OR14-3 Advantages and disadvantages of prophylactic central compartment lymph node dissection for differentiated thyroid cancer: the first randomized controlled study from a single referral center

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR14-Thyroid Cancer: Insights into Diagnosis & Treatment
Clinical
Saturday, June 15, 2013: 11:30 AM-1:00 PM
Presentation Start Time: 12:00 PM
Room 103 (Moscone Center)
David Viola*1, Laura Valerio1, Pinuccia Faviana1, Eleonora Molinaro1, Elisa Sensi1, Laura Agate1, Gabriele Materazzi1, Fulvio Basolo1, Paolo Miccoli1, Paolo Vitti2 and Rossella Elisei1
1University of Pisa, Pisa, Italy, 2University of Pisa, Italy
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and commonly metastasizes to locoregional lymph nodes (up to 65%). Despite its lymphotropism that is considered a risk factor for persistent/recurrent disease the clinical benefit of prophylactic central compartment lymph node dissection (pCCND) in DTC is still controversial. This treatment seems to reduce DTC recurrence rates and mortality. However the lack of prospective randomized trials and a higher rate of surgical complications represent the major concerns. Moreover the increasing incidence of DTC that from some authors are considered indolent arises the necessity to better define the optimal treatment for DTC patients (pts).

The aim of this prospective randomized controlled study was to evaluate the advantages and disadvantages of pCCND, in particular: the outcome, the rate of surgical complications and the possible predictors of central compartment lymph node metastases of DTC pts treated with either total thyroidectomy (TTx) or TTx and pCCND.

A total of 169 DTC pts without evidence of preoperative/intraoperative lymph node metastases (N0) were randomly assigned to TTx, (Group-A, n=84) or TTx with pCCND (Group-B, n=85).

The two groups did not differ for the epidemiological and clinical-pathological features but, as expected, only from a high prevalence of microscopic central compartment lymph node metastases (N1a) in Group-B (50%). After a mean follow-up of 3.5 years no difference was observed in the outcome of the two groups. Group-A pts were treated with a higher number of 131I courses (p=0.0017) than Group-B while a higher prevalence of permanent hypoparathyroidism was observed in Group-B (p=0.046). Among Group-B, N1a pts had a higher prevalence of extrathyroid extension (p=0.002) and advanced stage (p=0.046), no other predictors of central compartment lymph node metastases were found. Moreover pCCND “upstaged” 3.5% of pts and in 1.2% affected radioiodine treatment decision.

In conclusion no preoperative features of DTC could suggest for or against central compartment lymph node dissection. Total thyroidectomy alone was as effective as total thyroidectomy with prophylactic central compartment lymph node dissection with a lower rate of surgical complications but the necessity of a higher number or radioiodine courses. Neck dissection will increase the number of patients that according to the European and American guidelines need to be treated with radioiodine.

Nothing to Disclose: DV, LV, PF, EM, ES, LA, GM, FB, PM, PV, RE

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm