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Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients

BACKGROUND: Lymph nodal involvement is very common in differentiated thyroid cancer, and in addition, cervical lymph node micrometastases are observed in up to 80 % of papillary thyroid cancers. During the last decades, the role of routine central lymph node dissection (RCLD) in the treatment of pap...

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Autores principales: Gambardella, Claudio, Tartaglia, Ernesto, Nunziata, Anna, Izzo, Graziella, Siciliano, Giuseppe, Cavallo, Fabio, Mauriello, Claudio, Napolitano, Salvatore, Thomas, Guglielmo, Testa, Domenico, Rossetti, Gianluca, Sanguinetti, Alessandro, Avenia, Nicola, Conzo, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028971/
https://www.ncbi.nlm.nih.gov/pubmed/27644091
http://dx.doi.org/10.1186/s12957-016-1003-5
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author Gambardella, Claudio
Tartaglia, Ernesto
Nunziata, Anna
Izzo, Graziella
Siciliano, Giuseppe
Cavallo, Fabio
Mauriello, Claudio
Napolitano, Salvatore
Thomas, Guglielmo
Testa, Domenico
Rossetti, Gianluca
Sanguinetti, Alessandro
Avenia, Nicola
Conzo, Giovanni
author_facet Gambardella, Claudio
Tartaglia, Ernesto
Nunziata, Anna
Izzo, Graziella
Siciliano, Giuseppe
Cavallo, Fabio
Mauriello, Claudio
Napolitano, Salvatore
Thomas, Guglielmo
Testa, Domenico
Rossetti, Gianluca
Sanguinetti, Alessandro
Avenia, Nicola
Conzo, Giovanni
author_sort Gambardella, Claudio
collection PubMed
description BACKGROUND: Lymph nodal involvement is very common in differentiated thyroid cancer, and in addition, cervical lymph node micrometastases are observed in up to 80 % of papillary thyroid cancers. During the last decades, the role of routine central lymph node dissection (RCLD) in the treatment of papillary thyroid cancer (PTC) has been an object of research, and it is now still controversial. Nevertheless, many scientific societies and referral authors have definitely stated that even if in expert hands, RCLD is not associated to higher morbidity; it should be indicated only in selected cases. MAIN BODY: In order to better analyze the current role of prophylactic neck dissection in the surgical treatment of papillary thyroid cancers, an analysis of the most recent literature data was performed. Prophylactic or therapeutic lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, and papillary thyroid cancer were used by the authors as keywords performing a PubMed database research. Literature reviews, PTCs large clinical series and the most recent guidelines of different referral endocrine societies, inhering neck dissection for papillary thyroid cancers, were also specifically evaluated. A higher PTC incidence was nowadays reported in differentiated thyroid cancer (DTC) clinical series. In addition, ultrasound guided fine-needle aspiration citology allowed a more precocious diagnosis in the early phases of disease. The role of prophylactic neck dissection in papillary thyroid cancer management remains controversial especially regarding indications, approach, and surgical extension. Even if morbidity rates seem to be similar to those reported after total thyroidectomy alone, RCLD impact on local recurrence and long-term survival is still a matter of research. Nevertheless, only a selective use in high-risk cases is supported by more and more scientific data. CONCLUSIONS: In the last years, higher papillary thyroid cancer incidence and more precocious diagnoses were worldwide reported. Among endocrine and neck surgeons, there is agreement about indications to prophylactic treatment of node-negative “high-risk” patients. A recent trend toward RCLD avoiding radioactive treatment is still debated, but nevertheless, prophylactic dissections in low-risk cases should be avoided. Prospective randomized trials are needed to evaluate the benefits of different approaches and allow to drawn definitive conclusions.
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spelling pubmed-50289712016-09-22 Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients Gambardella, Claudio Tartaglia, Ernesto Nunziata, Anna Izzo, Graziella Siciliano, Giuseppe Cavallo, Fabio Mauriello, Claudio Napolitano, Salvatore Thomas, Guglielmo Testa, Domenico Rossetti, Gianluca Sanguinetti, Alessandro Avenia, Nicola Conzo, Giovanni World J Surg Oncol Review BACKGROUND: Lymph nodal involvement is very common in differentiated thyroid cancer, and in addition, cervical lymph node micrometastases are observed in up to 80 % of papillary thyroid cancers. During the last decades, the role of routine central lymph node dissection (RCLD) in the treatment of papillary thyroid cancer (PTC) has been an object of research, and it is now still controversial. Nevertheless, many scientific societies and referral authors have definitely stated that even if in expert hands, RCLD is not associated to higher morbidity; it should be indicated only in selected cases. MAIN BODY: In order to better analyze the current role of prophylactic neck dissection in the surgical treatment of papillary thyroid cancers, an analysis of the most recent literature data was performed. Prophylactic or therapeutic lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, and papillary thyroid cancer were used by the authors as keywords performing a PubMed database research. Literature reviews, PTCs large clinical series and the most recent guidelines of different referral endocrine societies, inhering neck dissection for papillary thyroid cancers, were also specifically evaluated. A higher PTC incidence was nowadays reported in differentiated thyroid cancer (DTC) clinical series. In addition, ultrasound guided fine-needle aspiration citology allowed a more precocious diagnosis in the early phases of disease. The role of prophylactic neck dissection in papillary thyroid cancer management remains controversial especially regarding indications, approach, and surgical extension. Even if morbidity rates seem to be similar to those reported after total thyroidectomy alone, RCLD impact on local recurrence and long-term survival is still a matter of research. Nevertheless, only a selective use in high-risk cases is supported by more and more scientific data. CONCLUSIONS: In the last years, higher papillary thyroid cancer incidence and more precocious diagnoses were worldwide reported. Among endocrine and neck surgeons, there is agreement about indications to prophylactic treatment of node-negative “high-risk” patients. A recent trend toward RCLD avoiding radioactive treatment is still debated, but nevertheless, prophylactic dissections in low-risk cases should be avoided. Prospective randomized trials are needed to evaluate the benefits of different approaches and allow to drawn definitive conclusions. BioMed Central 2016-09-19 /pmc/articles/PMC5028971/ /pubmed/27644091 http://dx.doi.org/10.1186/s12957-016-1003-5 Text en © The Author(s). 2016 Open AccessThis article is 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, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Gambardella, Claudio
Tartaglia, Ernesto
Nunziata, Anna
Izzo, Graziella
Siciliano, Giuseppe
Cavallo, Fabio
Mauriello, Claudio
Napolitano, Salvatore
Thomas, Guglielmo
Testa, Domenico
Rossetti, Gianluca
Sanguinetti, Alessandro
Avenia, Nicola
Conzo, Giovanni
Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients
title Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients
title_full Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients
title_fullStr Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients
title_full_unstemmed Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients
title_short Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients
title_sort clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028971/
https://www.ncbi.nlm.nih.gov/pubmed/27644091
http://dx.doi.org/10.1186/s12957-016-1003-5
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