Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma

Davide Giordano, Andrea Frasoldati, Enrico Gabrielli, Carmine Pernice, Michele Zini, Andrea Castellucci, Simonetta Piana, Alessia Ciarrocchi, Silvio Cavuto, Verter Barbieri

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Abstract

Objective.The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC.Study Design.Observational retrospective controlled study. Methods: Clinical records of patients (n = 610) surgically treated for cN0-PTC at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008, were retrospectively reviewed. Study population was divided into three groups according to surgical treatment: Group A, total thyroidectomy (n = 205); Group B, total thyroidectomy and elective ipsilateral CND (n = 281); Group C, total thyroidectomy and bilateral CND (n = 124). Results: Of a total of 610 patients, 305 (50%) were classified as low-risk, 278 (45.57%) as intermediate-risk, and 27 (4.43%) as high-risk. Response to initial therapy was excellent in 567 patients (92.95%), acceptable in 21 (3.44%), and incomplete in 22 (3.61%), with no significant differences among groups. Locoregional recurrence was detected in 32 (5.2%) out of 610 patients. Distant metastasis was found in 15 patients (2.5%). Statistical analysis showed no significant differences in the rates of locoregional recurrence (p = 0.890) or distant metastasis (p = 0.538) among groups. Disease-specific mortality and overall survival did not significantly differ among groups (p = 0.248 and 0.223, respectively). Rate of permanent hypoparathyroidism was significantly higher in Group C patients compared to those in Groups A and B. Conclusion: CND does not confer any clear advantage in the treatment of low-risk patients, regardless of surgical procedure. Instead, bilateral CND may be effective in limiting disease relapse and/or progression in patients at higher prognostic risk. Our data indicate that elective CND does not confer any clear advantage in terms of locoregional recurrence and long-term survival, as demonstrated by outcomes of the study Groups, regardless of their different prognostic risk. Elective CND allows a more accurate pathologic staging of central neck lymph nodes, despite its increasing the risk of permanent hypoparathyroidism. Intraoperative pathologic staging is a valuable tool to assess the risk of controlateral lymph node metastasis in the central neck compartment and to limit more aggressive surgery only to cases, otherwise understaged, with lymph node metastasis.

Original languageEnglish
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
DOIs
Publication statusAccepted/In press - Apr 5 2017

Fingerprint

Neck Dissection
Neoplasm Metastasis
Thyroidectomy
Recurrence
Lymph Nodes
Hypoparathyroidism
Neck
Survival
Papillary Thyroid cancer
Otolaryngology
Italy
Therapeutics
Retrospective Studies
Odds Ratio
Outcome Assessment (Health Care)

Keywords

  • Central neck dissection
  • Elective
  • Hypoparathyroidism
  • Locoregional recurrence
  • Papillary thyroid carcinoma
  • Survival

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma. / Giordano, Davide; Frasoldati, Andrea; Gabrielli, Enrico; Pernice, Carmine; Zini, Michele; Castellucci, Andrea; Piana, Simonetta; Ciarrocchi, Alessia; Cavuto, Silvio; Barbieri, Verter.

In: American Journal of Otolaryngology - Head and Neck Medicine and Surgery, 05.04.2017.

Research output: Contribution to journalArticle

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abstract = "Objective.The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC.Study Design.Observational retrospective controlled study. Methods: Clinical records of patients (n = 610) surgically treated for cN0-PTC at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008, were retrospectively reviewed. Study population was divided into three groups according to surgical treatment: Group A, total thyroidectomy (n = 205); Group B, total thyroidectomy and elective ipsilateral CND (n = 281); Group C, total thyroidectomy and bilateral CND (n = 124). Results: Of a total of 610 patients, 305 (50{\%}) were classified as low-risk, 278 (45.57{\%}) as intermediate-risk, and 27 (4.43{\%}) as high-risk. Response to initial therapy was excellent in 567 patients (92.95{\%}), acceptable in 21 (3.44{\%}), and incomplete in 22 (3.61{\%}), with no significant differences among groups. Locoregional recurrence was detected in 32 (5.2{\%}) out of 610 patients. Distant metastasis was found in 15 patients (2.5{\%}). Statistical analysis showed no significant differences in the rates of locoregional recurrence (p = 0.890) or distant metastasis (p = 0.538) among groups. Disease-specific mortality and overall survival did not significantly differ among groups (p = 0.248 and 0.223, respectively). Rate of permanent hypoparathyroidism was significantly higher in Group C patients compared to those in Groups A and B. Conclusion: CND does not confer any clear advantage in the treatment of low-risk patients, regardless of surgical procedure. Instead, bilateral CND may be effective in limiting disease relapse and/or progression in patients at higher prognostic risk. Our data indicate that elective CND does not confer any clear advantage in terms of locoregional recurrence and long-term survival, as demonstrated by outcomes of the study Groups, regardless of their different prognostic risk. Elective CND allows a more accurate pathologic staging of central neck lymph nodes, despite its increasing the risk of permanent hypoparathyroidism. Intraoperative pathologic staging is a valuable tool to assess the risk of controlateral lymph node metastasis in the central neck compartment and to limit more aggressive surgery only to cases, otherwise understaged, with lymph node metastasis.",
keywords = "Central neck dissection, Elective, Hypoparathyroidism, Locoregional recurrence, Papillary thyroid carcinoma, Survival",
author = "Davide Giordano and Andrea Frasoldati and Enrico Gabrielli and Carmine Pernice and Michele Zini and Andrea Castellucci and Simonetta Piana and Alessia Ciarrocchi and Silvio Cavuto and Verter Barbieri",
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T1 - Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma

AU - Giordano, Davide

AU - Frasoldati, Andrea

AU - Gabrielli, Enrico

AU - Pernice, Carmine

AU - Zini, Michele

AU - Castellucci, Andrea

AU - Piana, Simonetta

AU - Ciarrocchi, Alessia

AU - Cavuto, Silvio

AU - Barbieri, Verter

PY - 2017/4/5

Y1 - 2017/4/5

N2 - Objective.The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC.Study Design.Observational retrospective controlled study. Methods: Clinical records of patients (n = 610) surgically treated for cN0-PTC at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008, were retrospectively reviewed. Study population was divided into three groups according to surgical treatment: Group A, total thyroidectomy (n = 205); Group B, total thyroidectomy and elective ipsilateral CND (n = 281); Group C, total thyroidectomy and bilateral CND (n = 124). Results: Of a total of 610 patients, 305 (50%) were classified as low-risk, 278 (45.57%) as intermediate-risk, and 27 (4.43%) as high-risk. Response to initial therapy was excellent in 567 patients (92.95%), acceptable in 21 (3.44%), and incomplete in 22 (3.61%), with no significant differences among groups. Locoregional recurrence was detected in 32 (5.2%) out of 610 patients. Distant metastasis was found in 15 patients (2.5%). Statistical analysis showed no significant differences in the rates of locoregional recurrence (p = 0.890) or distant metastasis (p = 0.538) among groups. Disease-specific mortality and overall survival did not significantly differ among groups (p = 0.248 and 0.223, respectively). Rate of permanent hypoparathyroidism was significantly higher in Group C patients compared to those in Groups A and B. Conclusion: CND does not confer any clear advantage in the treatment of low-risk patients, regardless of surgical procedure. Instead, bilateral CND may be effective in limiting disease relapse and/or progression in patients at higher prognostic risk. Our data indicate that elective CND does not confer any clear advantage in terms of locoregional recurrence and long-term survival, as demonstrated by outcomes of the study Groups, regardless of their different prognostic risk. Elective CND allows a more accurate pathologic staging of central neck lymph nodes, despite its increasing the risk of permanent hypoparathyroidism. Intraoperative pathologic staging is a valuable tool to assess the risk of controlateral lymph node metastasis in the central neck compartment and to limit more aggressive surgery only to cases, otherwise understaged, with lymph node metastasis.

AB - Objective.The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC.Study Design.Observational retrospective controlled study. Methods: Clinical records of patients (n = 610) surgically treated for cN0-PTC at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008, were retrospectively reviewed. Study population was divided into three groups according to surgical treatment: Group A, total thyroidectomy (n = 205); Group B, total thyroidectomy and elective ipsilateral CND (n = 281); Group C, total thyroidectomy and bilateral CND (n = 124). Results: Of a total of 610 patients, 305 (50%) were classified as low-risk, 278 (45.57%) as intermediate-risk, and 27 (4.43%) as high-risk. Response to initial therapy was excellent in 567 patients (92.95%), acceptable in 21 (3.44%), and incomplete in 22 (3.61%), with no significant differences among groups. Locoregional recurrence was detected in 32 (5.2%) out of 610 patients. Distant metastasis was found in 15 patients (2.5%). Statistical analysis showed no significant differences in the rates of locoregional recurrence (p = 0.890) or distant metastasis (p = 0.538) among groups. Disease-specific mortality and overall survival did not significantly differ among groups (p = 0.248 and 0.223, respectively). Rate of permanent hypoparathyroidism was significantly higher in Group C patients compared to those in Groups A and B. Conclusion: CND does not confer any clear advantage in the treatment of low-risk patients, regardless of surgical procedure. Instead, bilateral CND may be effective in limiting disease relapse and/or progression in patients at higher prognostic risk. Our data indicate that elective CND does not confer any clear advantage in terms of locoregional recurrence and long-term survival, as demonstrated by outcomes of the study Groups, regardless of their different prognostic risk. Elective CND allows a more accurate pathologic staging of central neck lymph nodes, despite its increasing the risk of permanent hypoparathyroidism. Intraoperative pathologic staging is a valuable tool to assess the risk of controlateral lymph node metastasis in the central neck compartment and to limit more aggressive surgery only to cases, otherwise understaged, with lymph node metastasis.

KW - Central neck dissection

KW - Elective

KW - Hypoparathyroidism

KW - Locoregional recurrence

KW - Papillary thyroid carcinoma

KW - Survival

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