Lymph node dissection in patients with differentiated thyroid carcinoma - who benefits?

Introduction: Papillary and follicular thyroid carcinomas are the most common thyroid malignancies and are usually indolent. Lymph-node involvement increases the rate of tumor recurrence and reduces long-term survival. However, characteristics such as age, long-term iodine deficiency, histological grade, extrathyroidal extension and distant metastases are clearly much more potent adverse factors than cervical lymph node metastases. Although there are no prospective randomised studies showing the overall benefit of routine cervicocentral lymphnode dissection in addition to total thyroidectomy, we propose this procedure as a standard part of primary surgery in differentiated thyroid carcinoma (DTC). Results: In specialised centres, morbidity is not higher than for thyroidectomy alone. However, there is a significant increase in morbidity after re-operation in the cervicocentral compartment. Modified neck dissection of the cervicolateral compartment should only be performed if there is clinical evidence of lymph-node involvement in this area. Conclusions: This strategy provides the optimal surgical treatment for all subgroups of patients with DTC and creates optimal conditions for effective postoperative radioiodine ablation, which is another prognostic factor strongly associated with recurrence and survival in these patients.