Decision making for the central compartment in differentiated thyroid cancer |
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| Authors: | João Gonçalves Filho Mark E. Zafereo Faisal I. Ahmad Iain J. Nixon Ashok R. Shaha Vincent Vander Poorten Alvaro Sanabria Avi Khafif Hefetz K. Thomas Robbins Dipti Kamani Gregory W. Randolph Andres Coca-Pelaz Ricard Simo Alessandra Rinaldo Peter Angelos Alfio Ferlito Luiz P. Kowalski |
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| Affiliation: | 1. Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil;2. Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA;3. Consultant Otorhinolaryngologist Head and Neck Surgeon NHS Lothian/ Edinburgh University, UK;4. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;5. Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium;6. Head and Neck Surgeon, Department of Surgery, School of Medicine, Universidad de Antioquia-Fundacion Colombiana de Cancerologia-Clinica Vida, Medellin, Colombia;7. ARM Center for Advanced Otolaryngology Head and Neck Surgery, Assura Medical Center, Tel Aviv, Israel;8. Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA;9. Division of General Otolaryngology and Thyroid and Parathyroid Endocrine Surgery, Mass. Eye and Ear, Boston, MA, USA;10. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain;11. Consultant Otorhinolaryngologist Head and Neck Surgeon Head and Neck Cancer Unit Guy''s and St Thomas'' Hospital NHS Foundation Trust London, London, UK;12. University of Udine School of Medicine, Udine, Italy;13. Professor of Surgery, Chief of Endocrine Surgery, University of Chicago Medicine, Chicago IL, USA;14. Formerly Director of the Department of Surgical Sciences and Chairman of the ENT Clinic at the University of Udine School of Medicine, Udine, Italy |
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| Abstract: | The central compartment is a common site for nodal spread from differentiated thyroid carcinoma, often occurring in patients without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0). However, the role of elective central compartment neck dissection (CND) among patients with DTC remains controversial. We performed a systematic literature review, also including review of international guidelines, with discussion of anatomic and technical aspects, as well as risks and benefits of performing elective CND. The recent literature does not uniformly support or refute elective CND in patients with DTC, and therefore an individualized approach is warranted which considers individual surgeon experience, including individual recurrence and complication rates. Patients (especially older males) with large tumors (>4 cm) and extrathyroidal extension are more likely to benefit from elective CND, but elective CND also increases risk for hypoparathyroidism and recurrent nerve injury, especially when operated by low-volume surgeons. Individual surgeons who perform elective CND must ensure the number of central compartment dissections needed to prevent one recurrence (number needed to treat) is not disproportionate to their individual number of central compartment dissections per related complication (number needed to harm). |
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| Keywords: | Thyroid cancer Central compartment Neck dissection Thyroidectomy Lymph node metastases Level VI Surgery |
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