Prophylactic central lymph node dissection in cN0 patients with papillary thyroid carcinoma: A retrospective study in China

The objective of the study was to assess the patterns of central cervical lymph node metastasis (CLNM) and evaluate the prophylactic central lymph node dissection (CLND) in papillary thyroid carcinoma (PTC) patients without clinical positive lymph nodes.We retrospectively reviewed 1555 patients with PTC between 2003 and 2008. Lymph node metastatic risk factors and the pattern of lymph node metastasis in PTC were studied using multivariate analysis.Male patients, aged ≤ 45 years, the presence of extrathyroidal extension, and a primary tumor size > 10 mm were identified as risk factors for CLNM with odds ratios of 2.089, 2.417, 1.534, and 3.079, respectively. Among 1555 patients, 97 cases (6.24%) had transient hypoparathyroidism, and only two patients (0.13%) had permanent hypoparathyroidism. Recurrent laryngeal nerve injury after thyroidectomy occurred in 14 patients (0.9%). In this group, nine cases were transient injury and the remaining five were permanent. During the period of follow-up, ranging from 5 years to 10 years, 18 patients (1.16%) were found with locoregional recurrence.Taken together, in terms of the high incidence rate of CLNM in cN0 PTC patients, we believe that routine prophylactic CLND is optimal for clinically negative PTC patients, during their first treatment, especially for those with risk factors for CLNM.