Impact of prophylactic central lymph node dissection on the complications and recurrence rates in papillary thyroid carcinoma—An AFCE (French‐speaking Association of Endocrine Surgery) multicentre study based on the EUROCRINE® national data

Abstract

Background

Prophylactic central neck dissection (pCND) remains controversial during the initial surgery for preoperative and intraoperative node‐negative (cN0) papillary thyroid carcinoma (PTC).

Methods

Patients undergoing thyroidectomy with or without pCND (Nx) for PTC in nine French surgical departments, registered in the EUROCRINE® national data in France between January 2015 and June 2021, were included in a cohort study. Demographic and clinicopathological characteristics, complications, and recurrence rates were compared using multivariate regression analysis.

Results

A total of 1905 patients with cN0 PTC were enrolled, including 1534 who had undergone pCND and 371 who hadn't (Nx). Of these, 1546 (81.2%) were female, and the median age was 49 years (range: 15–89 years). Patients who had undergone pCND were more likely to have multifocal tumors ( n = 524 [34.2%] vs. n = 68 [18.3%], p < .001) and larger tumors (15.3 vs. 10.2 mm, p = .01) than patients with Nx. Of the patients with pCND, 553 (36%) had positive central LN (N1a), with a median of 1 N1 (IQR 0–5). pCND was associated with a higher temporary hypocalcemia rate ( n = 25 [8%] vs. n = 15 [4%], p < .001). The rates of permanent hypocalcemia and temporary and permanent recurrent laryngeal nerve (RLN) palsy were not significantly different between the two groups ( p > .2). After adjusting for covariates (age, sex, multifocality, and pathological T stage) in a multivariable Cox PH model, the performance of lymph node dissection (pCND vs. no‐pCND) was not associated with PTC recurrence ( p = .2).

Conclusion

pCND in PTC does not reduce recurrence and is associated with a two‐fold increase in the incidence of transient hypoparathyroidism. These data should be considered while issuing further guidelines regarding the treatment of patients with cN0 PTC.