Wu Zeng-Gui, Zheng Wen-Ting, Chen Li-Jie, Zhu Fang-Shuang, Ma Zhao-Sheng, Cao Fei-Lin, Cui Bin-Bin, Xie Bo-Jian, Yan Xing-Qiang
Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China.
Front Endocrinol (Lausanne). 2025 May 16;16:1597661. doi: 10.3389/fendo.2025.1597661. eCollection 2025.
Therapeutic central neck dissection (CND) is strongly recommended for patients with clinically node-positive (cN1) papillary thyroid carcinoma (PTC). However, the role of prophylactic central neck dissection (PCND) remains controversial for clinically node-negative (cN0) PTC, particularly in papillary thyroid microcarcinoma (PTMC). To better elucidate the benefits and disadvantages, we conducted a retrospective analysis with a follow-up of more than 10 years.
A total of 377 consecutive patients were enrolled in this study between April 2011 and March 2015. 146 patients underwent total thyroidectomy alone (TT group), while 231 patients underwent total thyroidectomy and prophylactic central compartment lymph node dissection (TT+PCND group). Considering the low risk of recurrence, all patients did not receive radioiodine treatment. Post-surgical pathological and preoperative clinical courses, local recurrence, postoperative complications, and follow-up data were all collected.
In the TT+PCND group, 82 patients (35.3%) had occult lymph node metastasis and a higher risk of postoperative complications, including lymphatic leakage, recurrent laryngeal nerve injury, hypoparathyroidism, and accidental parathyroidectomy. Hypoparathyroidism and accidental parathyroidectomy showed a significantly increased risk (p = 0.005, p = 0.049). However, there were no differences in survival and recurrence rates between the two groups.
Routine prophylactic central neck dissection is unnecessary for patients with clinically node-negative papillary thyroid microcarcinoma, as the postoperative complications are significant, while the benefits remain unclear.
对于临床淋巴结阳性（cN1）的乳头状甲状腺癌（PTC）患者，强烈推荐进行治疗性中央区淋巴结清扫（CND）。然而，对于临床淋巴结阴性（cN0）的PTC，尤其是乳头状甲状腺微小癌（PTMC），预防性中央区淋巴结清扫（PCND）的作用仍存在争议。为了更好地阐明其利弊，我们进行了一项随访超过10年的回顾性分析。
2011年4月至2015年3月期间，共有377例连续患者纳入本研究。146例患者仅接受全甲状腺切除术（TT组），而231例患者接受全甲状腺切除术及预防性中央区淋巴结清扫（TT+PCND组）。考虑到复发风险较低，所有患者均未接受放射性碘治疗。收集术后病理及术前临床病程、局部复发、术后并发症及随访数据。
在TT+PCND组中，82例患者（35.3%）有隐匿性淋巴结转移，术后并发症风险较高，包括淋巴漏、喉返神经损伤、甲状旁腺功能减退和意外甲状旁腺切除。甲状旁腺功能减退和意外甲状旁腺切除的风险显著增加（p = 0.005，p = 0.049）。然而，两组之间的生存率和复发率没有差异。
对于临床淋巴结阴性的乳头状甲状腺微小癌患者，常规预防性中央区淋巴结清扫是不必要的，因为术后并发症严重，而益处尚不清楚。
