PROPHYLACTIC CENTRAL NECK DISSECTION FOR PAPILLARY THYROID CANCER EFFECT ON LOCOREGIONAL RECURRENCE AND COMPLICATIONS; A PROPENSITY SCORE MATCH ANALYSIS WITH LONG TERM FOLLOW-UP

AUTHORS:
N. Voloudakis (Thessaloniki, Greece) , E. Bellou (Thessaloniki, Greece) , A. Basios (Thessaloniki, Greece) , G. Kotoreni (Thessaloniki, Greece) , M. Velikoudi (Thessaloniki, Greece) , S. Atmatzidis (Thessaloniki, Greece) , B. Papaziogas (Thessaloniki, Greece) , I. Koutelidakis (Thessaloniki, Greece)
Background:
Prophylactic central neck dissection (pCND) in addition to total thyroidectomy (TT) includes removal of central compartment lymph nodes in the absence of clinical involvement on preoperative and intraoperative evaluation. Data on the long-term oncologic outcomes and surgical complications in the literature remain conflicted and is the aim of investigation in this study
Methods:
A retrospective review of prospectively collected data of patients that underwent thyroid operations for papillary cancer between 2013 and 2019 was performed. Patients receiving either TT or TT+pCND were identified, and then matched with propensity score for age, sex and tumor diameter. Demographic data, final histology, transient or permanent complications, and recurrence rates were evaluated
Results:
During the study period, out of 293 patients with papillary cancer, 77 patients underwent TT and 48 TT + PCND for a Bethesda V or VI nodule. The latter were matched with 47 TT patients. Three patients were lost to follow-up. After matching, the two groups had a significant difference only concerning N1 stage (TT: 4.8% Vs pCND: 46.3%, p<0.001). Concerning complications, a significant difference was observed only in transient hypoparathyroidism (TT: 31.1% Vs pCND: 56.3%, p=0.017). No disease specific death occurred, while for a median follow up of 87.5 months (range: 49-119) no difference in recurrence was observed (TT: 4.2% vs pCND: 2.1%, p=1)
Conclusions:
Although prophylactic central neck dissection detected occult lymph node metastasis at a high rate, this did not provide improved oncologic outcomes in this series, while being associated with increased rates of transient hypoparathyroidism.