diameter(p=0.148), and tumor characteristics. After more than 10 years(mean follow-up: 12,9±2 years), no significant differences were observed in surgical and oncological outcomes. Mean Tg levels were 0.11±0.05 ng/ml(Group A) and 0.33±1,26 ng/ml (Group B)(p=0.146). Only one Group B patient had serum Tg antibody levels exceeding 15 IU/ml, with no variations. No significant differences in complication rates (permanent hypoparathyroidism, p=0.229; permanent vocal cord paralysis, p=0.640) and recurrence(p=0.640) were noted. Neither radioiodine dose(p=0.820) differed. The only observed distinction was more parathyroid removal in pCCND cases based on histological examination(p=0.005).
Conclusions:
Patients with PTC without preoperative or intraoperative evidence of suspicious lymph nodes (cN0), whether treated with TT alone or TT+pCCND, exhibited similar outcomes in terms of recurrence, disease persistence, and complications.