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Glover AR, Gundara JS, Norlén O, et al. The pros and cons of prophylactic central neck dissection in papillary thyroid carcinoma. Gland Surg. 2013;2(4):196-205doi: 10.3978/j.issn.2227-684X.2013.10.05.
Glover, A. R., Gundara, J. S., Norlén, O., Lee, J. C., & Sidhu, S. B. (2013). The pros and cons of prophylactic central neck dissection in papillary thyroid carcinoma. Gland surgery, 2(4), 196-205. https://doi.org/10.3978/j.issn.2227-684X.2013.10.05
Glover, Anthony R, et al. "The pros and cons of prophylactic central neck dissection in papillary thyroid carcinoma." Gland surgery vol. 2,4 (2013): 196-205. doi: https://doi.org/10.3978/j.issn.2227-684X.2013.10.05
Glover AR, Gundara JS, Norlén O, Lee JC, Sidhu SB. The pros and cons of prophylactic central neck dissection in papillary thyroid carcinoma. Gland Surg. 2013 Nov;2(4):196-205. doi: 10.3978/j.issn.2227-684X.2013.10.05. PMID: 25083483; PMCID: PMC4115751.
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Gland Surg. 2013 Nov;2(4):196-205. doi: 10.3978/j.issn.2227-684X.2013.10.05.

The pros and cons of prophylactic central neck dissection in papillary thyroid carcinoma.

Gland surgery

Anthony R Glover, Justin S Gundara, Olov Norlén, James C Lee, Stan B Sidhu

Affiliations

  1. Kolling Institute of Medical Research, Cancer Genetics Laboratory, Royal North Shore Hospital and University of Sydney, St Leonards, NSW, Australia ;
  2. University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia.
  3. Kolling Institute of Medical Research, Cancer Genetics Laboratory, Royal North Shore Hospital and University of Sydney, St Leonards, NSW, Australia ; ; University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia.

PMID: 25083483 PMCID: PMC4115751 DOI: 10.3978/j.issn.2227-684X.2013.10.05

Abstract

Prophylactic central neck dissection (pCND) for management of papillary thyroid carcinoma (PTC) is controversial. Compared to many malignancies, PTC has a high overall survival but local recurrence due to lymph node metastases continue to present management challenges. Unlike lateral cervical nodal metastasis metastasis, central neck nodal metastasis are unable to be reliably detected clinically or radiologically at pre-operative assessment. Residual disease (recurrent or persistent) typically requires re-operative surgery in the central compartment, which carries a heightened risk of significant morbidity. These nodal groups can be accessed during the index thyroidectomy for PTC. Thus, pCND offers potential to reduce the rates of recurrence and the need for re-operative surgery in the central neck. This benefit needs to be balanced with the potential morbidity risk from pCND itself at the index resection. This review will discuss the advantages and disadvantages of pCND with regard to long-term outcomes and potential morbidity. The rationale of pCND will be discussed, along with the indications for ipsilateral and contralateral pCND, the role of re-operative surgery for recurrence and the use of selective versus routine pCND. Strategies to select higher risk patients for pCND with the use of molecular markers will be addressed, along with a discussion of quality of life (QoL) research in PTC.

Keywords: Lymph node; elective; metastasis; morbidity; prophylactic

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