Prophylactic Bilateral Central Neck Dissection Should Be Evaluated Based on Prospective Study of 581 PTC Patients

Abstract

Background: Prophylactic central lymph node dissection (PCND) had been a basic consensus for patients with papillary thyroid carcinoma in China. However, unilateral or bilateral central lymph node dissection (CND)was still controversial. This study aimed at investigating the safety and long-term benefit for the patients with bilateral central lymph node dissection (BCCD). Methods: 581 patients were enrolled and divided randomly into the test and control groups according to a different range of CND. 285 patients were prospectively assigned to undergo lobe thyroidectomy plus BCND in the test group, in comparison 296 patients were assigned to undergo lobe thyroidectomy plus ipsilateral central lymph node dissection (ICND) in the control group. Results: We found that the numbers of total LN and N1a in the test group were higher than that of the control group (p=0.002), but there was no difference in the number of metastasized lymph nodes (p=0.857) and tumor recurrence (p=0.308). Additionally, in the aspect of postoperative complication (1 day after surgery), the serum levels of parathyroid hormone in the BCND group were lower than that in the ICND group (P =0.010), and the numbers of transient laryngeal nerve palsy were higher than that(p=0.033). meanwhile we further found that tumors size larger than 1cm and tumor side lymph node metastasis were related to the contralateral lymph node metastasis. Conclusion: BCND resulted in more positive lymph nodes and complications while did not change the patient's long-term prognosis. It may be an alternative for patients with tumor sizes larger than 1cm in large medical centers.