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Total Thyroidectomy Without Prophylactic Central Cervical Lymph Node Dissection: Is It Oncologically Safe in Patients with Early-Stage Papillary Thyroid Carcinoma

Received: 5 November 2017     Accepted: 15 November 2017     Published: 11 December 2017
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Abstract

Background: The necessity and the benefits of prophylactic central cervical lymph node dissection (PCLND) in clinically node negative patients with early-stage papillary thyroid carcinoma (PTC) remain controversial. Objective: to evaluate the safety of total thyroidectomy without PCLND in clinically node-negative early-stage PTC. Patients & Methods: 34 patients with T1 or T2 & N0 PTC were included in the study and submitted to total thyroidectomy without PCLND. Post-operatively, all patients received TSH suppression therapy & radio-active iodine (RAI) ablation. Any suspicious local neck recurrence during the follow up was confirmed cytologically and treated by RAI ablation. Results: The mean age was 42.1 years. 55.9% of patients were less than 45 years and 44.1% were 45 years old or more. Male to female ratio was 10:24. T1 was found in 14 cases & T2 in 20 cases. Total thyroidectomy was successfully done for all the cases. Central cervical lymph nodes sampling was done in 5 cases. Excised lymph nodes were found in 8 specimens; 5 cases with lymph node sampling (14.7%) and 3 cases (8.8%) with accidental lymph node excision during thyroidectomy. only 6 of these 8 patients (17.6%) showed positive metastasis (pN1). No recurrent laryngeal nerve injury was reported. In 12 patients (35.3%), temporary hypocalcemia was encountered. The mean follow up period was 34.6 months. There were 2 recurrences (5.9%); 1 in the central & 1 in the lateral neck compartment. All recurrences were treated by RAI ablation. No distant metastasis or mortality was reported. Conclusion: total thyroidectomy without PCLND in clinically node-negative early stage PTC is an excellent treatment option that gives adequate loco-regional control of the disease with low rate of surgical complications. Close follow up for longer periods is needed.

Published in Journal of Surgery (Volume 5, Issue 6)
DOI 10.11648/j.js.20170506.17
Page(s) 124-129
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Papillary Thyroid Carcinoma, Cervical Lymph Node Dissection, Total Thyroidectomy

References
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    Tamer Abd-Elhafez El-Bakary, Mohamed Aly Mlees. (2017). Total Thyroidectomy Without Prophylactic Central Cervical Lymph Node Dissection: Is It Oncologically Safe in Patients with Early-Stage Papillary Thyroid Carcinoma. Journal of Surgery, 5(6), 124-129. https://doi.org/10.11648/j.js.20170506.17

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    ACS Style

    Tamer Abd-Elhafez El-Bakary; Mohamed Aly Mlees. Total Thyroidectomy Without Prophylactic Central Cervical Lymph Node Dissection: Is It Oncologically Safe in Patients with Early-Stage Papillary Thyroid Carcinoma. J. Surg. 2017, 5(6), 124-129. doi: 10.11648/j.js.20170506.17

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    AMA Style

    Tamer Abd-Elhafez El-Bakary, Mohamed Aly Mlees. Total Thyroidectomy Without Prophylactic Central Cervical Lymph Node Dissection: Is It Oncologically Safe in Patients with Early-Stage Papillary Thyroid Carcinoma. J Surg. 2017;5(6):124-129. doi: 10.11648/j.js.20170506.17

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  • @article{10.11648/j.js.20170506.17,
      author = {Tamer Abd-Elhafez El-Bakary and Mohamed Aly Mlees},
      title = {Total Thyroidectomy Without Prophylactic Central Cervical Lymph Node Dissection: Is It Oncologically Safe in Patients with Early-Stage Papillary Thyroid Carcinoma},
      journal = {Journal of Surgery},
      volume = {5},
      number = {6},
      pages = {124-129},
      doi = {10.11648/j.js.20170506.17},
      url = {https://doi.org/10.11648/j.js.20170506.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20170506.17},
      abstract = {Background: The necessity and the benefits of prophylactic central cervical lymph node dissection (PCLND) in clinically node negative patients with early-stage papillary thyroid carcinoma (PTC) remain controversial. Objective: to evaluate the safety of total thyroidectomy without PCLND in clinically node-negative early-stage PTC. Patients & Methods: 34 patients with T1 or T2 & N0 PTC were included in the study and submitted to total thyroidectomy without PCLND. Post-operatively, all patients received TSH suppression therapy & radio-active iodine (RAI) ablation. Any suspicious local neck recurrence during the follow up was confirmed cytologically and treated by RAI ablation. Results: The mean age was 42.1 years. 55.9% of patients were less than 45 years and 44.1% were 45 years old or more. Male to female ratio was 10:24. T1 was found in 14 cases & T2 in 20 cases. Total thyroidectomy was successfully done for all the cases. Central cervical lymph nodes sampling was done in 5 cases. Excised lymph nodes were found in 8 specimens; 5 cases with lymph node sampling (14.7%) and 3 cases (8.8%) with accidental lymph node excision during thyroidectomy. only 6 of these 8 patients (17.6%) showed positive metastasis (pN1). No recurrent laryngeal nerve injury was reported. In 12 patients (35.3%), temporary hypocalcemia was encountered. The mean follow up period was 34.6 months. There were 2 recurrences (5.9%); 1 in the central & 1 in the lateral neck compartment. All recurrences were treated by RAI ablation. No distant metastasis or mortality was reported. Conclusion: total thyroidectomy without PCLND in clinically node-negative early stage PTC is an excellent treatment option that gives adequate loco-regional control of the disease with low rate of surgical complications. Close follow up for longer periods is needed.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Total Thyroidectomy Without Prophylactic Central Cervical Lymph Node Dissection: Is It Oncologically Safe in Patients with Early-Stage Papillary Thyroid Carcinoma
    AU  - Tamer Abd-Elhafez El-Bakary
    AU  - Mohamed Aly Mlees
    Y1  - 2017/12/11
    PY  - 2017
    N1  - https://doi.org/10.11648/j.js.20170506.17
    DO  - 10.11648/j.js.20170506.17
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 124
    EP  - 129
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20170506.17
    AB  - Background: The necessity and the benefits of prophylactic central cervical lymph node dissection (PCLND) in clinically node negative patients with early-stage papillary thyroid carcinoma (PTC) remain controversial. Objective: to evaluate the safety of total thyroidectomy without PCLND in clinically node-negative early-stage PTC. Patients & Methods: 34 patients with T1 or T2 & N0 PTC were included in the study and submitted to total thyroidectomy without PCLND. Post-operatively, all patients received TSH suppression therapy & radio-active iodine (RAI) ablation. Any suspicious local neck recurrence during the follow up was confirmed cytologically and treated by RAI ablation. Results: The mean age was 42.1 years. 55.9% of patients were less than 45 years and 44.1% were 45 years old or more. Male to female ratio was 10:24. T1 was found in 14 cases & T2 in 20 cases. Total thyroidectomy was successfully done for all the cases. Central cervical lymph nodes sampling was done in 5 cases. Excised lymph nodes were found in 8 specimens; 5 cases with lymph node sampling (14.7%) and 3 cases (8.8%) with accidental lymph node excision during thyroidectomy. only 6 of these 8 patients (17.6%) showed positive metastasis (pN1). No recurrent laryngeal nerve injury was reported. In 12 patients (35.3%), temporary hypocalcemia was encountered. The mean follow up period was 34.6 months. There were 2 recurrences (5.9%); 1 in the central & 1 in the lateral neck compartment. All recurrences were treated by RAI ablation. No distant metastasis or mortality was reported. Conclusion: total thyroidectomy without PCLND in clinically node-negative early stage PTC is an excellent treatment option that gives adequate loco-regional control of the disease with low rate of surgical complications. Close follow up for longer periods is needed.
    VL  - 5
    IS  - 6
    ER  - 

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Author Information
  • General Surgery Department, Tanta University Hospital, Tanta, Egypt

  • General Surgery Department, Tanta University Hospital, Tanta, Egypt

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