Prophylactic Central Neck Dissection in Stage N0 Papillary Thyroid Carcinoma

Objective: To assess the disease-free survival results of prophylactic central neck dissection for papillary thyroid carcinoma preoperatively staged as N0. Design: Inception cohort. Setting: Head and neck surgery unit at a national oncologic center. Patients: Patients with a histologically confirmed diagnosis of stage N0 papillary thyroid cancer but no previous oncologic treatment, no recurrent tumor, and no distant metastasis. Intervention: Central neck dissection intended as curative treatment. Main Outcome Measure: Disease-free survival. Demographic, clinical, therapeutic, pathologic, and neck recurrence information was also collected. Results: A total of 266 patients were included. Mean (SD) follow-up time was 6.9 (4.3) years. Ninety percent of patients had a follow-up longer than 2 years. Prophylactic central neck dissection was performed in 136 patients (51.3%). Of those patients who underwent central neck dissection, 112 had metastatic lymph nodes (82.3%). Neck recurrence occurred in 45 patients (16.9%). Overall, 5-year neck disease-free survival was 86.8%; it was 88.2% in the central neck dissection group vs 85.6% in the group that did not undergo central neck dissection (P = .72). In the multivariate analysis, factors related to central neck dissection were macroscopic extrathyroidal extension (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.19-3.79) and multifocality (OR, 3.96; 95% CI, 2.08-7.53). In Cox multivariate analysis for disease-free survival, central neck dissection did not show any significant effect. Conclusion: Prophylactic central neck dissection did not show any advantage in the rate of neck recurrence in patients with N0 clinical stage disease.