@article{877deb3a69fd4eceb2c0847cc26e832d,
title = "Decision making for the central compartment in differentiated thyroid cancer",
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).",
keywords = "Central compartment, Level VI, Lymph node metastases, Neck dissection, Surgery, Thyroid cancer, Thyroidectomy",
author = "{Gon{\c c}alves Filho}, Jo{\~a}o and Zafereo, {Mark E.} and Ahmad, {Faisal I.} and Nixon, {Iain J.} and Shaha, {Ashok R.} and {Vander Poorten}, Vincent and Alvaro Sanabria and Hefetz, {Avi Khafif} and Robbins, {K. Thomas} and Dipti Kamani and Randolph, {Gregory W.} and Andres Coca-Pelaz and Ricard Simo and Alessandra Rinaldo and Peter Angelos and Alfio Ferlito and Kowalski, {Luiz P.}",
note = "Funding Information: Recently, two prospective studies examining the benefit and risks of elective CND were published. Viola et al. (2015) in a randomized controlled study evaluated 181 patients with PTC without evidence of lymph node metastases (cN0), among these, 88 patients were treated with TT, and 93 patients were treated with TT with elective CND. The mean follow-up time for this study was 59 ± 7 months. The study confirmed a high prevalence of lymph node micrometastases (46%). Nevertheless, patients in both groups had a comparable outcome, with the similar percentage of disease free patients and of patients with biochemical and structural recurrence in each group. This result strongly supports the concept that lymph node micrometastases do not affect the clinical outcome of PTC patients. Postoperative complications were higher in patients who underwent TT with CND [46]. Lee et al. (2015) performed a prospective randomized study to evaluate the benefit of prophylactic CND in 257 patients with PTC who were clinically node-negative (cN0). Of these, 104 patients had TT alone, and 153 patients had TT with elective CND. The mean follow-up duration was 49 ± 16 months for patients undergoing a TT versus 55 ± 11 months for patients who had a TT plus CND. Micrometastasis was found in 23% of the patients who underwent elective CND. There was no significant difference in the disease recurrence rates between the two groups (3.9% in the TT versus 3.3% in the TT with elective CND). However, the complication rate in the TT with elective CND group was significantly higher than that in the TT only group [67]. Publisher Copyright: {\textcopyright} 2018",
year = "2018",
month = nov,
doi = "10.1016/j.ejso.2018.08.005",
language = "English (US)",
volume = "44",
pages = "1671--1678",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",
number = "11",
}